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2006 November/December

2006 November/December (4)

Friday, 26 December 2008 13:35

A Week of Silence

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A Week of Silence

Quieting the Mind and Liberating the Self

By Daniel Siegel

I'm flying from Los Angeles to Boston for a week-long meditation retreat, and I'm feeling nervous. For the next seven days, I'll be sitting in silence with 100 other scientists at the Insight Meditation Society in Barre, Massachusetts, at an event sponsored by the Mind and Life Institute, an organization devoted to the scientific study of mindfulness and compassion. The event is unique: when before have 100 scientists, most of whom specialize in studying the brain, gathered together to sit in silence for a week and learn "mindfulness meditation"?

I know that teaching mindful awareness to people can markedly improve their physical and mental well-being. At the UCLA Mindful Awareness Research Center, we recently conducted an eight-week pilot study that demonstrated that teaching meditation to people, including adults and adolescents with genetically loaded conditions like attention-deficit/hyperactivity disorder, could markedly reduce their level of distraction and impulsivity.

Still, I have no background in meditation, my mind is always busily running on at least 10 cylinders, and I've never been known for my taciturnity.

I told a friend about the silence coming up and he said that talking with other people is his "life's blood," and that connecting with others--the talk, the eye contact, the closeness--was what gave his life meaning. Me, too, I said. How will it be to sit completely still for long periods of time, not communicating either verbally or nonverbally (part of the deal) with anybody else for seven days? Why am I doing this? I wonder if it's too late to back out of the whole thing.

Scientists in Silence

There wasn't much for me to do in preparation except pack up warm clothes and shoes for this occasion to be in New England in the dead of winter. I was advised the best thing I could do to get ready was to tie up all the loose strings at home and work so that in the silence of the retreat, I wouldn't feel the urge to call, e-mail, or write anybody back in my ordinary world. As a psychiatrist interested in the brain and relationships, I can't help wondering what will take over the language-processing areas of my left hemisphere when they, presumably, become silent during meditation? Words are digital packets of information that convey to ourselves and others our models of conceptual reality--how we see and think about the world. They're part of the brain's top-down apparatus for ordering and making sense of incoming sensory information.

But then I think of poetry--a different use of language, which inhibits the strictly hierarchical, top-down, left-brain processes organizing our raw experience into a preconceived grid. Poetry, like silence, creates a new balance of memory and moment. We see with fresh eyes through the poet's artistry, which illuminates with words a new landscape that before was hidden beneath the veil of everyday language. Our ordinary language can be a prison, locking us in the jail of our own redundancies, dulling our senses, clouding our focus. By presenting ambiguities, by using words in unfamiliar ways, by juxtaposing elements of perceptual reality in new combinations, by evoking imagery, poets and their poetry offer us fresh, novel possibilities for experiencing life.

Perhaps the silence of this week will do the same for me.

Day One

I arrive at the Insight Meditation Society, where we'll be spending the week together. After a brief dinner, tour, assignments of daily cleaning duties, and an introductory talk, we've already begun the silence. The idea is to immerse ourselves in the subjective reality of our own minds. With some direction from the insight-meditation faculty here, we're to dive deeply into the waters of our own internal sea. The form of mindfulness we'll be learning this week comes from the 2,500-year-old Buddhist practice of Vipassana meditation, which is often translated as "clear seeing."

On the first day, we learn to sit in the meditation hall with the brief instructions to merely "watch our breathing." This capacity to focus attention is the first step of mindful-awareness training. When we notice our attention has wandered away from the breath, the instructions tell us, we're to gently return our focus of attention to the breath. That's it. Over and over again. I feel relieved. How hard can this be?

But by the end of the first day of practicing this concentration aspect of the meditation, my confidence level has definitely plummeted. I thought I had what the instructors call "good attention," but, in fact, my mind is repeatedly not cooperating with the instructions to "just focus on the breath." After a few moments, it seems I can barely make it through an entire breath without having my mind pulled toward different thoughts like a dog zigzagging on a walk, drawn this way and that by enticing scents along the path.

Our instructors tell us that this continual wandering is a totally natural part of the mind itself, and suggest we try just to focus on half a breath at a time: the in-breath, then the out-breath. This helps a bit, but my mind still goes strolling off in all directions. This is sometimes called a "proliferation of the mind," we're told--the way the thoughts generate more and more conceptual thinking. The "solution" to this dilemma, once we become aware that our minds have been hijacked by stray thoughts, is to calmly return to focusing on our breath, over and over and over--at least a million times, it seems to me, during the 45-minute session of sitting meditation.

After each sitting period, we do walking meditation that lasts from half an hour to an hour. While walking, we're to focus on the sensations in our feet and lower legs, step by step. When we notice our minds wandering from the sensation of the steps, we're to bring our focus back to the walking. Same deal: my mind has a mind of its own and goes where it wants to, not where "I" intend for it go.

Our instructions are expanded more as this first full day goes on. We learn that concentration on the breath will enhance the first step of mindfulness, which is to aim and sustain our attention. By learning to keep our attention focused, we can prevent the constant stream of wayward thoughts, the concepts that comprise our mental processes and get in the way of truly experiencing sensations. Sensation is the gateway to direct experience they tell us. When we can "just" see, or smell, or taste, or touch, or hear--our first five senses--then we enter the realm of being in the moment, a distant realm from where I am with all of the clutter in my mind, as I just sit, and walk, and sit, and walk. Getting close to sensation, it seems, is intended to enable us to just experience without the interference of thinking.

This first day has been both odd and stressful. Being in silence and out of direct communication with anyone makes me feel a bit stir-crazy. I'm driven to connect, but we're "forbidden" from communicating with anyone, with words or gestures, eye contact or facial acknowledgments of connection. This is the rule that precludes us from joining in any way, and I feel some part of my brain is aching to reach out to the many who are here. I'm beginning to talk to myself, not just in my head, but out loud. I'm even telling myself jokes and laughing. Then I say "Shhh!" to myself, remembering the rule about the noble silence: no communication with anyone. But how about with myself?

During the practice I try to remember what I told myself before this began: Make every breath an adventure. Now I say to myself, "Every half breath an adventure." But I'm saying this with words, and somehow words have become an enemy, those proliferative concepts that keep me from direct sensation. I'm trapped. I feel confused. I'm feeling the sensations directly, I feel, or I think, but I'm also not giving up the conceptual, word-based dialogue in my head--the words that summarize what I'm doing, like taking a walk, eating an apple--instead of just letting me be doing it. I've got some narrator in me that just won't quit. "Go ahead, try to just drink that soy milk: S-O-Y M-I-L-K I read on the carton. The letters jumping into my sight like a long-lost friend. I even have the words active in my mind when sitting and walking in our sessions. This makes me feel I'm not "meditating mindfully." Maybe I'm just too intellectual and filled with ideas and questions, words and concepts to be doing any of this.

Day Two

Something shifted today. We get up at 5:15 every day and are in sitting meditation by 5:45. At the end of the first 45-minute session, I had the startling feeling that no time had passed at all. I sat down, began watching my half breath, and before I knew it, the bell had sounded for our 6:30 breakfast. I hadn't fallen asleep, as I was still sitting bolt upright, my head straight, legs still folded beneath me. Then I went for a long, mindful walk in the snow in the forest outside the main building. At one point, I saw this gorgeous vista of a white-blanketed valley framed by the snow-covered limb of a tall pine, icicles dangling down from a nearby boulder. To my surprise, I burst into tears at the vivid sights and smells and cool air on my face, the sound of the wind in the trees and the crunching snow beneath my boots. And then, just as quickly, I heard a thought in my head say, "You'll die one day and none of this will be here for you." My exhilaration vanished in an instant, leaving me distraught. I felt defeated and deflated. It was as if an ancient war were being waged, magnified in my isolated head, between thoughts and sensations.

Later, during a brief group meeting, I described this experience to the teacher and wondered if their mindfulness teaching was playing favorites, as if sensations were better than thinking or anything else we might do, perhaps even than talking with each other. Why were sensations being privileged over thoughts? A teacher said that we'd soon learn that anything arising in the mind, from sensations to thoughts, is to be accepted as it comes without judgment. Her instruction was deeply helpful, making me feel there didn't have to be a war in my head between direct sensation and conceptual thinking anymore. Perhaps I could broker a truce between the two. But I was surprised that such a simple instruction could produce such a huge shift in my experience.

With this new perspective in mind, at dinner, I had a remarkable experience eating an apple. At each of the meals, in fact in all of our activities besides just the formal sitting and walking practice, we're to be "mindful." What this means is to be awake and aware of what's happening as it's happening. I decided to eat an apple for dessert. Feeling free to think as well as sense, I decided to do a mind experiment of enhancing the experience of eating the apple. I cut a piece and looked at its texture. I felt the skin, the pulp, and the edge where they met. I smelled the aroma and drank in its wafting, expanding scent. I even decided to put the piece of apple to my ear and see how it sounded (yes, I know, ridiculous, but molecules vibrate and that's exactly what sound is, so why not try?). All I could hear was the sound of others in the room, no whirring atoms shaking my ear drum. When I placed the apple slowly in my mouth, I could hear the crunching, taste the burst of flavor, feel the pieces against my tongue and teeth, and then sense the shift as the mashing pieces got smaller, and then moved down my throat, into my esophagus, and down into my stomach.

Feeling free now to allow conceptual thoughts into the picture, I allowed my mind to expand and play with images and sensations of the apple's making its way through my digestive system, being absorbed into my body, and becoming an integral part of me. Then I thought about where the apple had come from--the people in the kitchen who (hopefully) washed it, the staff who bought it, the orchard from which it was picked, the tree on which it grew, and the seed from which that tree sprouted. With the freedom to enjoy this imagery, I suddenly felt a sense of wholeness and oneness with everything--the earth, the chain of people, my body.

