6 Life Lessons From Ones With Dementia

I spent Thanksgiving Day in the dementia care community where I work. Throughout the day, I got reminders about what matters in life, and what doesn't. Take a guess, then read on . . . 

Mind

Few of us pause to appreciate the beauty of our human mind. Not until we are brought face to face with the reality of a mind stripped of some of its essential functions, do we become grateful for what we have 'up there'. The ability to comprehend and make sense of things, to speak and be understood, to make decisions, to have sound judgment, to move, to have emotions, to control them, to remember what just happened, to orient ourselves visually and spatially . . . So many things we owe to the healthy mind! Every day, I marvel at my mind's ability to function so well. And I also ready myself for the eventuality of it failing some day. Not getting attached, even to the mind itself, that which makes mindfulness possible.

Body

The body that once felt eternal, has a way of betraying the very old and the ones with dementia. One by one, systems start failing. Vision, hearing are usually first. Then the legs give way, and a series of assistive devices take over. The cane, then the walker, then the wheelchair, then the reclining chair when even sitting becomes too hard . . . Pretty soon, it is the arms and hands’ turn to go limp. Bodily functions follow, that can no longer be controlled. And close to the end, even swallowing becomes a challenge. Then heart, and breath. The body, just like the mind is a wonderfully engineered machinery programmed from the start for obsolescence. While it works, we tend to treat it with nonchalance. Seeing what happens eventually serves as a powerful reminder to appreciate this body while it is still working, and to also not cling to it too much. It cannot be trusted, just like the mind.

Success

Lawyer, judge, inventor, entrepreneur, surgeon, artist, psychologist, writer . . . they made a mark in society, and had the good fortune of having success, lots of it. Now, there is hardly a trace left of their previous life, apart from fading pictures of past glorious moments, and here and there respectful references to ‘Doctor this', 'Doctor that’. Time and the inability to hang on to memories have a way of erasing what once seemed so important. The world moves on, and the young take over. Seeing this process can help us not fall into the trappings of success, and conversely, failure. No need to get too excited one way or the other. 

Money

It does not matter how much money we make or have. Eventually, we all end up without the ability to enjoy or miss those things we used to cling to. This is not to say we should not plan for the future and make sure we have a comfortable home. It just means we will eventually have to let go of all our ‘things’. Those material possessions are not what matters in the end. Very few of the people I spend time with, talk about what they used to own . . . And the ones who do, all do let go in the later stages of their illness. My mother was one of those people. 

Relationships

Nothing’s for sure, including those close relationships we take for granted. Loved ones upon whom we may have counted for comfort in our old days, those people may die on us, or have a change of heart. The old man who believes that his daughter has died is not far from the truth. His daughter is still very much alive, but she has not visited or called him in years . . . And the woman who thought her husband would be there for her, is now a widow wondering where her beloved has gone. Relationships with those we love and who love us are to be treasured. And we need to expand our circle of love to not just our family and friends, but also anyone with whom we can have a meaningful connection, even if for only a moment. 

Self

This thing we call ‘I’ is not worth getting so preoccupied with. If we live long enough, that too will be chipped away, until we no longer have a sense of identity. The glue that kept our story going will have dried up, and now there will only be a vague sense of existence, and remnants from past habits, that’s all. Yet, most of us spend so much of our lives thinking, acting based on this concept of ‘I’, ‘Me’, and ‘You’. We worry so much about what happened to 'I' in the past, and what is going to happen to it in the future. Our carefully constructed identity is indeed just a story with a beginning, middle and end. For many of us that story will end way before our final years, and in its place will be a void waiting to be filled with new meaning, new ways of occupying ourselves, right there, right now.

What life lesson(s) if any have you learned from being around persons with dementia?

12 Reasons to Startup With Mindfulness

I have been most grateful for the many ways in which mindfulness practice has sustained me in my journey as a startup entrepreneur. For those of you on a similar journey, here are 12 reasons why you might want to consider taking up mindfulness. 

Mindfulness, commonly known as the practice of present moment attention, also encompasses the cultivation of other qualities which happen to be essential for entrepreneurship. Here they are, in no particular order:

Mindfulness

Paying attention to the big picture and small details that can do you in 

Persistence

To overcome inevitable challenges, disappointments, obstacles, setbacks.

Effort 

Not being afraid to give of oneself completely, hard work.

Desire

Passion and love for the cause.

Faith 

In outcome, process, and more importantly, one's ability.

Non attachment

Particularly to one's views when it is clear that another course of action is required. And also, the outcome. 

