Unknown's avatar

the sacred and profane of death and dying

Book review of Katy Butler’s Knocking on Heaven’s Door: The Path to a Better Way of Death.

Katy Butler is a daughter, a writer, a life partner, a Buddhist. Mostly, Katy Butler is a daughter of whom more was asked by the medical system than should have been and more was expected of than could have been imagined by anyone as her father journeyed into his death.

This is the story of a family caught in the velocity of a medical momentum which erupts when someone enters the chaotic zone between a good life and good death. It is a heart-wrenching telling of what happens when we unwittingly place our trust in systems rather than people, in hope rather than clarity of thought. It is also a revealing, investigative and hard-nosed exposé of the death-preventing devices we hope would be life-sustaining. Butler invites us to journey with her to the realization that “(t)he honest, natural death is no longer the default pathway.” She begins by bringing us into her parents’ kitchen, sharing a cup of tea with her mother. This is a scene that can evoke memories of sweet poignancy of beginnings or endings; but here, here, there is a different evocation, a different prayer for an ending.

In  my role as a therapist, I have had the privilege to sit with spouses and adult children who were in the center of the turmoil of a loved one’s passing. The primary referral for “treatment” was triggered, they tell me, when they blurted out to their physician a wish that their loved one would die rather than continue to suffer. Typically, the physician panics and sees this as a pathological response to caregiving; some may even report this fearing the distraught spouse or child may act on those wishes. Butler explores with tremendous sensitivity this unspeakable longing for suffering to end without ever dropping into unnecessary angst or drama. But that is just the first three pages. The entire journey she takes with her mother and siblings is a wisdom trail from unknowing to being with not knowing, from waiting to bearing witness, from reacting to systemic demands to compassionate action.

The event line of the book is typical: her father has a stroke. In the usual process of rehabilitation treatment, decisions are made. It is not the decisions themselves but the revelation, through Butler’s skillful foreshadowing, that there are always unforeseeable consequences. And for many of those consequences, the mission of the medical industry often runs orthogonal to the values of the family and ethics of a supported death. The medical history of life-sustaining devices and interventions (surgeries, medication) is brilliantly interwoven into the narrative. Without taking us away from the unfolding tension, it makes us want to shout into the book “Oh, don’t do it! Don’t do it!”

But this is more than a story of one family’s tumultuous love for each other and their battle with the medical system. It is a cautionary tale for each of us, even if we think death is occupied with our future and not our present. It revealed for me that it is not about finding that right person to “pull the plug.” In fact, by the time it gets to that significant point, too many decisions have been made without full awareness and “pulling the plug” plays the smallest role in ending suffering. Butler writes tenderly, “Dying is hard on the dying. Death is hard on the living.”

Dying is not an acceptable topic of conversation. Still. Yet. Even. But converse on it we must because by looking away we only create a larger cauldron of suffering for those to whom we have entrusted our final moment – so wrongly believing it will only be that moment in which they will be called to act. Butler’s story carries this urgent message. We can honour the concept of dying as sacred but it can become a tragic process if we do not consider that getting to death itself can be a tainted and misguided journey.

