FULL CATASTROPHE LIVING
Reformatted public domain text taken from: http://satipatthana.org/kabatzinn.html
Using the Wisdom
of Your Body and Mind to Face Stress, Pain, and Illness
THE PROGRAM OF THE STRESS REDUCTION CLINIC AT THE UNIVERSITY OF
MASSACHUSETTS MEDICAL CENTER
Jon Kabat-Zinn, Ph.D.
This book describes the program of the Stress
Reduction Clinic at the University of Massachusetts Medical Center. The
content does not necessarily reflect the position or policy of the
University of Massachusetts Medical Center, and no official institutional
endorsement of the content should be inferred. The recommendations
made in this book are generic and are not meant to replace formal medical
or psychiatric treatment. Individuals with medical problems should
consult with their physicians about the appropriateness of following the
program and discuss appropriate modifications relevant to their unique
circumstances and condition.
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.
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5
Being in Your Body: The Body-Scan Technique
It is
amazing to me that we can be simultaneously completely preoccupied with
the appearance of our own body and at the same time completely out of
touch with it as well. This goes for our relationship to other people's
bodies too. As a society we seem to be overwhelmingly preoccupied with
appearances in general and appearance of bodies in particular. Bodies are
used in advertisements to sell everything from cigarettes to cars. Why?
Because the advertisers are capitalizing on people's strong
identification with particular body images. Images of attractive men and
seductive women generate in viewer's thoughts about looking a certain way
themselves to feel special or better or happy.
Much of our
preoccupation with how we look comes from a deep-seated insecurity about
our bodies. Many of us grew up feeling awkward and unattractive and
disliking our body for one reason or another. Usually it was because there
was a particular ideal "look" that someone else had and we didn't, perhaps
when we were adolescents, when such preoccupations are at a feverish peak.
So if we didn't look a certain way, we were obsessed with what we could do
to look that way or to compensate for not looking that way, or we were
overwhelmed with the impossibility of "being right." For many people, at
one point in their lives, the appearance of their body was elevated to
supreme social importance and they felt somehow inadequate and troubled by
their appearance. At the other extreme were those who did look "the right
way." As a result they were frequently infatuated with themselves or
overwhelmed by all the attention they got.
Sooner or later people
get over such preoccupations, but the root insecurity can remain about
one's body. Many adults feel deep down that their body is either too fat
or too short or too tall or too old or too "ugly," as if there were some
perfect way that it should be. Sadly we may never feel completely
comfortable with the way our body is. We may never feel completely at home
in it. This may give rise to problems with touching and with being touched
and therefore with intimacy. And as we get older, this malaise may be
compounded by the awareness that our body is aging, that it is inexorably
losing its youthful appearance and qualities.
Any deep feelings of
this kind that you might have about your body can't change until the way
you actually experience your body changes. These feelings really stem from
a restricted way of looking at your body in the first place. Our thoughts
about our body can limit drastically the range of feelings we allow
ourselves to experience.
When we put energy into actually
experiencing our body and we refuse to get caught up in the overlay of
judgmental thinking about it, our whole view of it and of ourself can
change dramatically. To begin with, what it does is remarkable! It can
walk and talk and sit up and reach for things; it can judge distance and
digest food and know things through touch. Usually we take these abilities
completely for granted and don't appreciate what our bodies can actually
do until we are injured or sick. Then we realize how nice it was when we
could do the things we can't do anymore.
So before we convince
ourselves that our bodies are too this or too that, shouldn't we get more
in touch with how wonderful it is to have a body in the first place, no
matter what it looks or feels like?
The way to do this is to tune
in to your body and be mindful of it without judging it. You have already
begun this process by becoming mindful of your breathing in the sitting
meditation. When you place your attention in your belly and you feel the
belly moving, or you place it at the nostrils and you feel the air passing
in and out, you are tuning in to the sensations your body generates
associated with life itself. These sensations are usually tuned out by us
because they are so familiar. When you tune in to them, you are reclaiming
your own life in that moment: and your own body, literally making
yourself more real and more alive.
THE BODY SCAN MEDITATION
One very powerful technique we use to reestablish contact with
the body is known as body scanning. Because of the thorough and minute
focus on the body in body scanning, it is an effective technique for
developing both concentration and flexibility of attention
simultaneously. It involves lying on your back and moving your mind
through the different regions of your body.
We start with the toes
of the left foot and slowly move up the foot and leg, feeling the
sensations as we go and directing the breath in to and out from the
different regions. From the pelvis, we go to the toes of the right foot
and move up the right leg back to the pelvis. From there, we move up
through the torso, through the low back and abdomen, the upper back and
chest, and the shoulders. Then we go to the fingers of both hands and move
up simultaneously in both arms, returning to the shoulders.