I floated out of the dining room and wanted to speak to someone, but remembered the silence. A friend had been in the room, but we couldn't talk. I went outside and gazed at the almost-full moon in a cloud-strewn evening sky. I felt a presence next to me and found my friend had come out also, on his way to the sleeping area, and paused a moment by me in the silence under the stars. In that silence, a million words couldn't have said what that shared moment in the moonlight felt like.

Day Three

Today I met with another teacher for a one-to-one meeting. I tried to describe the apple experience. I said that I felt as if there were a flowing river creating my awareness, and this meditation practice was enabling me to go up the current to visit the individual streams flowing into that river--one stream of sensation, one of concepts. This image made me feel more at ease with whatever arose in my mind. He answered by telling me that he often felt that he'd "finally gotten it," only to realize that there was always something new to experience in awareness. He suggested that I might not want to hold on to any fixed idea of "how things are," but just see what happened.

I felt dismissed and irritated by his response. After this ten-minute meeting, my head was filled with worded-thoughts and the next few sessions were "difficult." A difficult session feels as if it were going nowhere; as if instead of feeling the spaciousness of a calm and stable mind, I'm simply spacing out. Spacing out instead of "spacing in." I get lost in thoughts easily and somehow don't come back to the breath.

But in the end, this teacher was right. It would get quite a bit more complicated and would be forever changing. No matter how illuminating some experiences have been, you can never predict what the next session will feel like. The mind is always in flux, and nothing seems to predict anything. The idea is to give up expectation and let whatever happens, happen.

In our group instructions, we've gone from being told to just watch the breath to also being told to notice sounds and feel our bodies. The breath is like an anchor point, a place to start, but noticing sounds gives us a wider expanse. The body scan--sensing each part of our body, one area at a time--enables us to open our awareness intentionally to the predominant sensations in our body. We just drop into awareness of the body or our senses and take in whatever arises.

Day Four

We're now expanding the field of awareness to move from the concentration on the breath to becoming mindful and receptive to all that arises, including the experience of mindfulness itself. Nothing is excluded. But the receptive mind isn't a passive mind. There's a quality of active engagement, not just with the object of attention, but with awareness itself. Yet this active sense isn't strained--it has a flowing, grounded, and intentional quality to it.

An insight that emerged on a walking session today came into my awareness without words. This insight was that deep in mindfulness, it isn't possible to get bored. Words portray a concept, a verbal thought that may articulate even a nonverbal idea. But an insight, like this one, feels more like a shift in internal perspective than a conceptual idea.

There's a strange change today. It feels as if some part of my mind that was aching to connect with others has given up aiming for them and has turned inward toward myself. I feel a surge of awareness of each step, a kind of connection to myself that wasn't there before. No moment is like any other, even step after step after step. I feel with each step the pressure on the ball of my feet transitioning to the sole and then the heel. And then the shift in weight in my legs as the next foot takes on the pressure of my body. Each step is unique. There's no place other than here, no moment other than now. I'm filled with excitement. I feel a floating sensation on the walking meditation, each moment inflated with a kind of helium from my mind.

I want to tell someone, so I tell myself.

Day Five

We've been working on full mindfulness in experiencing our sensations, feelings, mental activities, and states. One practice is to start with grounding yourself in a focus on the breath and then move into a more open, expanded, and inquiring state of awareness, which feels something like "bring it on." Whatever comes, will come. We're told that it helps some people notice a thought or sensation or mental state (without getting sucked into it) to imagine it emerging from a mouse hole in the wall. Others imagine the thought appearing on a video screen that they can turn on or off.

Neither of those worked for me. Instead, my awareness of the present moment emerged in my mind's eye as a valley. Thoughts and feelings and images would float like clouds into this valley, where I could see them, name them ("thinking" or "feeling" or "imaging"), and just let them float off, out of my valley of the present moment. Sometimes a thought would arise without my awareness that it had come and, in an instant, I'd be "lost in thought." There'd be no separation between the thought and me. I'd not only be lost in it, I'd be the thought. At those moments, I was no longer in the valley, but had been swept up into the clouds.

When I became aware of my unawareness of my breath, the key wasn't to get mad or frustrated or feel like a failure, but to just take note of this experience. It also helped to remember what our teachers told us: that no matter how many decades people spend practicing mindful awareness, there's always the regular "getting lost in thought" experience. This is just how the mind works. But building mindful awareness helps you see a thought as just arising and floating away. The thought loses its power to kidnap you, make you its captive.

We've been also working on ancient meditative practices for the cultivation of "loving-kindness." Loving-kindness is a fundamental part of mindfulness meditation and aspires to imbue us with a positive regard for all living creatures, our selves included, and the world at large. A set of sayings is repeated, beginning with a focus on the self. These are the particular articulations of those sayings taught by Sharon Salzberg: "May I be safe and protected from harm. May I be happy and have a peaceful and joyful heart. May I be healthy and have a body that supports me with energy. May I live with the ease that comes from well-being." Having an image of your self in mind can deepen these practices. As these statements are made, the mind's awareness of the body can focus on the heart region, the area just beneath the chest, as one breathes in, and breathes out. Beginning with loving-kindness for ourselves is necessary, because if we can't feel it for ourselves, how can we feel it for others?

After focusing on the self, we focus on others. We wish safety, happiness, health, and ease first on a benefactor (someone who's supported us and our development in life), then on a friend, followed by someone about whom we feel neutral. Often an image of that person is useful to have in mind as these wishes are expressed. The next step is harder--wishing these blessings on a "difficult" person in our life, one with whom we may have a challenging relationship. And the next step can be even harder: we're asked to offer and ask for forgiveness. "I ask you for forgiveness for anything I've done or said that's caused you harm or painful feelings." Then, with the same words, one forgives this person.

I chose a friend with whom I've had a long-standing relationship that had ended with confusion and hostility recently. I pictured his face, saw the troubles that led to our rift, and asked his forgiveness for what had happened between us. It was hard, as he hasn't been forthcoming in trying to make a reconnection. But the exercise, including forgiving him for what had happened, helped me feel a sense of resolution.

I personally found this deeply moving, but several in the group during evening lectures expressed difficulty forgiving those who'd done them harm. For others, this entire "metta" or loving-kindness practice was uncomfortable, and some even stopped coming when this was the guided-meditation topic of the session. A number of people later would say that they had a hard time forgiving someone who'd wronged them and hadn't apologized for the transgressions.

Day Six

I'm feeling as if I now have three palpable streams of awareness flowing into my river of consciousness. One is direct sensory experience. These sensations of my body or of my perceptions feel raw and bare. When I walk, I feel the pressure on the heel of my foot, the transition to the ball, the distribution of weight unevenly onto my toes, the movement of my hips as my other leg slowly swings over the center of gravity and my body leans forward, the next heel touching earth, my other foot's toes releasing and taking flight. I'm not observing this as a perception; I'm sensing it. As it's happening in real time, I feel there are no words to describe these sensations, no concepts to analyze and cluster them. They just are their sensory fullness--sights and sounds, inner gurglings, tensions, pressures. I also become quite aware of the second stream--the conceptual stream in the idea of walking. I can almost hear the thought--"walking"--in words that aren't quite audible in my mind. But now there's also a third stream flowing that I call the "observer"--the sense that I'm watching myself from afar, out of my head, floating in the hall above me or in the trees above the path where I'm walking.

Each stream--sensation, concept, observer--seems to coexist in the valley of the present moment. I note them, even observing the observer. How odd. At some point, I feel as if I'm losing my mind as my sense of reality crumbles, unraveling before my mind's eye, literally. Or am I actually finding it? I walk on. Step by step, I watch my mind. I feel my steps. I observe my feeling and even feel my observing.

I haven't had a conversation with anyone besides brief moments with my teachers in almost a week. No interactions, no speech, no reciprocity. I'm surrounded by others, but am far away, yet so close. I've been carrying out the assigned job of cleaning our hall's bathroom each day. I dreaded this routine at first, but somehow have come to enjoy it, to even relish the task. There's a kind of connection I feel with the mop, scrubbing the toilet, washing the sink. Day by day, I've come to expect the same sort of reaction from the cleaning fluids, the sponges, the rags. It feels comforting to know that somewhere in all this there's some sort of predictability. I scrub, the dirt disappears. Magic. But in the open valley of the present moment, I never know what will arise.

Needing some kind of anchor point during the walk, I think of a mnemonic for the whole thing. I know we've been told to say to ourselves, "not now" or "no thank you" to acknowledge an interesting idea and not get swept up in it. But I can't help myself. Or perhaps I am helping myself. Step by step my shoeless feet are floating over the wooden floor of this walking room. Step by step. I think: Sensation. Okay. Observation. Fine. Concept. Good. Each of these three streams gives me a sense of knowing the present moment, a knowing paradoxically without words, without concepts, without sensations. This knowing is a kind of subterranean stream beneath this valley of the present moment, a formless Knowing : K. How will I ever remember this amazing vision? Then I think, " S. O. C. K." So a sock is around the sole of my feet and SOCK is surrounding the soul of mindfulness, step by step, moment by moment.

Earlier I'd described a three-stream awareness in a question-and-answer period and asked if I was losing my mind. When the observer becomes excessively active, I said, it seems to destroy the direct sensory experience, just as the conceptual thoughts used to do. Do I need to get rid of the observer? I asked. No, the teacher responded. The idea is balance. I can live with that. In fact, I can float with that. And, of course, on the following walk, another mnemonic emerges--the ABCDE of mindfulness: A Balance of Concept and Direct Experience. My left hemisphere just won't quit!

Day Seven

This is the day we "break silence." They've planned a brief, three-hour period of formal discussion, followed by an evening meal full of chatter and social connections, during which we won't be aware of the taste the food, I imagine, and then a silent evening meditation before going to sleep until tomorrow morning's final meditation and discussion. We first meet in pairs, and I'm dying to describe my experience. I tell my partner about these mnemonics and he likes the YODA one best: You Observe and Decouple Automaticity. This describes the role of reflection in waking us up into mindful awareness: observation disrupts being on automatic pilot. We laugh about the idea of "Yoda's Socks." Mindfulness may involve more than just sensing--it may include that capacity to be aware of awareness, to observe experience. When we observe, we can disengage the automatic chatter and less obvious filtering that our emotions and habitual schema create as they distance us from direct experience. Observation feels like the key that ironically unlocks the doors for direct sensation: we observe and note our conceptual mind, and free ourselves to enter the valley of the present moment more fully.