It is worth mentioning that this book stands as an act of profound courage. It is brutally honest about the nature of relationships, searingly insightful in the potential of healing, and shines an intense light on our ignorance of what naively assume is a good death. For that alone, it is an important one to read.

~~~~~~~~~~~~~~~~~~~~~~

If you are interested in learning more about how to prepare and be with that honest death, here are some resources:

The Metta Institute offers training and workshops on end-of-life care as well as resources for practice.

The New York Zen Center for Contemplative Care offers grief and bereavement counselling, end-of-life programs, and meditations. Contemplative Care: A Film is an excellent resource.

Being With Dying Training at Upaya Institute is a rich program ranging in its training by Frank Ostaseki (Metta Institute), Laurie Leitch & Loree Sutton (Social Resilience Model), and Susan Bauer-Wu (Living with chronic illness).

The Canadian Palliative Hospice Care Association lists resources and programs for several professional groups (interestingly no psychologists), family caregivers, and volunteers.

The Quality End of Life Care Coalition of Canada document is a “Blueprint for Action – 2010-2020” to improve end-of-life care and ensure training and funding for Canadians.

Unknown's avatar

on mindfulness, muggles, & crying wolf

I try. Really, I do.

This month has been bubbling with various posts on Eastern scholars decrying Western Mindfulness. It began with Ron Purser and David Loy’s HuffPo article, Beyond McMindfulness which is likely the first time anyone from the Buddhist scholarship community has overtly taken on the therapeutic, coaching Mindfulness machine. In brief, Purser & Loy expressed concerns that the current movement of Mindfulness is not only denaturing the dharma but also lending power to corporations so that already-beleaguered employees can be lulled into a somnolent state through practices like “nonjudgmental awareness.”

The results of the Purser & Loy article were not what I would have expected: linguistic mudslinging. Protests from what may be called the “secular” mindfulness groups were no less than defensive and somewhat histrionic.  Sadly, there were worthy points in the protests but mostly lost in the defensiveness and the mutually admiring comments that followed. (There’s a difference between acknowledging a good point and hopping on the bandwagon.)

Heavy hitters like Elisha Goldstein and Jeremy Hunter responded on blogs and websites. They make some good points but the overall tone is dismissive and there’s a lot of “they just don’t understand” commentary. I can’t blame the secular/therapeutic folks for the reactionary stance although I do have to ask: if you’re teaching mindfulness, how the heck do you end up being reactionary?

Ted Meissner of Secular Buddhist conducted an interview with Purser & Loy which I’d recommend – if only to hear how it should be done.  Announced in the podcast, Ted’s new venture Present Moment: Mindfulness practice and science is a nice out-growth of his interest in making Buddhist teachings more accessible. I like that Ted points out in the Purser-Loy interview that the issue of watering down the dharma may be confounded on both sides (he was referring to the religious-secular Buddhist issues he encounters) because “we’re not even doing the same thing.”

These are important and difficult issues to address. A long tradition of doing it one way has morphed into what seems on the surface as a travesty, a commodification of something sacred. As a Buddhist and a therapist who finds tremendous value in the Mindfulness-Based Interventions (MBIs), I find myself constantly caught in the middle of the battle for ownership of this precious resource. However, having come to terms with my own personal and professional dilemma around the use and potential abuse of the practice of mindfulness, I have to say this particular round of arguments has been maddening. So I wrote an article that summarizes the concerns of the Mindfulness Muggles and Wizards with no expectations that either will embrace the other.

Ted Meissner’s comment resonated with me on many levels. Perhaps this is not quite what he intended but I wondered: Are we not doing the same thing? The intention of Buddhist practice is the alleviation of suffering. So yes, regardless of whether you are part of the traditional school of mindfulness training or the pragmatic school, we are trying to lift the veil of suffering. I think the more piercing question is whether we are doing it the same way.

Are we doing it the same way? No. Traditional approaches to mindfulness are embedded in a religious/spiritual process that is not always relevant or necessary in a pragmatic sense. Moreover, the application of MBIs occurs in arenas where religious overtones can prevent them from being used or where a specific religion’s approach would be disrespectful to the indigenous religion. And no, we cannot argue that Buddhism is so adaptive that it can fold into any religious milieu. That’s like having your rice cake and communion host too.

Are we talking about the same thing? Perhaps. Christopher Titmuss wrote a terrific post that effectively said, Stop crying wolf!  A generally good rejoinder to the worries of creating corporate sheep or super-soldiers, Titmuss points out that there really is no evidence of this happening. However, I was struck by the way he (and others in the Buddhist writing world) zoned in on the language. Specifically, Titmuss and others have jumped on terminology like “nonjudgmental awareness,” “bare awareness,” etc. to argue that therein lay the magical seed of corruption. In other articles, the key words picked on to evoke the wolf are “not having emotions drive behavior,” “psychologically armour-up.” Let’s face it, if we want to spin an argument, we will spin it to our advantage no matter what side we’re on. An honest reading of all these terms may be helpful. Perhaps “nonjudgmental awareness” means attending to things without getting caught in the interpretative process. Perhaps there is a difference between “being judgmental” and “being discerning.” Perhaps “not having emotions drive behavior” refers to not acting impulsively or without consideration of the relational aspects of the situation.  Perhaps if we apply mindful listening, we would hear each side’s meaning and transcend the hot button words.

In fact, the biggest problem is from the language used on the Buddhist side. Everyone (and I find myself guilty as charged) zooms into the problem as not teaching “Right Mindfulness.” Search any post or interview and it will be the bête noire of pragmatic mindfulness that is raised to prove it is being done wrong.  I was especially disappointed in a recent interview with Alan Senauke on Tricycle in which he too commented that Mindfulness-Based Interventions are not Right Mindfulness. I admire Senauke and wonder how the interviewer managed to troll and hook him into this specious argument. Right Mindfulness is not the issue because if we take Bhikkhu Bodhi’s definition of Right Mindfulness, MBIs contain all the elements of his definition. What is at issue is mindfulness as a mental factor wherein it becomes the means to discern wholesome from unwholesome mental states. So the question really is whether we are assessing pragmatic mindfulness appropriately. Is it Right Mindfulness? Yes. Is it cultivating the mental factor of mindfulness? That may be arguable because it doesn’t hold the practice of sila in the foreground.

Let’s get back to that wolf at the temple door. Titmuss is correct in pointing out that there is no evidence of mindfulness being used for evil ends. Having worked in this field for 10 years, I have yet to be asked to turn corporate citizens into sheep or had participants in our military program turn into Terminators. Then again, we weave into the program practices that reflect the sila aspect of mindfulness.  However, it is important to examine these concerns. A Google search of “use of mindfulness in the military” turns up a number of hits.  None are related to making better “baby-killers.” As someone who works with the military, I find it astonishing that typically clear thinkers forget something fundamental. Given the exponential increase in mental illness from overseas deployments, we might argue that even intense military training can’t make super-soldiers who go out, do heinous things, and return unaffected. [Edit: This article on mindfulness in the military was just posted and is excellent.]

As for the corporate wolf, that’s an important one. My concerns are more about the sellers in the temple than in the product being supposedly commodified. It is true that anyone with a semblance of marketing skills can package mindfulness and flog it. Do we have control over this? None whatsoever. Particularly because there are no constraints on what most professionals can do and even less so in the unregulated professions. But here’s a more important question: Can mindfulness can be commodified? It always was, has been and will be. The exchange of goods for services has been part of every culture no matter whether we dress it up in robes or three-piece suits. Are we reacting to this because of the spiritual aspect of mindfulness? Most likely.

And that’s the final question: Why are there sides? I suppose it’s human. We all love our gurus and ideological stances. If the comments on posts around the blogosphere and speciality groups like LinkedIn are any indication, there are enough of these to love. What worries me most is just that; we are so caught on supporting our favourite personalities and celebrities that our forebrain has gone well offline. These are important questions being raised by both sides and the answers will not be easily surrendered from the clouds of greed, anger, and ignorance. What I wish I saw was more critical thinking from all sides and perhaps we will discover that there are no Muggles or Wizards, just magic.