Saturday, August 9, 2014

5 Contemplations For Dementia Care Partners

Sooner or later, during one's mindful journey, one becomes faced with a wall. One has a choice then. To keep bumping one's head against the inevitable, or to stop and contemplate the very nature of the wall itself. The wall is about the impermanence of life, and our need to face that truth. Many times, whenever grief wells up inside, as it did earlier today, I call upon the 5 Remembrances:

I am of the nature to grow old.
I cannot escape growing old.

I am of the nature to have ill health.
I cannot escape having ill health.

I am of the nature to die.
There is no way to escape death.

All that is dear to me and everyone I love are of the nature to change.
There is no way to escape being separated from them. 

I inherit the nature of my actions in body, speech and mind.
My actions are the ground on which I stand.

Strangely enough, I find great comfort in telling myself those lines. It is as if the telling is paving the way for acceptance of what is to come, or what has already happened.  During my work with those in the early stage of cognitive impairment and also with dementia caregivers, I have learned to tailor the 5 Remembrances to more specifically address the unique challenges of the dementia journey. It goes like this:

I am of the nature to grow old.
I cannot escape growing old.

I am of the nature to have ill health of body and/or mind.
I cannot escape having ill health of either body and/or mind.

I am of the nature to die.
There is no way to escape death.

All that is dear to me and everyone I love are of the nature to change.
There is no way to escape being separated from them, in either body or mind.

There is no avoiding making mistakes.
I am doing the best I can and I hold myself with compassion.

May you contemplate those words often. And may you find comfort in them. 

Sunday, June 15, 2014

Mindful Presence to Ease the Dementia Journey

(cross-post from Huffington Post)

Imagine a marathon you did not sign up for, and yet, you are told you have to run the race until the end. To add to the challenge, you are to carry a heavy load on your shoulders, and the load will get heavier and heavier as the race goes on. This is what the dementia journey is like for most family caregivers... Keeping with the marathon metaphor, what is needed is a way for caregivers to develop the strength that will be required of them over the long run. The Presence Care program is a new, integrative approach that combines mindfulness and compassion practices with understanding of the dementia experience. Its goals are to ease care burden and stress, and to help foster greater well-being for both caregivers and the persons in their care. It goes like this:

1. Understand dementia.

The more we can learn about the disease, the better equipped we are to understand what the person needs and why they are behaving in certain ways. Dementia affects different parts of the brain, each responsible for different cognitive domains such as memory, language, behavior, executive function, or movement. Not all dementias affect the same domains, and we need to know which ones are impacted and what that means in terms of the person's interactions with us. For instance someone struggling with executive function will have trouble initiating tasks and will be dependent on others to get engaged into activities. We also need to guard from our tendency to position the person with dementia as less able than they really are. Many abilities are preserved throughout dementia. In many cases, emotional intelligence is even heightened.

2. Practice mindfulness.

Using Jon Kabat-Zinn's definition, mindfulness is being fully aware of the present moment, on purpose, and without judgment. The validity of mindfulness as a powerful stress-reduction tool is no longer in question. That benefit alone makes it worthwhile for stressed out dementia caregivers to undertake mindfulness practice. The other, equally important reason has to do with the way in which mindful attention allows us to notice what is happening moment to moment, that may impact the person's experience. What do we bring into the situation? What do we hear? What do we see? What is the person telling us with her body language? Armed with that awareness, we then have a chance to act in a way that is most beneficial to the person. Of course, remembering to be mindful does not come naturally. We need to train our mind to come back to the present moment. This is done by setting time aside to practice every day. Even only five minutes of sitting and paying attention to the breath can make a big difference.

3. Respond with compassion.

Compassionate care is a natural outcome of mindfulness practice. In the mindful noticing of stress for the other person lies the seed for our compassionate response. I worked once with an elder man with Parkinson's who was moved to tears once his wife learned to model her steps after his. It took them both a good ten minutes to walk the twenty feet from my office to their car. Mindful "pacing with" is a wonderful practice that helps us shift from trying to get somewhere fast to becoming fully present for ourselves and the other person, while walking together. Such walking is an example of compassionate response.