As we emerged from silence, a strange phenomenon seemed to occur that I've subsequently been informed is common, not just with scientists: there was a frantic sense, a kind of party atmosphere, once we could speak after our lonely, silent sojourn. But when we later returned to silence, I felt surprising relief, and an open, spacious sense of my mind's coming back to me. I could feel a clearing of my awareness when I knew I wasn't to speak to anyone. That lack of contact freed my mind to be open again, to connect to itself. There's some kind of clarity that comes with silence.

Still, that night, when I called home for the first time in a week, I was glad to connect with my wife and children. And yet, even though things were fine at home, my mind couldn't stop thinking about our conversation, the plans, the tones of voice, things to be done. For the first time all week, I had a hard time falling asleep and awoke several times, just thinking of various things that had evaporated from my awareness during the week. The pull of my regular life made me realize that I hadn't been aware of how much quieter my mind had become.

I'd been drinking hot tea all week long without a problem. After calling home, moving out of mindfulness and back into the frenzy and hustle and bustle of "civilian" life, I burnt my tongue. I was thinking of something else instead of being aware of the tea as I was drinking it. Without mindfulness, we can get harried, and burnt.

During the brief science discussions about our ideas and experiences on the last night of the week, I couldn't get my head in gear. What struck me was how utterly conceptual the conversations felt, and I just wasn't in a frame of mind to reengage in that way. I welcomed the return to silence that last night. On the ride to the airport the next day with two friends, though, I felt we could go into our experience deeply, slowly, without interruption. It felt satisfying to try to put the week into words and share that with one another. I said that it had felt as though some part of my mind that usually connects with others had, by the middle to end of the week, turned its focus onto the only person available: me. As I described my experience, I could feel that they were attuning to me in a way that I'd felt I was attuning to myself during the week. My science mind imagined it was the mirror neurons that enabled us to resonate with one another. That resonance of internal and interpersonal attunement felt deeply gratifying.

Now, many months later, I find myself still riding the current of those four streams of awareness--sensation, observation, concept, and knowing--that seem to create my experience of the present moment. Having had a week of a silent retreat feels, for me, like a gift of getting to know myself in a new way. Even as a therapist and someone who engages in nearly nonstop reflection, being alone with my own mind during that time somehow brought out a new sense of myself that stays with me to this day.

How have I changed? One way is that the stream of direct sensation seems much stronger and less vulnerable to being crowded out of my life by conceptual thoughts, or even by observation. There's been more than a "truce" created among these distinct ways of knowing now--I feel a new sense of harmony since the retreat. I no longer become locked on any judgment that one way of being is better than another. Each has its own role to play in the spectrum of life.

In my professional world, I've found that teaching mindfulness has taken on a new dimension with my patients. There's a sense of a central "hub" within my mind that's become more spacious and holds more of the moment of being between us. It's hard to describe, but perhaps the feeling is best expressed like this: Being is just this. Whatever is here, we--you, me, relatives, friends, our patients, our students--can contain the fullness of the experience and ride the waves of our awareness streams together. That spaciousness can be shared. A wheel of our awareness can become a collective, group experience, filled with awe, and the illusion of our separateness revealed for what it is: a creation of our minds, a neural invention.

Somehow I feel an open access to a core self beneath identity from the week of silence. This core way of being, underneath the clutter of personality, is something we all have. The simplicity of attuning to our breath, to ourselves, perhaps permits us to gain access to a deeper self that's the common ground that we can share as we bring mindfulness to each other. At that core place, there may be a path toward healing our global community, one mind, one moment at a time, since kindness is to our relationships what breath is to life.

Daniel Siegel, M.D., is the author the forthcoming book The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being , from which this article was adapted. He's codirector of the UCLA Mindful Awareness Research Center. Contact:

Friday, 26 December 2008 13:34

Appointments With Yourself

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Appointments With Yourself

Don't Mistake Your Schedule for your Life

By Michael Ventura

Now is an obvious word, but a tricky concept. As soon as you say "now," the now in which you said it has passed. Where did it go? It went that-a-way. Just like the now in which you said "Where did it go?" Thinking about "now" can make you dizzy.

We speak about "the present moment" and the ability to be fully present, and we claim a sort of smudgy understanding of what that means. But what is "the present moment? Seriously! "Be in the now." "Be here now!" "Be present." "In family life be completely present," says Laozi's Tao Te Ching (in Stephen Mitchell's New Age-ish translation)--a sentiment echoed in one way or another by every marriage counselor alive.

Americans have heard and used these phrases for about 40 years, as Eastern and New Age concepts influenced psychology and other ologies. We're all familiar with expressions like "right attention," "mindfulness," and family therapy's emphasis on what's happening in this room right now.

There have even been attempts to quantify the present. In Daniel Stern's The Present Moment, he states that "present moments last from 1 to 10 seconds with an average around 3 to 4 seconds," and submits this definition: "The present moment is structured as a micro-lived story with a minimal plot and a line of dramatic tension made up of vitality effects." Obviously, once you delve into it, now isn't as exact a word as it appears.

Finding the Present

The primary definition of now in the Oxford English Dictionary is "at the present time or moment," which, as we've just seen, isn't very useful. There's more utility in the dictionary's second definition: "in the present circumstances"-- that spreads out "now" comfortably. We're not talking about one moment, or one perception, or 10 seconds; rather, we're talking about a kind of place within time, a "here," these present circumstances. "Here" as in: what we're presently engaged upon, in the place that we are.

So you're taking a walk, and the entire walk is "now." You're having a conversation, and the entire conversation is "now." You're making love, writing, cooking, telling a bedtime story--the entire act is "now." That's a manageable present, something that can be discussed without requiring the capacities of a Zen master.

A manageable present, but also complex and variable. You're taking a walk. In a park, say. And let's say you're an attentive person--you're not one of those people who walks staring down at their shoes. You notice birds, trees, clouds, kids playing, an aged person sitting on a bench, a couple walking hand-in-hand. It's nice, it's sane, you have the gently relaxed feeling that the world isn't ending at the moment; maybe soon, but there's time enough yet for a walk in the park. Also, something worrisome and/or interesting is going on in your relationship, and you're chewing on that.

The mind is a nonlinear organ: while you're mulling your thoughts and you're attentive to the comparative sanity of the park, something you see reminds you of something else and takes you away from your primary thoughts. "Now" you're in three places at once, at a leisurely pace: the park, the relationship, and the fact that kid over there is doing just what you used to do as a kid, or that you once had a dog like that dog this very pretty lady is walking, and you notice the lady, too. Thus "now" is continually expanding and contracting on your walk. It's a bird, it's a kid, it's a memory, it's your girl- or boyfriend, sometimes one at a time and sometimes kind of all at once--assuming, again, that you're having a decent sort of day, there's no particular crisis, and you aren't obsessing. Various things are going on all around you and within you, and you're walking in the park.

I take this walk-in-the-park kind of activity to be the state that the Zen poet Ikkyu described when he said: "so many people know but don't know they know / walking to work talking to themselves" (Stephen Berg's translation, Crow with No Mouth ). What do they know? They know how to be in the now. The trick is knowing that you know, which doesn't necessarily require years of meditation. The great mystics are always saying (infuriatingly) that the very big things are actually very simple. In this case, knowing that you know is simple. It doesn't require "enlightenment" (whatever that is); it requires only appreciation.

Add appreciation to this "now"--add, that is, a bit of consciousness, the awareness that, "Hey, this right here is pretty nice"--and your "now" expands to the whole walk, the whole park, the entire present circumstance. Presto, you're in the now! If you can appreciate it. If you can't, you may also be in the now, but you don't know it; that is, you don't appreciate it--and if you don't know it, don't appreciate it, you're not fully there.

So say you're walking in the park and appreciating it--it isn't over-the-top happiness, it isn't profound awareness, but it's pretty good. Then your cell phone rings. (We're assuming that, like many of us, you're foolish enough to take your cell phone on a walk in the park.) It's the significant other you've been thinking about, calling from another state where she (for the sake of argument) has been for a week on business or whatever, and she isn't due back for two more weeks. You're glad to hear her voice. She says she misses you. You sense that she expects you to say, in return, that you miss her. But what if you aren't missing her? That doesn't mean you don't love her. It's just that on this pleasant walk in the park, you aren't particularly missing her. It might be better if she was there, but she isn't, and she can't be, and she won't be, and it's still a good walk in the park without her. If you say, "I miss you, too," you're lying, and there's a flat dullness to that kind of little lie--it sours the moment; enough lies like that, and it sours the relationship. (As someone once said to me--a line I later stole--"Never say 'I love you' when what you mean is 'Good morning.'")

So she says "I miss you" and you don't want to say "I miss you, too" because, at the moment, you don't. But if you say, "I don't miss you," you're in trouble, and you're hurting a person you don't want to hurt. What's "missing" anyway? It's a feeling that leaves a hole inside; it's a feeling that says, "The present circumstance isn't enough, even though it's all you have."

Missing is usually a sense of incompleteness, a lonely insufficiency of the self; when acute, missing can even feel like a kind of panic. Either way, missing arises out of a feeling that's more profound: longing. But longing--if you allow yourself to long for someone, if you appreciate the depth of the feeling--can be a lovely sensation. Missing leaves a hole; longing can feel full. You feel the longing filling you up, expanding your heart. And "I long for you" is so much more romantic than a perfunctory "I miss you, too." (If you actually do long for her, as a sort of constant undertow when she isn't around.)