Loving kindness

First for oneself, then others. This does not mean being meek . . . 

Concentration

Being focused on the work to be done.

Discernment 

Guarding from hasty decisions and taking the time to sort things out. 

Equanimity

Not being fazed by all the things that go wrong - they will go wrong!

Not self

Getting one's ego out of the way. Instead doing what is required by the work and circumstances.

Friendships

Most importantly, picking partners, mentors, friends wisely. 

What else would you add to the list? 

Labeling and Counting

Whenever my mind is in too much turmoil to easily settle, I rely on the following two techniques:

1. First is labeling:

It can be as simple as recognizing the arising of a thought disturbance. Or if the awareness is so inclined, it can get a bit more specific: worrying, obsessing, work, boredom, aversion, escaping . . . The labeling helps one take one step back from the content of the thought itself, into the larger awareness of mind activity.

2. Second, is counting:

Breath, steps, whatever the object of our attention, as long as it is repetitive, we can use counting as a way to keep our awareness on its intended object. I have learned to count from one to ten, starting over after number ten is reached. If the mind strays in the middle of the sequence, one is to start over from one again. I try to keep it simple and natural. Letting each number fall wherever it wants within each breath, each step.

How do you help your mind?

6 Common False Views About Mindfulness Practice

Inspired in part by some of the comments on this blog, I posted this on the Huffington Post earlier this week:

Mindfulness is often times misunderstood, and that's unfortunate. Such misconceptions can lead folks to give up their practice prematurely. It can also prevent them from reaping the full benefits of true mindfulness. Here are some of the most common false views about mindfulness that I have encountered and ways to change them: 

1. I can't stop my thoughts. 

Mindfulness is not about stopping one from thinking. Rather it is about noticing when thoughts arise and then bringing the mind back to the intended object of our awareness, often times the breath. To expect the mind to not think is ludicrous. The brain is programmed to think, and we spend most of our waking life thinking. It is unreasonable to expect the brain to shut off its thinking mode, just because we want to. When we meditate, we realize we are not in control. 

2. A few minutes is good enough. 

Even mindfulness is not immune to our fast-everything culture. There are teachers, and books that promulgate the idea that just a few minutes of mindfulness from time to time is enough. That is unfortunately not so. While it is true that a little bit of mindfulness is better than none, the reality is that mindfulness is just like any other skill. Practice a little, and you will make little progress. Practice a lot, and you will gain a lot. A good rule of thumb for mindfulness practice is 30 minutes of formal practice every day. I recommend first thing in the morning, as one is more likely to practice that way, and also one can reap the benefit of their early practice during the whole day. 

3. I imagine I am in a meadow. 

Guided imagery has its own set of healing properties. And it is not mindfulness practice. Mindfulness is about cultivating awareness of the present moment, not being taken away somewhere else. Next time you decide to meditate, remember to stay where you are! 

4. I feel worse when I meditate. 

With that statement, comes the immediate implication that meditation is not a good thing and should be abandoned. This idea comes from the false assumption that mindfulness is about feeling good. While it is true that mindfulness often leads to feeling more peaceful and content within oneself, there are many moments along the way when practice is all but pleasant. It is not unusual for new meditators to feel physical and emotional pains they were not aware of before. Meditation is about being mindful of what is, no matter how pleasant or unpleasant. 

5. Mindfulness is about just being aware. 

Another misconception is the notion that mindfulness is strictly a passive activity. Mindfulness in daily life -- not when sitting for formal practice -- encompasses both moment-to-moment awareness and skillful interventions based on what is observed. If I find my thoughts going in a direction which I know is harmful to myself or others, I am to stop those thoughts and substitute them with other more adaptive thoughts. This comes with practice, and is an important aspect of mindfulness. Commonly used cognitive therapy techniques for depression and anxiety, are a version of such mindfulness practice. 

6. I paint, that's my meditation. 

To get lost into the flow of a pleasurable or creative activity is not mindfulness, although it does entail the ability to concentrate which is part of mindfulness practice. When I used to paint for hours, I would get so absorbed into what I was doing, that I would lose track of time. But I could not remember much of what had happened during all those hours. When I meditate, the opposite happens. The emphasis is on putting my full attention on the present moment and being aware. It also involves insight, the ability to learn about myself in relationship to the present moment experience. 

I hope this is helpful... and I wish you to practice well!

A Book About Mindfulness, Alzheimer's, and Dementia

I have not been very good about posting lately . . . 