Then
we move through the neck and throat, and finally all the regions of the
face, the back of the head, and the top of the head. We wind up breathing
through an imaginary "hole" in the very top of the head, as if we were a
whale with a blowhole. We let our breathing move through the entire body
from one end to the other, as if it were flowing in through the top of the
head and out through the toes, and then in through the toes and out
through the top of the head.
By the time we have completed the
body scan, it can feel as if the entire body has dropped away or has
become transparent, as if its substance were in some way erased. It can
feel as if there is nothing but breath flowing freely across all the
boundaries of the body.
As we complete the body scan, we let
ourselves dwell in silence and stillness, in an awareness that may have by
this point gone beyond the body altogether. After a time, when we feel
ready to, we return to our body, to a sense of it as a whole. We feel it
as solid again. We move our hands and feet intentionally. We might also
massage the face and rock a little from side to side before opening our
eyes and returning to the activities of the day.
The idea in
scanning your body is to actually feel each region you focus on and linger
there with your mind right on it or in it. You breathe in to and out from
each region a few times and then let go of it in your mind's eye as your
attention moves on to the next region. As you let go of the sensations you
find in each region and of any of the thoughts and/or images you may
have found associated with it, the muscles in that region literally let go
too, lengthening and releasing much of the tension they have accumulated.
It helps if you can feel or imagine that the tension in your body and the
feelings of fatigue associated with it are flowing out on each outbreath
and that, on each inbreath, you are breathing in energy, vitality, and
relaxation.
In the stress clinic we practice the body scan
intensively for at least the first four weeks of the program. It is the
first formal mindfulness practice that our patients engage in for a
sustained period of time. Along with awareness of breathing, it provides
the foundation for all the other meditation techniques that they will work
with later, including the sitting meditation. It is in the body scan that
our patients first learn to keep their attention focused over an extended
period of time. It is the first technique they use to develop
concentration, calmness, and mindfulness. For many people it is the body
scan that brings them to their first experience of well-being and
timelessness in the meditation practice. It is an excellent place for
anyone to begin formal mindfulness meditation practice, following the
schedule outlined in Chapter 10.
In the first two weeks our
patients practice the body scan at least once a day, six days per week
using the first practice tape. That means forty-five minutes per day
scanning slowly through the body! In the next two weeks they do it every
other day, alternating with the yoga on the other side of the tape if they
are able to do it. If not, they just do the body scan every day. They are
using the same tape day after day, and it's the same body day after day
too. The challenge, of course, is to bring your beginner's mind to it, to
let each time be as if you were encountering your body for the first time.
That means taking it moment by moment and letting go of all your
expectations and preconceptions.
We start out using the body scan
in the early weeks of the stress clinic for a number of reasons. First, it
is done lying down. That makes it more comfortable and therefore more
doable than sitting up straight for forty-five minutes. Many people find
it easier, especially at the beginning, to go into a deep state of
relaxation when they are lying down. In addition, the inner work of,
healing is greatly enhanced if you can develop your ability to place your
attention systematically anywhere in your body that you want it to go and
to direct energy there. This requires a degree of sensitivity to your body
and to the sensations you experience from its various regions. In
conjunction with your breathing, the body scan is a perfect vehicle for
developing and refining this kind of sensitivity. For many people the body
scan provides the first positive experience of their body that they have
had for many years.
At the same time, practicing the body scan
cultivates moment-to-moment awareness. Each time the mind wanders, we
bring it back to the part of the body that we were working with when it
drifted off, just as we bring the mind back to the breath when it wanders
in the sitting meditation. If you are practicing with the body-scan tape,
you bring your mind back to wherever the voice on the tape is when you
realize it has wandered off.
When you practice the body scan
regularly for a while, you come to notice that your body isn't quite the
same every time you do it. You become aware that your body is changing
constantly, that even the sensations in, say, your toes, may be different
each time you practice using the tape or even from one moment to the next.
You may also hear the instructions differently each time. Many people
don't hear certain words on the tape until weeks have passed. Such
observations can tell people a lot about how they feel about their bodies.
Mary religiously practiced the body span every day for the first
four weeks of the program in a class ten years ago. After four weeks she
commented in class that she could do it fine until she got to her neck and
head. She reported that she felt "blocked" in this region each time she
did it and was unable to get past her neck and up to the top of her head.
I suggested that she imagine that her attention and her breathing could
flow out of her shoulders and around the blocked region and that she might
want to try that. That week she came in to see me to discuss what had
happened.
It seems that she had tried the body scan again,
intending to flow around the block in the neck. However, when she was
scanning through the pelvic region, she had heard the word genitals for
the first time. Hearing the word triggered a flashback of an experience
that Mary immediately realized she had repressed since the age of nine.