It's difficult to appreciate missing, but not as difficult to appreciate longing. Missing whisks you out of the present circumstance; but a recognition of longing deepens and nuances the present circumstance. Again, it's that small thing, appreciation--to appreciate the moment you're actually experiencing, instead of faking a feeling you aren't having or allowing yourself to be preoccupied with missing a moment you aren't experiencing.

"Be here now" is pretty vague. "Appreciate, and don't fake," that's concrete. You may or may not be able to do it, but at least you know what it is. It may take time and trouble to learn how to do it, but at least you know whether you're doing it or not. "Do I appreciate my circumstances? If not, why not?" That's at least a starting point. "Do I do a lot of faking?" That's at least an answerable question. It may take a lot of work to answer it thoroughly, but it can be answered. Maybe you need the help of a therapist to answer it. Maybe you can figure it out, sooner or later, on your own. Either way, through these questions, you enter a mental and emotional territory the poet Rilke described: " Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer."

Frenzied Schedules

But it isn't so easy to "live the questions" in a multimedia, interactive era of cell phones and pagers in which we're expected to be constantly available--I've called it "The Age of Interruption." We've even devised nifty gadgets for interrupting ourselves, and never letting the present speak to us on its own terms. The iPod supplies a constant soundtrack wherever you are--background music to force the present into whatever mood, or pastiche of moods, you programmed into it. (We may not experience this as a form of interruption, but that's what it is, albeit self-induced.) For many of the young, cell phones and iPods are taken for granted, almost as biological appendages, and their concept of "the present" involves instant electronic connection to their friends and family at all times. Meanwhile, in our big cities, it's hard to be out of sight of some ad that exists for no other reason than to wrest your attention from the present to something you can buy. Life now is a kind of cacophony that's difficult to turn down and almost impossible to turn off.

The daily round has become frantic, for workers and homemakers alike--we need Day Runners just to keep track of what we're supposed to do! Each task interrupts the last, nothing one does feels fully completed, and many live their lives always a little panicky, as though late for an appointment. (The appointment they're really late for is an appointment with themselves.)

Jungian psychologist James Hillman told me once that in his clinical practice, he found that nothing was harder to "treat," to do therapy with and upon, than peoples' schedules. He said it was very difficult to get people to see that their schedule was their life --the skeletal structure of their existence. You're not going to change your life much unless you change your schedule: open it up so that the unexpected may enter. Else how can the present be a presence instead of just another goal--or just something else you don't have time for?

So when I write of a walk in the park, someone might be saying, "What are you talking about, who the hell has time for a walk in the park?!" Your weeks may be so oppressively scheduled that you never, or rarely, take the time for something like a walk in the park. In such circumstances, your inner life, which no one can avoid having, can get in the way and become something to be suppressed, not explored. Your self becomes a burden--a danger to the marriage, the children, the job. Ask questions like "Do I do a lot of faking?" "Do I appreciate my present circumstances, and if not, why not?" and truthful answers could bring your life down around your head.

People in these circumstances rarely want to be "in the now," in the sense that we've been speaking of. Rather, they seek to lose themselves in their tasks so that they don't rock the boat. Their schedules become not something to be addressed and changed, but something in which to hide.

Living with Courage

Often the price of success, or the price of simply fitting in, demands not only conformity (the suppression of self) but passivity. And we can lock ourselves into conformity and passivity simply by, as the saying goes, "working hard and playing by the rules." For example, the average college student goes into massive debt to achieve a masters or doctoral degree. It's the work of a decade to pay off that debt, a decade during which one willingly accumulates many other obligations. Often by her mid-thirties, that Ph.D. recipient has a family and children. Sometime in her late thirties or early forties, the desire to be more her own person, more in charge of her own time, more "in the present moment" becomes urgent. How to do it? The possibility of breaking free, of fulfilling herself, seems slim to nonexistent. For many, the obligations they've bought into have compromised their inner lives beyond hope, and a genuine appointment with themselves can never be kept.

It's difficult, if not impossible, to appreciate your circumstances if those circumstances imprison. It's tough to learn not to fake if you're living a lie, or many lies, and if those lies have become the terms of your survival. For many people, that's "normal life." Therapy can help you cope, and coping is better than nothing, but no one mistakes it for fulfillment.

For some, "the present moment" is nothing less than terrifying, when faced full on, without blinders, without apologies. The marriage is sunk in compromise, the job sucks, the children are an endless worry, and God doesn't respond. If even one of these aspects goes well--the marriage is alive, or the job is full of interest, or the kids are alright, or God is a comforter instead of a terrorist--then we are (as Southerners say) shitting in high cotton. Who wants to face "the present moment" in most circumstances? Better to watch TV, videos, or Jeopardy. Anything becomes better than an awareness of where you are. Anything becomes better than not faking.

But this is really nothing new. In a world far milder and more orderly than ours, Thoreau observed that "the mass of men lead lives of quiet desperation."

The odds have always been against any individual who desires to live a free inner life--and a free inner life means not being afraid of, indeed relishing, the present moment. To buck the odds takes courage. To determine to find one's way through the societal maze to a place where "the present moment" can blossom requires not one but many small acts (perhaps large acts!) of courage. But "courage" isn't a fashionable word anymore; I can't remember the last time I heard anyone use it in conversation.

We don't tell each other, or ourselves, something our great-grandparents assumed: if you don't have a certain amount of courage, you can't live worth a damn in this world. Psychology, philosophy, religion, money--they won't help if you don't have any courage. But courage isn't necessarily something innate that one has or doesn't have; for most of us, courage is something that you learn, cultivate, grow into step by step, mistake by mistake--like love. Courage, like love or freedom, is something you have to want. Certainly, if you won't cultivate your courage, "be here now" is forever beyond your grasp.

"This was about courage," writes Doris Lessing in her Golden Notebook. "It's a small painful sort of courage which is at the root of every life, because injustice and cruelty is at the root of life. And the reason why I have only given my attention to the heroic or the beautiful or the intelligent is because I won't accept that injustice and cruelty, and so won't accept that small endurance that is bigger than anything." We aren't speaking of anything grand. It takes courage to admit that you're unhappy, and still more to address that fact. It takes courage to decide you need therapy, and more courage to go through the process. It even takes a kind of courage to say, "Today, come hell or high water, I'm taking a slow walk in the park."

Blessings from the Past

All I can offer as a guidepost to the present moment is something that happened to me--an element that helped me be "in the now," as that grating saying goes. And, for me, this step took what Lessing calls "a small painful sort of courage."

It involved memories. Memories "come up," as we say, all the time, in every kind of situation. The past adheres, in the form of memory, to most present circumstances. And, except when we're actually trying to remember, we're usually not in control of what we remember. Something reminds you of something and zap: you're remembering. A scent, a sight, a song can take you back decades.

As a writer, I'm perhaps especially susceptible to memory because there's a sense in which writing is memory. It may be argued that a writer works in the medium of memory even more than in the medium of language. For a writer, often the prime function of language is to serve, preserve, and transmute memory--as fiction, poetry, nonfiction, or even as thought. So I'm often preoccupied with the meaning of memory itself, and with the significance of specific memories.

Like anybody, I have many bad memories. Gradually, by hook or by crook, most of us learn to live with that. But I began to be bothered by this question: Why do good memories, wonderful memories, sometimes cause me intense pain?

Not all good memories, of course, but gorgeous memories like: when I was falling in love with Z (and with several other letters of the alphabet); or moments of great happiness in my first marriage and my second (both long past); or a good memory of a dead or lost friend; or a rare good memory from childhood--excellent moments, rich with life. So why should they cause pain--so much pain, sometimes, that, lacking courage, I'd shut the good memories down?

I began to wonder why these good memories, memories that shouldn't be avoided but cherished, should wrench me away from an appreciation of this moment--from the courage to be in this moment? The events evoked were anything but depressing or sad, so why should the memory of them depress and sadden me "in the now"? Because the romance or friendship or marriage later went bad. Because one good childhood memory brings up a dozen that were awful. What happened later colors the good memory and leaves a bad stain--the awful and ever-present fear of loss.

Even the good things that didn't go bad: a great bunch of kids I taught, whom I'll never see again; a marvelous adventure that I'll never have again; the sensation of being young (for I'm not young anymore and will never be again). Excellent times! Why should the sudden thought of them cause pain, and the fear of pain, in the present?

Because those times, those adventures, those loves are gone forever. And I seem particularly sensitive to that, not in a sentimental or nostalgic way, but simply with a sense of irrevocable loss. That sense of loss, and fear of further loss, was clouding my present.

Then one day, something changed. I can't tell you why it happened or how; it just happened. On a street where I'd once walked with someone precious to me, someone whom I'd since lost, I "saw" (in my mind's eye) the two of us walking ahead of me, as we used to walk, smiling as we used to smile, with our old radiance. And instead of feeling the pang of loss and fear of memory, I felt something very different, and I said softly but aloud: "Go well, my beauties."

The memory didn't wrench me out of the present, nor did it cause sadness and fear--it was poignant, yes, but in a sweet way. I knew everything that was going to happen to those people, some of it good, some of it not. I knew that, contrary to what they felt and thought then, one day, their paths would diverge forever. And what I felt was to wish them well. Both of them. He would one day turn into me, and she--I can't know whom she's become. But I wished them well. "Go well, my beauties." And that felt good in that present moment. And the memory faded, and the fear of loss faded, and I was right there on that street, in the present, with no past burden.

From that time on, when a memory arises, I see it clearly, and I say, softly or to myself, "Go well, my beauties." And the memory passes without wounding. I'm doing something in the present that relates to the past but isn't gripped by the past. My ghosts are welcome, and, being welcome, they quickly go elsewhere--they still have much to do. Because of this, my present feels vastly expanded. Memories are no longer interruptive or fearsome; they're part of the present, and I've found that when I've blessed them--"Go well, my beauties"--good and bad alike leave a loveliness in my present air. It's as though the past is saying, as Jacob said to the angel, "I will not let thee go except thou bless me."