The good news is I just signed a contract with New Harbinger Publications to write a book about a topic very close to my heart. 'The Liberated Caregiver: A Mindfulness-Based Guide to Stress-Free Alzheimer's and Dementia Care' (working title).

My hope is that the book will be helpful to those who need mindfulness the most - in my opinion - the family and professional caregivers tending to those with dementia. I have spent the last several years honing the curriculum which I now teach at UCSF OSHER Center for Integrative Medicine, and the timing seemed right for sharing it more widely.

It has been a work a love, and not a day goes by without me thinking about my mother whose legacy lives on in my work with those with Alzheimer's and dementia and their caregivers.

It has also been quite a crusade, as the mainstream is only now waking up to the importance of offering a dementia-specific mindfulness training for caregivers.

Last, it has been a collaborative effort involving all the people along the way who have contributed in one way or another to the shaping of this work. I am especially grateful to Dr. Kevin Barrows, at UCSF, for taking such an active role and interest in the Mindfulness-Based Dementia Care program. 

Tending the Garden in My Heart

I continue to feel moved to focus on the heart. Throughout each day, paying attention to the stirrings within, and noticing the constant changes. Most precious has been Ayya Khema's image of the inner garden with flowers and weeds. The flowers are the beautiful emotions in the love family - love, compassion, rejoicing, and equanimity. The weeds are the hindrances that keep arising and need constant attention - greed, ill will, anger, fear, worries . . . 

There is no shortage of reasons to visit the garden in my heart. Each time, feeling the love or its possibility, and right next to it, a small weed or a tall one. Some weeds are more easy to see than others. When I feel envy, it is not hard noticing the immediate unpleasantness. Wise mind knows better than to linger in such thoughts. Instead, better step back at once and name the weed. Envy, envy, I am going to cut you down right there, right now, so that I can see and feel the beautiful pink flower. Opening the heart is a habit that can be cultivated, like anything else. 

Other weeds are harder to see, as they have a way of blending with the blooms. Feeling love, it would be easy to overlook the tinge of attachment and fear that comes along. Yet, there is no mistaking the slight constriction in the throat, the tension in the chest. What I call love needs to be stripped from such weeds. 

This is an all consuming practice that leaves little interest for writing about the practice . . . 

How are you taking care of your heart?

A Love Practice

With mindfulness practice, one becomes more and more convinced of the impracticality of not harboring love in one's heart. Conditional love, ill will, anger, hate all contribute to unhappiness. And all are self-created. Upon close examination, it simply does not make sense to let those fester inside. Life is too short. Not a single moment to be wasted. That is the good news. 

Of course, abandoning old ways is not so easy. A lifelong of bad mind habits cannot be undone that quickly. The mind hangs on to self-righteous thoughts. It keeps coming back with the same old, same resentments, same separating views. It does not take much for the heart to follow, with a tightening, a closing of the half-open door. Chaos usually ensues, and more misery. That is the challenge.

This week, I had a chance to see resentment build to a point of seemingly no return. For a few days, mind and heart did their dance, hesitating between further justification or the possibility of release. It took stepping back, and resting on the foundation of practice to decide on the latter. It came down to a willingness to love above all. I found the heart deep down yearning for this clearing. 

I am most thankful for the unwitting teacher in my life, the mirror I sometimes push away because of its unflattering reflections. Ayya Khema is my other helper on the path of love. In those moments, when I am not so sure, her words are always there, ready for my picking:

The love has to come from our heart. So if there is no love for ourselves, no understanding for our own difficulties, how can we love another? We always think we do, but it is the kind of love that demands something. It wants something back. Maybe it doesn't even want love back, but it wants something back. It wants the right kind of attitude from the other person, the right kind of behavior, the right kind of being together -- there's some demand being made. As long as we're demanding something -- be it ever so subtle -- so long our love cannot be pure. Love can only be pure if it's given without any payment. 

And this:

Our work on the purification of our heart lies in our daily encounters with anyone, particularly human beings. It's not so difficult to love a little bird that has by mistake strayed into our room and we're trying to get him out again, poor little bird, nice little bird. But somebody who has strayed in our room and wants to sit there and talk while we're sleepy, well, there needs to be a little more determination to love that one. It's human beings that we need to work with. All of us have that opportunity constantly, and there's no excuse not to do it, because this is actually what our life is all about. It's an adult education class.

And that:

The heart just has to love; it doesn't have to discriminate. And when we can see the difference between the usual judgments and just loving -- not discriminating -- we have taken a very important step.