It reawakened in her a memory of having been frequently molested sexually,
by her father between the ages of five and nine. When she was nine years
old, her father had a heart attack in her presence in the living room and
died. As she recounted it to me, she (the little, girl) didn't know what
to do. It is easy to imagine the conflicted feelings of a child, torn
between relief at the helplessness of her tormentor and concern for her
father. She did nothing.
The flashback concluded with her mother
coming downstairs to find her husband dead and Mary sitting in a corner.
Her mother blamed her for her father's death because she had not called
for help and proceeded to beat her about the head and neck in a fury with
a broom.
The entire experience, including the four-year history of
sexual abuse, had been repressed for over fifty years and had not emerged
during more than five years of psychotherapy. But the connection between
the feeling of blockage in the neck during the body scan and the beating
she received decades earlier is obvious. One cannot but marvel at her
strength as a young girl to repress what she was unable to cope with in
any other way. She grew up and raised five children in a reasonably happy
marriage. But her body suffered over the years from a number of worsening
chronic problems including hypertension, coronary disease, ulcers,
arthritis, lupus, and recurrent urinary tract infections. When she came to
the stress clinic at age fifty-four, her medical record stood over four
feet tall and in it her physicians made reference to her medical problems
by using a two-digit numbering system. She was referred to the stress
clinic to learn to control her blood pressure, which was not well
regulated with drugs, in part because she proved highly allergic to most
medications. She had had bypass surgery on one blocked coronary artery the
previous year. Several of her other coronary arteries were also blocked
but were considered inoperable. She attended the stress clinic with her
husband, who also had hypertension. One of her biggest complaints at the
time was that she was unable to sleep well and was awake for long
stretches in the middle of the night.
By the time she finished the
program, she was sleeping through the night routinely, her
blood pressure had come down from 165/105 to 110/70, and
she was reporting significantly less pain in her back and shoulders.
At the same time the number of physical symptoms she
complained of in the previous two months had decreased dramatically while
the number of emotional symptoms that were causing her distress had
increased. This was due to the flux of emotions unleashed by her flashback
experience. To cope with it, she increased her psychotherapy sessions from
one to two per week. At the same time she continued to practice the body
scan. She returned for a two-month follow-up after the program ended. At
that time the number of emotional symptoms she reported over that period
had decreased dramatically as well, a result of articulating and working
through some of her feelings. Her neck, shoulder, and back pain had all
decreased even further as well.
Mary had
always been extremely shy in groups. She had been practically incapable of
even saying her name when it was her turn to talk in her first class. In
the years that followed, she kept up a regular meditation practice, using
primarily the body scan. She returned many times to speak to other
patients who were just starting out in the clinic, telling them about how
it had helped her and recommending that they practice regularly. She
fielded questions gracefully and marveled at her newfound ability to
speak in front of groups. She was nervous but she wanted to share some of
her experience with others. Her discovery also led to her joining an
incest survivors' group, in which she was able to share her feelings with
people who had had similar experiences.
In the years that
followed, Mary was often hospitalized, either for her heart disease or for
the lupus. It seemed that she was always going into the hospital for
tests, only to wind up having to stay for weeks without anybody being able
to tell her when she could go home. On at least one occasion her body
swelled up to the point where her face seemed to be twice its normal size.
She was almost unrecognizable.
Through it all, Mary managed to
maintain a remarkable acceptance and equanimity. She felt she almost had
to make continual use of her meditation training in order to cope with her
spiraling health problems. She amazed the physicians taking care of her
with her ability to control her blood pressure and with her ability to
handle the very stressful procedures she had to undergo. Sometimes they
would say to her before a procedure, "Now, Mary, this may hurt, so you had
better do your meditation."
I learned that she had died early one
Saturday morning, on a day that we were having our all-day session in the
stress clinic. I went to her room to say my
good-byes. She had known the end was near for some time and had approached
it with a peacefulness that surprised her. She was aware that her
suffering would soon be over, but she expressed regret at not having had
more than a few years to revel in, as she put it, her "newfound liberated,
aware self" outside of the hospital. We dedicated the all-day session to
her memory. In the stress clinic we miss her to this day. Many of her
doctors came to her funeral and cried openly. She wound up teaching us
about what is really important in life.
Over the years, we have seen quite a few people in
the clinic with severe medical problems who had similar stories of sexual
or psychological abuse as children. They certainly suggest a possible
connection between repressing this kind of trauma in childhood, when
repression and denial may be the only coping mechanisms available to a
child under some circumstances, and future somatic disease. The retaining
and walling off of such a traumatic psychological experience must in some
way induce enormous stress in the body, which might, years down the road,
undermine physical health.
Mary's experience with the body scan is
not meant to imply that everybody who practices the body scan will have
flashback experiences of repressed material. Such experiences are rare.
People find the body scan beneficial because it reconnects their conscious
mind to the feeling states of their body. By practicing regularly, people
usually feel more in touch with sensations in parts of their body they had
never felt or thought much about before. They also feel much more relaxed
and more at home in their bodies.