We cannot be in the present until the past lets us go. It'll never leave entirely; it must always return. I suppose it needs a lot of blessing. But, blessed, it'll let us go . . . and the blessing, because it occurs in the present, also blesses the present.

Just Being

In a life running from one sort of appointment to another, space must be made for appointments with oneself. This, too, takes that "small courage," but all talk of being "in the now" is pointless without unspecific appointments with oneself.

Some time ago, my friend and teacher, George, asked if there was any moment of the day when I wasn't doing. I said, "I meditate." He said, "That's doing. It's a specific effort with a goal." "Well," I said, "occasionally I'll just pour myself a cup of tea and stare out the window." He said, "Drink more tea."

It was a concrete suggestion; a way for me to spend some unscheduled time with me, in the present. A walk is good, too. (Not for exercise. Exercise is doing. ) There are days when I'm all jangled with doing; when being in the present seems a distant memory. I suddenly remember George's "Drink more tea," and I make myself a cup of tea and just sit and sip a while. You sit and sip, the mind wanders (which is its natural state--the mind is a wanderer). It wanders back to itself, always. I find that I suddenly, again, really am where I am. In the present. And much more easeful about whatever comes next.

In Hillman's terms, George was "treating" my schedule.

Our schedules are enemies of the presence of the present--"officiating devils," to steal Heinrich Zimmer's term. "But," he also said, "the officiating devil is not very difficult to trick." You can trick it with a cup of tea, a walk, a question, a blessing, appreciation. It isn't that complicated. The really important things are simple, the sages like to say. It simply takes attention. Even the most harried person can sit a little while with a cup of tea. To be "in the moment" is within anyone's reach.

I've found that many people don't like to be told that. Makes them cranky. Nevertheless, it's within anyone's reach, the now, the true present, the expansive moment in which one meets oneself and does . . . nothing. "Just visit," as they say in Texas. Be with the moment, which (the Zen guys are right) is yourself.

You can do it. Have a cup of tea.

Michael Ventura's biweekly column appears in the Austin Chronicle

Friday, 26 December 2008 13:27

The Precarious Present

Written by



The Precarious Present

Why is it So Hard to Stay in the Moment?

By Robert Scaer

"I just can't seem to stop my mind," Linda told me. "I try to relax, but after a few moments, my brain starts to buzz again with a jumble of thoughts and feelings. I can't seem to turn them off." As she spoke to me during our second visit, she was visibly distressed. She had the pinched face and hunched shoulders of someone who felt at once threatened and helpless.

"Lots of times, it's the same old thing, just the same old negative thoughts and worries and blaming myself," Linda went on. "Sometimes I try to head them off by going out for a run, but they come back later. When they really get ahold of me, I get kind of shaky, dizzy, and sick to my stomach. If they go on long enough, I actually get a stiff neck, and eventually a headache."

A client's negative, intrusive thoughts are a therapist's stock and trade. Ditto the accompanying roster of bodily complaints, from stomach pains and neck tightness to headaches and back problems. In my 20 years as medical director of a multidisciplinary chronic-pain program, I've found these body-mind intrusions to be a sort of generic marker for significant emotional disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and adjustment disorder.

But if Linda's distress seems familiar, it isn't just because we see this kind of client so frequently in our offices. It's also because her complaint rings true for "healthy" people like ourselves. All of us ruminate, bringing up the cud of old memories and unresolved problems, in the process experiencing a sinking feeling in the stomach or perhaps a tightening in the throat. As we well know, these experiences usually arise unbidden and often at inopportune times, such as when we're reading a book, eating a meal, or even, God forbid, making love! And when we're interrupted in this way, we basically lose it: we forget why we went into the bedroom, we lose track of our place in the book, and, if the intrusion is upsetting enough, we may even lose the wherewithal to continue with what's going on right now. We've experienced that most insidious of insults to our mind--the corruption of the present moment by emotion-linked memory.

When we catch ourselves in this state of nonpresence, we're likely to chalk it up to "mind chatter." When a client reports these repetitive intrusions, we may wonder about a tendency toward obsessiveness or the possibility of depression and/or anxiety. While all of these interpretations may have some validity, I believe that much more is at stake. I propose that in many of these moments of body-mind intrusion, our brain is trying to protect us from mortal danger arising from memories of old, unresolved threats. In short, we're in survival mode.

"Ordinary" Trauma

To understand the meaning of these everyday emergency responses, and to transform them into opportunities for healing, we first need to rethink our fundamental assumptions about trauma. I propose that the sources of trauma are far more complex than the standard Diagnostic and Statistical Manual (DSM) definitions. Under Criterion A, the DSM-IV defines trauma as the result of having "experienced, witnessed or been confronted with . . . actual or threatened death or serious injury . . . to self or others" and responding to that event with "intense fear, helplessness or horror."

This definition isn't wrong, but it's woefully incomplete. In fact, any negative life event occurring in a state of relative helplessness--a car accident, the sudden death of a loved one, a frightening medical procedure, a significant experience of rejection--can produce the same neurophysiological changes in the brain as do combat, rape, or abuse. What makes a negative life event traumatizing isn't the life-threatening nature of the event, but rather the degree of helplessness it engenders and one's history of prior trauma.

Let's look at the first criterion--the person's relative state of helplessness in the face of a threat. We can often avoid being traumatized by an actual life threat if we remain in control of the situation, either by effectively fighting back or escaping the situation. If we've adequately defended ourselves, our survival brain doesn't need to store the body-mind messages of a trauma as an ongoing warning signal. But if we haven't prevailed--if we couldn't avoid the oncoming car or fend off the mugger--the brain remembers that experience as mortally threatening.

The second precondition for the development of trauma is one's storehouse of prior trauma. If you endure a relatively minor negative life event that somehow reminds you of a prior event in which you were helpless, trauma can result. Let's say you're facing surgery of a fairly safe and common sort--say, a cataract removal. For many people, the procedure would be relegated to the category of "unpleasant but bearable." But for you, this situation brings back memories of having your tonsils out when you were 6. Your parents weren't allowed in the operating room with you, and you briefly saw a scary, sharp instrument, and, all in all, you felt helpless and terrified. (You may be conscious of these memories, or you may simply be aware of a tightening in your throat or the desire to scream when you think of the upcoming cataract procedure.) Because your survival brain still thinks it's in danger from that tonsillectomy, it'll store this new, similar experience as dangerous by association. Not only will you experience the cataract operation as traumatic, but you'll also be even more vulnerable to trauma during the next medical procedure you undergo.

All of us, clients and professionals alike, will continue to set ourselves up to be retraumatized until we recognize that many of our negative intrusive thoughts and sensations are, in fact, symptoms of trauma. They may not be identified as such in the DSM-IV, but these more commonplace body-mind invasions assume the same meaning, if not the intensity, as the trauma-related thoughts and flashbacks of full-fledged PTSD. In both PTSD and what we might call "ordinary" trauma, conscious and unconscious memories brutally intrude upon and corrupt the present moment. Not everyone suffers from PTSD, but each of us has sustained many of these smaller traumas, setting us up for being continually shoved out of the present moment into a frightening, helpless past.

Who Cares about the Present?

In psychiatrist Daniel Stern's model, the "present moment" is a brief period--lasting perhaps 1 to 10 seconds--that represents our conscious experience of the here and now. Only in the present moment can we fully live. If our "nows" are perpetually interrupted by intrusive memories, we're essentially stuck in a time warp formed by those stored perceptions. We can't problem-solve, we can't experience a daffodil or a sunset, we can't relate to other people, resolve old conflicts, or form new attachments. Only in the here and now can we directly experience, and move ahead with, our lives. The present is indeed a precious commodity.

Yet we repeatedly squander it. Therapists most readily witness this dissipation of the present moment with certain clients, the ones who focus obsessively on ancient complaints and worries to the exclusion of creative or productive ideas that might help them move forward. Many of these clients also complain of various aches and pains, most commonly gut symptoms, such as acid reflux or irritable bowel, or chronic pain in the head, neck, or back.

But if we're honest, we also recognize this corruption of the present in our own lives. How often do we find ourselves ruminating about this or that familiar resentment or well-worn worry? How often do we truly notice where we are, whom we're with, or what's actually happening--that is, experience our own precious moments? It's as though some dark, implacable entity invades our minds and bodies and fills them to the brim, leaving little space for pleasure in our aliveness, much less for growth or healing. That entity, I believe, is the total body-mind experience of a past trauma.

Remembered Horrors

Let's take a moment to look at the two primary types of memory that contribute to trauma. One type is emotion-linked conscious memory, which gives rise to the intrusive, troubling thoughts we keep experiencing. These thoughts arise from some little cue in the environment that reminds us of an unresolved conflict. For example, you may be balancing your checkbook when your mind suddenly jumps to the letter you received years ago from your ex-wife's lawyer demanding an accounting of your income and threatening to haul you into court if you didn't comply.

At other times, intrusive thoughts may pop up from a purely internal cue. You may be thinking about vacation plans for a trip to Hawaii when you flip to the memory of losing your luggage, includi­ng all of your money, in the Honolulu airport on a prior trip. Since you often don't consciously notice these cues--they can flit through the mind in a millisecond--you often find yourself bewildered by a sudden change in mood. You'd been feeling perfectly fine; why, now, do you feel so scared or so oddly dispirited?

And why, for that matter, are you clenching your teeth so hard your jaw hurts? Another kind of memory is at work here: the hardwired recollection of what the body experienced in trauma. Acquired in a flash and stored for a lifetime, these unconscious, procedural memories serve as survival mechanisms, ready to be unleashed instantly in the face of present, perceived danger. The clenched teeth that kept you from crying when you lost all your luggage now sets in whenever you plan a vacation; the spasm in your neck that started after a long-ago car accident now occurs whenever you're stuck in traffic; the cramping you felt in your gut whenever your father harshly scolded you now hits whenever your boss gives you feedback about your work performance. All of these bodily reactions serve as warnings from your survival brain that an old danger has resurfaced. It signals: Watch out! You're in big trouble! Right now! In these everyday circumstances, we experience a terrifying past exactly as though it were the present.