I would like to end with a note on self-compassion. With greater awareness and deeper understanding of the person's needs often comes the painful realization of our own inadequacies, and of times before when we may have unintentionally hurt the person in our care. We address this by giving ourselves frequent self-compassion breaks, a practice developed by Kristin Neff. First, we recognize the suffering in our heart: "This is painful." Then we see that suffering as a part of the human condition: "We all struggle in our lives." Third, we extend kindness to ourselves: "May I forgive myself." The dementia care journey is an ongoing adult education in mindfulness and love. If we learn to view every one of our dementia care experiences as just that, we will do ourselves a great service, and we will be more free to give the person what they need.

Monday, May 5, 2014

Mindfulness Haiku

For the first time
Warm breath against upper lip
Feeling the sweetness.

Such awesome delight
Never to be missed again
What was I thinking?

Sunday, March 30, 2014

Many Ways to Love

The more I live, the more I understand love. What it is, and what it isn't: 

It is now clear that love is to be found within myself, and not outside. 
Love does not expect anything from the other person. 
Love is about giving, not expecting. 
Love does not ask for the person to stick around, or love us. 
Love does not discriminate, and offers a limitless world of people to be loved. 
Love is  an inclination of the heart. 
Love is also a discipline of the mind to not close the heart. 
Love is about not demanding from others the perfection that eludes us. 

Lately, I have been gifted with yet another insight about love. I have come to realize that each person has a different way of expressing love. Some ways are more obvious, others less so and require some deciphering. Mostly, I need to not project my own way with love unto others. It is helpful being aware of one's idea about love. I tend to equal love with kind words, physical closeness, and generous gestures. That's a lot to ask . . . 

Others around me have been my best teachers, showing me different, and sometimes opposite ways of expressing love:

One is clumsy with words and quick to react. Yet, he can be the kindest, most generous man. I can choose to focus on his weakness, or I can hone in on the times when his heart 'speaks'. 

Another shows her love through food, just like the man in the movie 'Eat Drink Man Woman'. No words of love ever exchanged, or tight embraces to be had, but instead lovely feasts in the kitchen. 

That one has a way with gifts also, always knowing what will please me. Gift giving is an attempt by the otherwise parsimonious heart to say, "I love you". 

My father who was a difficult man, showed me his love by always coming through when I needed help. 

'She' expresses her love through a pet, and pulls me in by texting me cute pictures of the dog, wondering "what would I do without him?" 

My mother whose clinginess I tried to run away from, gave me the safety of her unconditional love.

Love comes to us in many ways. It is up to us to recognize it!

How can you tell that someone is trying to show you love? 

Tuesday, March 18, 2014

Is It Mindfulness or Meditation?

I get asked that question a lot, and the answer is, yes, and . . .

Yes, mindfulness is a form of meditation practice. Other names for such meditation are insight and Vipassana. Mindfulness was popularized thirty years ago by Jon Kabat-Zinn with his Mindfulness-Based Stress Reduction. The genius of Jon Kabat-Zinn has been to make this ancient form of meditation accessible to the mainstream. Mindfulness meditation is now taught in a wide range of settings including hospitals, clinics, schools, prisons, businesses, and other venues all other the U.S. and the rest of the world. It is the form of meditation that has been the subject of much attention from neuroscience research. It is the practice I teach in my Mindfulness-Based Dementia Care and other mindfulness-based programs for caregivers. Mindfulness as commonly taught these days, draws its roots from the most ancient tradition of Buddhism know as Theravada. It has been stripped of all its religious context, and only the methods for de-stressing the brain have been kept, thereby making it accessible to all, independent of their religious orientation. It is important to stress that contemporary mindfulness practice is completely agnostic. 

Other forms of meditation include zen, Tibetan, transcendental meditation (TM), Christian centering prayer, Sufism, and yoga meditation. 

Friday, February 28, 2014

Playing with Concentration and Insight

Inspired by Gil Fronsdal's recent talk on concentration, I digged deeper into the interplay between the two practices of concentration and insight. And came across, The Path of Concentration and Mindfulness, a very helpful article by Thanissaro Bhikkhu on his website. 

Both teachers emphasize the same thing, that concentration and insight cannot be separated, but rather work in concert. This is certainly what I have experienced in my practice:

We start with the intention of concentrating on a chosen object, most commonly the breath or the body. This becomes our frame of reference. Of course, for most of us, the mind does not stay still. Instead, it wants to wander. Hindrances become more obvious. We keep working on bringing back our attention to the breath, and in the process we get to clearly see the arising and passing of hindering thoughts:

What you need at this stage is a fixed point of reference for evaluating the events in the mind, just as when you're trying to gauge the motion of clouds through the sky: You need to choose a fixed point — like a roof gable or a light pole — at which to stare so that you can get a sense of which direction and how fast the clouds are moving. The same with the coming and going of sensual desire, ill will, etc., in the mind: You have to try to maintain a fixed reference point for the mind — like the breath — if you want to be really sensitive to when there are hindrances in the mind — getting in the way of your reference point — and when there are not.