The Trauma Capsule

It's vital to recognize that our memories of a traumatic event reflect that event precisely. So what we've got is a sharply defined and bounded state, or capsule, containing all of the pertinent stored memories for each traumatic experience we've endured. My patient, Linda, for example, can't stop the loop of negative memories of the gender discrimination she experienced on the job last year. Although she came to the job with management experience, she was assigned menial tasks, such as running errands to the office supply store. Worse, she was repeatedly the target of sexual innuendos from her older male boss. When she complained, the harassment ceased. Briefly, she felt empowered, but not for long: Linda was passed over for her next promotion, one she'd worked hard for and knew she deserved. Because she was paying back a college loan and had minimal savings, she couldn't quit--at least not right away. She felt trapped and helpless.

Now, memories of the experience intrude on her consciousness in a host of situations--whenever she's short of money, whenever she gets into an argument with her boyfriend, whenever she has to deal with any male authority figure. She experiences intrusion on the present moment by a kind of internal "capsule" reflecting all of the conscious and unconscious memories of her job experience--cognitive, emotional, and bodily. Simultaneously, she's assaulted by thoughts of her mistreatment, feelings of shame and anger, and a host of unpleasant physical sensations--the same tight neck and gut cramps she experienced at the time of the original trauma.

When these kinds of memories arise, they corrupt the present moment by inserting past events into present perception. If the original trauma was severe enough, such as assault, it can feel as though one's actually reliving a horrifying past event, as in a flashback. For "ordinary" trauma, such as repeated job discrimination, it can ignite the volatile compound of distressing thoughts, emotions, and autonomic states that Linda experienced. Because I view dissociation as the perception of past as present, I call this phenomenon the dissociative capsule.

The Body under Siege

We often misunderstand the physical symptoms of the dissociative capsule as somatization disorder, which is defined as the intrusion of persistent somatic symptoms that don't reflect an actual physical disorder. But the symptoms I've been describing are genuine physiological disorders. The more clearly we understand this reality, the better able we'll be to help our clients in distress. Let's look at how these physical symptoms are produced.

In the traumatized person, the muscle spasm that causes the neck pain and the abnormal motility of the gut that causes the cramps are actual physical phenomena triggered by the somatosensory and autonomic procedural memories of the original traumatic experience. Somatosensory memories include all of the sensations and the exact pattern of muscle activity that accompanied the trauma, such as the tightening of neck and jaw muscles. Autonomic memories, both sympathetic and parasympathetic, are often experienced as visceral sensations--a pounding heartbeat, cold sweaty hands, and pressure in the chest. Initially transient, these bodily changes can eventually lead to chronic disease. Numerous studies suggest links between early trauma and the development of fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, chronic back pain, and a variety of autoimmune diseases. The body remembers, and keeps on remembering.

Dissociation by Degrees

Each of us has our own, distinctive cache of dissociative capsules. The number of life traumas one has sustained will determine the number of capsules stored in procedural memory: there may be a few or there may be dozens. Many factors determine the size and intensity of each. A large, complex capsule created by severe and repetitive childhood trauma may intrude on the present moment repeatedly. In such cases, the present moment may be obliterated most of the time, causing maturational arrest at the age of the most severe trauma. This situation may explain the remarkable maturational suspension seen in such syndromes as borderline personality disorder and other severe attachment disorders in which the "self" may be stuck in the first decade of life. But it's important to remember that these dissociative states may form even in cases of "ordinary" trauma. Recall Linda's experience of gender-based job discrimination: because she suffered not merely shame, but shame in the context of helplessness due to her low rank in the corporate pecking order, her experience was genuinely traumatic.

Viewed from this perspective, one can see how many of the "little" conflicts associated with cultural and institutional bias can assume the dimensions of traumatic stress. In my own medical practice, many female patients who've struggled with persistent job discrimination have developed chronic fatigue syndrome, physical collapse, and even PTSD. Other patients have developed PTSD following their experience with an adversarial justice system during a plaintiff lawsuit following an auto accident.

For those who bear an existing burden of childhood trauma, even more "trivial" incidents can cause new trauma. I've treated hundreds of patients with full-blown PTSD following auto accidents occurring at speeds under five miles per hour. For these highly sensitized individuals, it isn't the accident per se that caused trauma, but the triggering of a dissociative capsule of earlier, unresolved trauma that transformed an unpleasant hassle into a genuine catastrophe.

Treatment: Mere Words Aren't Enough

Trauma healing, in essence, is the recovery of the purity of the present moment. This concept has vital implications for trauma therapy (which, from here on in, should encompass treatment for "ordinary" as well as extraordinary trauma). The bottom line: therapy must adequately address the body-based procedural memories that form a large part of the trauma structure.

Unless we can expunge the somatic contents of the dissociative capsule, they'll continue to emerge with every triggering event, contaminating the present moment and promoting further sensitization to trauma. But if we can find a way to extinguish these somatic cues, the accompanying emotions and autonomic feelings will also be neutralized, rendering the capsule inoperative. Emotions and autonomic states are inevitably associated with "feelings"--the body sensations directly linked to those states. Without the "feelings," the emotions and autonomic state have lost their threatening meaning for survival. The declarative memories of the event will remain, but in the absence of sensations and emotions, they'll be experienced as past events--period. The present moment will be liberated.

So, how do we get from here to there? The royal road to the present moment, I believe, is through the emotional brain. We know that the limbic nucleus, the right amygdala, evaluates the emotional content of incoming sensory stimuli. If stimuli imply threat, the amygdala triggers arousal, unless, somehow, it can be persuaded to go off duty. In his book The Feeling of What Happens, noted neurologist Antonio Damasio describes a woman with bilateral injury to the amygdala. Via personality and psychometric tests, Damasio discovered that while she remained functionally normal, she'd lost the capacity to experience fear or rage. Is it possible, then, that someone without a functioning amygdala would be incapable of being traumatized?

This hypothesis seems well worth exploring. If we can find a way to shut down the right amygdala while a client is exposed to the contents of the dissociative capsule, we should be able to extinguish its contents. With the amygdala "off-line," the traumatic memory would no longer be associated with the somatic cues of arousal--the tight chest, the pounding heart, the constricted throat. These symptoms would no longer intrude on the present moment. Procedural memories of the trauma--both bodily sensations and emotionally linked memories--would no longer convey threat in the here and now, because they'd accurately be perceived as old memories. We'd find ourselves restored to the present moment, in all of its richness and possibility.

Retraining the Brain

What therapeutic processes might convince the amygdala to "down-regulate?" I'm not touting any specific approach. But what we know about the neurophysiology of trauma suggests that some of the so-called somatic and energy therapies, such as Somatic Experiencing, EMDR, Emotionally Focused Therapy (EFT), and Thought Field Therapy (TFT), may be particularly well equipped to escort a traumatized person from the past back to the present. Let's look at how these approaches might fulfill some fundamental needs of trauma healing.

Integration of the cerebral hemispheres. The functioning of the left cerebral hemisphere is a brain state that's normally inhibited during arousal. Theoretically, bringing the left brain back "online" and integrating the left and right hemispheres would interfere with, and inhibit, the independent function of the right amygdala. Alternating visual, tactile and auditory stimulation might well integrate the two sides of the brain and down-regulate the right amygdala while the patient imagines the traumatic event, thereby removing the arousal charge.

Brain integration may explain why some of the seemingly bizarre repetitive behaviors of energy therapies seem to produce dramatic results for some patients. The alternating sensory stimulation of EMDR, as well as the eye-rolling, counting (left hemisphere) and singing (right hemisphere) employed by EFT, may help to integrate the brain hemispheres and thereby relegate traumatic memories to the past. The EFT practice of repetitively tapping acupuncture meridian points, which promotes autonomic homeostasis, may also put the brakes on brain arousal.

Ritual. This is often part of the healing process in non-Western and especially indigenous societies, where it's often practiced by tribal healers or shamans. Rituals often involve repetitive behaviors, such as drumming, dancing, or singing, and frequently induce hypnotic trance states. The use of hypnosis in healing trauma may have its roots in this process. In addition, social rituals may activate the anterior cingulate, the part of the cortex that's known to inhibit the amygdala. We know that the anterior cingulate plays an important role in mother-infant and social bonding, a state that may be replicated by social ritual. The potency of ritual also may explain the impact of the eye movements of EMDR, the tapping procedures of EFT and TFT, and the repetitive affirmative statements of the latter two approaches.

Empowerment. This is the ultimate goal of all trauma therapy. To heal, an individual must recover from the state of helplessness that defines the trauma experience. During a traumatic event, a person experiences physical helplessness and effectively freezes into that state, leading to all manner of pain and illness. To recover, one needs a way to thaw out the body.

This "melting" process is at the heart of Somatic Experiencing, a body-based therapy in which one accesses the felt sense of the trauma and allows the failed motor defense to emerge in the form of a "freeze discharge," wherein the individual moves out of immobility into an effective fight or flight response. This ability to achieve discharge can be facilitated via a number of other somatic approaches, including dance, balance, equestrian therapy, and art therapies. What these approaches have in common is their capacity to access the freeze discharge and extinguish somatic procedural memories through completion of the bodily act of defense or escape. This completion at once permits and celebrates reempowerment.

Making meaning. Talk does play an important role in trauma therapy, but not as the first order of business. Once the contents of the dissociative capsule are extinguished, client-therapist conversations can help to provide the client with conscious, cognitive meaning and perspective. Talk can empower a client with the knowledge that the occasional recurrence of residual somatic symptoms--a sudden bout of nausea, a strangled feeling in the throat--actually represent an event from the past, and not an imminent threat that wipes out the here and now.

All in all, perhaps this is the most important lesson of trauma recovery: we never do quite fully recover. After all, our trauma memory capsules are nothing less than survival mechanisms, working in tandem with the amygdala to try to keep us alive. As one would expect from a primitive survival mechanism, it can never be totally extinguished. (Recall that after many years, Pavlov's dogs were reconditioned to the bell with just one trial.) Our stored memories of personal danger are fierce, focused, and highly motivational.

Of course, we can make enormous strides in discharging the contents of our trauma capsules, especially via approaches that address our body-based memories. But as we make our vital journeys back to the present, we'd do well to cultivate an attitude of gentle acceptance. For it's quite possible that all the body-based therapy in the world, plus regular infusions of meditation, running, yoga, and other mindfulness practices, won't be enough to keep us permanently anchored in the here and now. It seems we just aren't wired to live there fulltime. But we can make extended visits. And when we do, we can explore the lush landscape of the present moment with more wonder, wisdom, and pleasure than ever before.

Robert Scaer, M.D., was formerly associate clinical professor of neurology at the University of Colorado Health Sciences Center in Denver, Colorado. He's published numerous articles and two books addressing the neurophysiology of trauma, diseases of trauma, and concepts of healing: The Trauma Spectrum and The Body Bears the Burden . Contact:

Monday, 10 November 2008 11:12

Facing Our Worst Fears

Written by Ari Rosenberg

Finding the Courage to Stay in the Moment

by: Reid Wilson

As I tell this story, you can ask yourself, "What's this have to do with the practice of therapy?" I'll answer, I promise--after the story.

It's Monday morning, and I've set aside several hours to work on this article before my next client comes. I've cleared my desk at my home office, turned off my e-mail, put a sign at the top of the stairs--"Serious Writing in Progress!"--and settled in for the duration. At my first break, I visit the bathroom to discover the toilet is plugged up. I flush to clear it and then . . . filthy brown toilet water is suddenly spilling over onto my white Berber carpet! I rush to turn off the intake faucet and it doesn't help! The water is literally pouring over the side onto my white Berber carpet! I reach for the plunger. Finally, after more mess splashes onto the rug, I get results. But now I'm faced with a monumental clean-up that'll take hours. No more writing! I'm angry, disgusted, anxious, frustrated, and feel somehow betrayed by fate--it's all so unfair! "Why now? Why me?" I grumble. "This is the last thing I need right now!"

But instead of letting myself stew in my own whine, this time, I take a step back and say quietly to myself something that's become my guiding maxim for such situations: "This is exactly what I need right now." Suddenly, all sound quiets in my mind. I'm calm and clear. I continue cleaning up efficiently, but without the mental suffering caused by all the background noise.

This is a trick I now draw on frequently. For all the riches of my life--family and friends who love me, health, satisfying work, a steady income--it never seems like enough. I tend to complain constantly and resist what's happening all the time. At any given moment, I'm complaining that this or that isn't as good, fast, satisfying, exciting, beautiful, or enlightening as it should be. Something is too cold, warm, salty, bright, dark, cheap, or old. I'm not strong, clever, wise, nice, diligent, or happy enough. In short, things are happening to me and feelings are rising in me that I don't want.

The toilet episode says it all. Stuff happens (to bowdlerize the more apposite expression)-- life happens. Instead of fighting it, whatever it is, now I try to welcome it. I don't have to figure out why a stopped-up toilet was "exactly what I needed," I just have to get into that perspective and, once there, it instantly lifts me from my suffering. It doesn't mean I don't recognize how inconvenient, painful, and unpleasant some situations are, but I can acknowledge those experiences and let go of the need to figure them out or fix them. I can embrace the struggle, wrap both arms around the doubts and uncertainties in my life, and shift from being worried to being curious. If I can catch myself saying "I don't like this, I don't want that, I'm unhappy with this outcome, I'm anxious about that, I'm threatened by this," by shifting into a welcoming mode--"This is exactly what I want right now"--I find myself in a much better place psychologically. Then I can peacefully concentrate on cleaning up that rug.

Of course, I don't exactly want my toilet spilling all over my rug. When I tell myself, "This is exactly what I want right now," I'm disciplining myself to stay in the present moment--not to wish for other moments or to wish that my life was different at the moment, but to accept that this moment is all I have at the moment. The only power possible in the moment is to face whatever it demands. When we stop filtering every event through our judgments of what it should or could be like, what we really want, we become alert to our surroundings and curious about how we can interact with them. This is much more fun than complaining that the world isn't following the rules that our little egos generate.

How have these concepts altered my therapeutic practice? As a therapist and as just a person, I'm beginning to learn how important it is for me to embrace bad feelings and discomfort--all those emotions we spend so much of our lives trying to avoid--and then go on right through them to the other side. I'm learning that each time I'm tempted to resist a moment of distress, anxiety, or painful reflection about the past, I invite greater suffering. When I don't accept the present moment, everything bogs down from there. I generate a complaint, I declare there's something wrong, and I try to squirm my way out. At that point, I'm stuck in avoidance and can't move forward to actually solve the problem. But if I can open myself to the painful reality of the moment, I actually suffer less.

I remember the experience of taking my first group therapy course in graduate school, 27 years ago. I still see the syllabus in my mind's eye, listing the dates when each of us would lead a simulated therapy group in class. We all dreaded it--dreaded messing up and looking stupid and incompetent in front of our peers. Perhaps I dreaded it more than most, because I was possessed of the rock-ribbed certainty that it was always my job to fix people, solve problems, do it right and do it fast, with no mistakes allowed. Not surprisingly, on the day when we began (I was in the first round of guinea pigs), I was in a cold sweat, almost panting with anxiety. Now I was faced with a situation that not only could spiral out of my control, but could make me look like a bumbler. What a catastrophe!

Then, as we got ourselves situated in our circle of chairs, our professor, John Gladfelter, introduced the task. "Here's the assignment. I want you to be the worst group therapist you can be. Just be as bad, as incompetent, as you can possibly manage." What?! I was stunned for a minute. When I realized he meant it, I felt my tension draining away like dirty water from a sink as I thought, "I can do that!"

How did it turn out? No one actually tried to be a buffoon. But with the pressure off, and with no need to strictly adhere to vague and ill-defined rules we still hadn't grasped entirely, we all witnessed moments of creativity and intuitive wisdom shining through. More than anything, we relaxed. Even I relaxed, as if given a reprieve from having to do everything perfectly. In relaxing, we could actually meet people on their own terms, see and hear them as they really were, let ourselves connect with them rather than funneling all our energy and attention into squelching or hiding our own fears. We got a taste of the healing power of human contact. And we experienced the freedom of spontaneity--of not being under the gun to predict and control everything that happened in our tiny little worlds. Gladfelter had brought our fears of what might happen into the present, by making it the assignment. In the present, the group had new liberty and power.

Now, as a therapist, I want to help clients discover this same kind of freedom--freedom from the anxieties that imprison them. And I now think that, rather than trying to suppress the symptoms of their anxiety, clients can better free themselves by engaging with their symptoms in a spirit of welcome and open-minded curiosity: "Hello, symptoms. Who are you and what are you trying to tell me?"

What this does is help clients begin to change their own frame of reference about their symptoms, and shift the perspective from which they observe what they're feeling. This shift from "symptoms=bad" to "symptoms=interesting" can utterly transform the way they view themselves and the world. By accepting what the present moment offers, by not resisting, they widen their present possibilities.

Welcoming Symptoms

Renee looked visibly frightened as she sat down for our first session together.

"Hi, are you nervous?" I asked brightly, realizing perfectly well that she was scared to death.

"I'm extremely nervous," she responded in a quavering voice. I asked her how nervous, on a scale of 0 to 10, and she rated her nervousness as about 8.5.

"Impressive!" I said jovially, "I like people to come in with high anxiety, because it means we have something to work with."

She continued, "I'm really afraid that my symptoms will get so bad--my heart will start pounding so hard and I'll be shaking so much--I won't be able to control them and they'll just overwhelm me."

"Well, you're not in control of them now, are you?" I asked.

"Not really," she responded, "but just talking to you, I'm not thinking about my heart pounding so much."

I leaned back, smiled broadly and said, "Ah. Then, maybe we should get your attention back on your heart again." We both laughed--I heartily, she uneasily, giving me an odd look, as if she were beginning to wonder what she was doing in my office.

A minute or two later, I asked her when the last time was that she'd felt she couldn't even move because her anxiety was so great. "A few years ago," she responded.

I said, almost gleefully, "A few years ago? So you're due for another episode any time now, aren't you?" Now she was looking at me with something approaching alarm, as though wondering, What's this character up to anyhow?

What I was up to doesn't look or sound like the standard, empathic, rapport-building opening moves of a senior therapist. In fact, to Renee, I must have seemed careless, provocative, insensitive, maybe even clueless. She'd entered my consulting room in a state of nearly full panic and I'd said I was pleased. She feared losing control, and I'd reminded her she's wasn't really in control at the moment. She was avoiding panic by not attending to her heart, and I'd suggested we should pay attention to her heart. She hadn't had a full panic attack in a few years, and I'd suggested she was due for one. What kind of therapy is this? What was I doing?

Now, in therapy, I dedicate myself to helping people learn to accept, even welcome, their symptoms. I try to teach them to run toward rather than from what they fear and hate most about their disorders. I insist that instead of trying to evade, stifle, override, or distract themselves from these symptoms, they work as hard as they can to make the symptoms worse. I do all this as a therapist dedicated to helping them genuinely recover from the suffering caused not only by their anxiety but, more to the point, by the endless and often counterproductive tactics they use to escape it. I invite clients--as I invited Renee--to join me in looking directly at their problem with curiosity, humor, and compassion.

My therapeutic premise is that people's worries can be signals warning them about something they need to attend to. But the repetitious, unproductive, obsessive thoughts that accompany anxiety disorders are simply distressing noise. If clients can change the frame of reference from "my obsessive thoughts are in response to a real and dangerous threat" to "my obsessive thoughts are pointless noise unrelated to a real threat," they have a steady platform from which to change their entire world view (and, incidentally, make the symptom go away).