Sometimes, and that was Gil's point during his talk, we are in such a state a mind, that we cannot even make it past the first couple of breaths. The mind is too unsettled and riddled with hindrances. The temptation may be great to abandon sitting altogether. That would be the wrong approach to meditation. Instead, we can make the hindrance the object of our meditation:

Suppose that anger is interfering with your concentration. Instead of getting involved in the anger, you try simply to be aware of when it's there and when it's not. You look at the anger as an event in and of itself — as it comes, as it goes. But you don't stop there. The next step — as you're still working at focusing on the breath — is recognizing how anger can be made to go away. Sometimes simply watching it is enough to make it go away; sometimes it's not, and you have to deal with it in other ways, such as arguing with the reasoning behind the anger or reminding yourself of the drawbacks of anger. In the course of dealing with it, you have to get your hands dirty. You've got to try and figure out why the anger is coming, why it's going, how you can get it out of there, because you realize that it's an unskillful state. And this requires that you improvise. Experiment. You've got to chase your ego and impatience out of the way so that you can have the space to make mistakes and learn from them, so that you can develop a skill in dealing with the anger. It's not just a question of hating the anger and trying to push it away, or of loving the anger and welcoming it.

We shift our attention to the business of setting aside the hindrance. This may be our whole meditation and it can go on for one day, one month, one year or more . . . Still, every time, we start with the breath or the body. Once we have purified our mind enough, then and only then, can we go back to working on truly concentrating on the breath. We want to pursue this lofty goal because a wisely concentrated mind gives us the chance of experiencing a stress-free state, independent of outer conditions. We are developing the inner happiness habit.

This is what happens for most people . . . There is the case also of persons for whom reaching deep concentration for a long time is possible right away. Gil cautioned against getting mistaken by such phenomenon, for it may be that we have learned to dissociate early on in our life, as an adaptive mechanism to traumatic circumstances for instance. Such people may be able to transfer that skill into their meditation practice, and literally cut themselves off from themselves. They are not able to integrate the transient freedom from concentrated states into their lives, and are therefore unable to gain insights into the trappings within their own mind. Their lives remain unchanged, and the opportunity for acquired wisdom and true inner happiness are missed altogether.

Friday, February 7, 2014

Past, Present, Future, and Mindfulness

Re-reading Thanissaro Bhikkhu's excellent book, The Wings of Awakening,  I stopped at page ten. There, the teacher gives a clear expose of this/that conditionality, and of how it gets played out moment to moment in our lives. This is a notion well-worth pondering and understanding, as it is the glue that links together past thoughts (and actions) with our present moment experience and also future states. Sitting still now, I not only experience what is happening in the moment, but also the consequences from past thoughts, actions, words that keep on reverberating in my mind, in often times mysterious ways. This is why despite all our intentions to meditate and experience peace, we often find our mind hindered by automatic thoughts related to the past.

How we relate to the present moment may, if it creates strong enough of an impression, impact our future. That impact may come in the form of lingering thoughts or emotions, or outside consequences from our environment. It can go both ways, positively or negatively, depending on the nature of our meeting with the moment. We also have some (limited) power regarding how we mediate the outcome of past experiences in the present moment. This in a nutshell, is my take away from Thanissaro Bhikkhu's explanation.

Of course, what is done is done, and the only freedom we have regarding our past deeds, is in how we meet their outcome, both inner and outer. Do we linger in guilt and self-hate? Or do we use our past unskillfulness as a mean to feeling more compassion towards others, and even more importantly ourselves? Do we use our mistakes as a reminder to practice mindfulness, which we know is the best safeguard against such unfortunate events? Do we surrender to the reality of our very human fallibility? Can we relax around gnawing thoughts, and embrace them with all the loving kindness we can find in our heart?

Screwing up is acceptable as long as we learn from it . . . How do you learn from the past?

I inherit the nature of my actions in body, speech and mind. 
My actions are the ground on which I stand. 
(Buddha's Fourth Remembrance)
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