Increasing Discomfort

Camille, who was diagnosed with obsessive-compulsive disorder (OCD), had become consumed with worries after her father informed her that he was buying a gun. She thought continually about the possibility of finding the gun and accidentally harming her parents with it. To avoid and neutralize these fears, she compulsively analyzed ways to avoid the danger--she imagined never coming into their house, or searching for the gun and then avoiding the hiding place, or asking her father to get rid of it.

Together, we established that her worry about accidentally shooting her own parents wasn't a reality-based signal or genuine alarm, but a false threat created by her OCD. Thus, her constant analysis of how she should avoid this danger was a chimera built on a falsehood. She experimented with this new frame of reference. She decided to treat her fears about the gun neither as a realistic response to a genuine danger nor as awful symptoms to suppress, but as tiresome noise--those fears were just there, like a mosquito droning in her ear.

The question then became: How best to respond to this pointless background noise? The answer: Camille would purposely try to accept it, even ratchet it up, rather than fight it--feel it, go through it, make it as bad as possible rather than evade it. Once she allowed herself to get into her distress as much as possible, she'd simply tell herself to drop it. In effect, she now had a readymade protocol: "I want to feel uncertain and uncomfortable and worried about the gun. I want to have these fears. That's how I'll get better. So I'm going to fully acknowledge that the worry is here, and then drop the topic as soon as it starts." When the worry popped up, she noticed it, accepted it, and then said quietly to herself, "Drop it!" No thinking, no analysis; she'd just follow the edict. When the topic arises, acknowledge it and then, "Drop it!"

Was this easy for Camille to do? Not at all. Analyzing the problem was her compulsion; it made her feel safe. When she dropped the analysis, she was faced with the dreadful question, "Will I harm my parents?" and had no answer. So she had to hang out with her fear and worry, which put her in considerable doubt and distress. But she was bolstered by her belief in this therapy, by my confident support, and by the success of previous experiments of this kind in the past. Then this experiment worked well, too. She learned that if she let herself feel the worry, while telling herself to drop the compulsive analyzing (which is a kind of tranquilizer), the worry itself gradually faded away--but only if she stayed with her doubt and discomfort. Finally, the entire issue disappeared from her radar screen.

Basically, what I was helping Camille do was to step away from the content of her thoughts, get some distance, and learn to regard it as a kind of game. She looked at her compulsive analyzing and problem-solving and said, "Here I am again, labeling something as dangerous and trying to avoid it." Then she embraced what she'd just been rejecting, "I'm going to act as though this is exactly what needs to be happening."

Ideally, if anxious clients can respond by saying "yes" to the encounter--to accept exactly what they're experiencing in that moment--then they'll be back in control. They can learn to do this if they can endure discomfort. But for many, anxiety has become so dominant that they can't make such a shift directly. To stay on course, they need some sense of safety and a strong faith. In the past, I'd have asked them to be anchored by the skills I taught them. But now, their relationship to me is playing a larger role. I have always felt compassion for their suffering. Now I'm better able to appeal to their courage, knowing the direct benefits that accrue from opening their arms to what they most fear.

In the early stages, when their courage and confidence is still at low ebb, I don't suggest they have to commit to actually trying to change--I only propose that they may want to try experimenting a little. As I suggest homework, I use expressions like, "How about playing with this move?" and "Perhaps you can fool around with these responses." I imply that these strategies are malleable and temporary: "What do you think about trying this move a few times just to see what happens? We can talk about it next time." It's easier for clients to set aside defenses and endure distress if they think the "trial" will only be for a few moments.

The key is helping them alter their frame of reference, which is the entrenched belief that they can't tolerate discomfort and insecurity, even for a moment. To gently challenge them, I turn their struggle with anxiety into a mental game. Anxiety pitches you uncomfortable physical symptoms and uncertainty about the future; it wins if it can get you to avoid threatening activities, fight the symptoms, and hope they go away. But somehow, if you can purposely encourage symptoms, act as if you want them rather than dread them, you trick anxiety and hoist it by its own petard, so to speak. This new frame of reference--treating anxiety as a kind of game--seems to refocus clients' attention away from a pointless fight with their symptoms. Just trying to rev up symptoms makes symptoms seem weaker, more under your control. Clients soon find, in fact, that as they stop resisting symptoms, the symptoms begin to fade and then disappear.

How does this work in practice? Social anxiety disorder gives us shaky hands, a quaking voice, and worry about the critical judgments of others. The anxiety "expects" us to try to avoid it--perhaps by never going to parties or giving a talk in public. So, in this new game, we flip things around. Imagine when feeling anxious before a performance that you ask anxiety to make your hands shake, your voice quake, and the fear worsen. Do your best to get those feelings to last as long as possible. Plead with anxiety to make your hands even shakier, your heart pound even more, your voice become even tighter! That is, refuse to play the game that the anxiety disorder expects. Take charge.

I encourage my clients to push the old game board away and pull up their own game board of seeking out doubt and distress when anxiety wants them to defend against it or run. They then see that the symptom isn't nearly as powerful when they're in charge of it.

Breaking Through to the Present

Let's return now to Renee, the client with panic disorder who was beginning to think she'd ended up with one strange therapist. Halfway through that first session, she was explaining that the lump in her throat was currently causing her the most anxiety. I suggested she ask her anxiety, "Would you please make my lump get stronger?"

Her eyes bulged. She exclaimed, "It sounds scary!"

I asked what she thought would happen.

She said, "I'll either stay the same or get worse. I can hardly imagine getting better by telling it to get worse." After some teasing and persuading, she agreed to try it anyway. What courage! Her first attempt being exceedingly feeble, so I modeled for her: "Anxiety, I beg you to make this knot stronger. I want it to be so large; I want it to be as big as a marble. I want it to be--how about a golf ball? Could you make it a golf ball? I'd like it to be so large that people start to see my neck protrude with this big ball in there. I want to make it so big that to swallow, my saliva has to go all the way around this lump and then down my throat. If you'd do that, it would make me sooo happy. It's so important. All these years I've done so much for you! I'm asking you one simple thing: to make my lump larger, my knot bigger. Please do this one thing for me."

I asked her to try her own version, "as if you're auditioning for a role, and this is your job, and if you don't do this persuasively you don't get the part. Are you willing to try this again?"

Renee nodded and addressed her anxiety in the beseeching voice of a lovelorn swain: "Anxiety, I beg you to make that knot much, much bigger." She laughed, "This just seems so unreal." She laughed again and said with more conviction, "Anxiety, make this knot as big as you possibley can!" Then she paused, looking surprised, and said, "It's not there, anymore."

"Excuse me, Renee?" I said in mock astonishment. "Try harder. Make it as big as you can."

She concentrated for a minute and then looked at me. "It's just not there."

"What do you mean, it's not there?" I asked severely.

"It's just gone," she giggled.

And there it is: Renee accepted her present discomfort and embraced her uncertainty. She set aside her worries about future discomfort and challenged her nemesis. In her anxiety, she wanted to hold back out of fear of her symptoms. Instead, she played her own game of pleading with anxiety to make her more uncomfortable, and the symptoms disappeared. We continued the session in this same provoking style, hyperventilating together until her legs were shaking and hands were tingling and I was sweating and seeing stars. Then she demanded the symptoms worsen and watched as they slowly dissipated.

What's happening here? Instead of experiencing the symptom as interrupting and disturbing the present moment, we invite the symptom into the present moment--at which point, we're in charge, and the symptom is working for us. We prove that we have the ability to achieve a present consciousness that's larger than the symptom.

Then we can move forward with comparatively little resistance, and perhaps some curiosity and interest. When all I have to do is be the worst group therapist in the room, I'm ready to go. When anxious people take on the "challenge" of shaking even more, racing their heart even harder, making the lump in the throat even bigger, they believe they have the skills to meet the challenge. And that changes everything, paradoxically making the heart slow, calming the shakes, and eliminating the lump.

The problems we suffer with anxiety often continue not because we have symptoms, but because we resist the fact that we're experiencing symptoms--doing our utmost to block out the symptoms, rather than getting to know them a little bit. Most of our clients come to us trying to end something unpleasant, seeking both comfort and predictability in their lives. The desire for a life without stress or doubt is perfectly natural. And yet, we compound our clients' problems when we collude in their goal of simply making the unpleasantness go away. Our objective should not simply be to block their discomfort and allay their doubts, but to help reduce their suffering--ultimately, a completely different task.

Discomfort is an inevitable byproduct of interacting with the world and learning what life's rules entail. Doubt arrives as we challenge the status quo and muster the courage to explore our own potential for creativity. Suffering, in contrast, arrives when we insist on playing life's game according to our own private rules, without doubt or discomfort. Not only is this enterprise doomed to fail, when we try to avoid the symptoms of our existential anxiety, we foreclose the possibility of living fully and exuberantly in the present. Instead of saying when adversity strikes, "I want to push this away so as not to experience it," I'm finding that accepting it as it unfolds in the present is the most efficient way around it.

Present tense is what it's all about--even if the present tense isn't always so wonderful. If I can be present, I become powerful--I'll have tossed aside the dominance of my doubts and desires. My mind and body can focus on the task immediately in front of me. I want to engage in the present, not push it away. That'll guide me to my future. I don't want to be experiencing this and wanting that. When I stay with "this" without resistance, whether it's my disappointment, anger, or pain, I have a platform from which I can move forward to something better.

How do we make this shift in consciousness? In the midst of a conflict, to tell yourself, "I'm okay with this experience" places you with the problem in the present. You let go of your rigid goals of how this moment should be and settle into what the moment is, not knowing how it'll turn out or should turn out, but more ready to face what comes.

Reid Wilson, Ph.D., is associate clinical professor of psychiatry at the University of North Carolina School of Medicine and coauthor of Stop Obsessing! How to Overcome Your Obsessions and Compulsions. His newest book is Facing Panic: Self-Help for People with Panic Attacks. Contact: Letters to the Editor about this article may be e-mailed to