INITIAL PROBLEMS WITH THE
BODY SCAN
When some people practice the body scan, they
sometimes have a hard time feeling their toes at first or other parts of
their body. Others, especially if they have a pain problem, may at first
feel so overwhelmed by the pain that they have trouble concentrating on
any other region of their body. Some people also find that they keep
falling asleep. They have a hard time maintaining awareness as they get
more relaxed. They just lose consciousness.
These experiences, if
they do happen, can all provide important messages to you about your own
body. None of them is a serious obstacle if you are determined to overcome
them and to go deeper in the practice.
HOW TO USE THE BODY SCAN
WHEN YOU DON'T FEEL ANYTHING OR WHEN YOU ARE IN PAIN
In
practicing the body scan, you tune in to the various regions one by one
and feel whatever sensations are apparent in each region. If, for
instance, you tune in to your toes and you don't feel anything, then "not
feeling anything" is your experience of your toes at that particular time.
That is neither bad nor good, it's simply your experience in that moment.
So we note it and accept it and move on. It is not necessary to wiggle
your toes to try to stir up sensations in that region so that you can feel
them, although that is okay, too, at the beginning.
The body scan
is especially powerful in cases where there is a particular region of your
body that is problematic or painful. Take chronic low-back pain as one
example. Let's say that when you lie down on your back to do the body
scan, you feel considerable pain in your lower back that is not relieved
by minor shifts in your position. You start off with awareness of your
breathing nevertheless, and then try to move your attention to the left
foot, breathing in and out to the toes. But the pain in your back keeps
drawing your attention to that region and prevents you from concentrating
on the toes or on any other regions. You just keep coming back to your
lower back and to the pain.
One way to proceed when this happens
is to keep bringing your attention back to your toes and redirecting the
breath to that region each time the back captures your attention. You
continue to move up systematically through your left leg, then your right
leg, then the pelvis, all the while paying meticulous attention to the
sensations in the various regions and to whatever thoughts and feelings
you become aware of regardless of their content. Of course much of their
content may concern your lower back and how it is feeling. As you then
move through the pelvis and approach the problem region, you remain open
and receptive, noting with precision the sensations you are experiencing
as you move into this region, just as you did for all preceding regions.
Now you breathe in to the back and out from the back, at the same
time being aware of any thoughts and feelings as they occur. You dwell
here, breathing, until when you are ready, you let go of the lower back on
purpose and move the focus of your attention to the upper back and the
chest. In this way you are practicing moving through the region of maximum
intensity, experiencing it fully in its turn when you come to focus on it.
You allow yourself to be open to all the sensations that may be there, in
all their intensity, watching them, breathing with them, and then letting
them go as you move on.
THE BODY SCAN AS A PURIFICATION PROCESS
The man from whom I learned the body-scan technique had been a
chemist before he became a meditation teacher. He liked to describe the
body scan as a metaphorical "zone purification" of the body. Zone
purification is an industrial technique for purifying certain metals by
moving a circular furnace the length of a metal ingot. The heat liquefies
the metal in the zone that is in the ring of the furnace, and the
impurities become concentrated in the liquid phase. As the zone of melted
metal moves along the length of the bar, the impurities stay in the liquid
metal. The resolidified metal coming out the back end of the furnace is of
much greater purity than it was before the process began. When the whole
bar has been treated in this way, the end region of the bar that was the
last to melt and resolidify (and that now contains all the impurities) is
cut off and thrown away, leaving a purified bar.
Similarly, the
body scan can be thought of as an active purification of the body. The
moving zone of your attention harvests tension and pain as it passes
through various regions and carries them to the top of your head, where,
with the aid of your breathing, you allow them to discharge out of your
body, leaving it purified. Each time you scan your body in this way, you
can think of it or visualize it as a purification or detoxification
process, a process that is promoting healing by restoring a feeling of
wholeness and integrity to your body.
Although it sounds as if
the body scan is being used to achieve a specific end, namely to purify
your body, the spirit in which we practice it is still one of
non-striving. We let any purification that
might occur take care of itself. We just persevere in the practice.
Through repeated practice of the body scan over time, we come to
grasp the reality of our body as whole in the present moment. This feeling
of wholeness can be experienced no matter what is wrong with your body.
One part of your body, or many parts of your body, may be diseased or in
pain or even missing, yet you can still cradle them in this experience of
wholeness.
Each time you scan your body, you are letting what will
flow out flow out. You are not trying to force either "letting go" or
purification to happen, which of course is impossible anyway. Letting go
is really an act of acceptance of your situation. It is not a surrender to
your fears about it. It is a seeing of yourself as larger than your
problems and your pain, larger than your cancer, larger than your heart
disease, larger than your body, and identifying with the totality of your
being rather than with your body or your heart or your back or your fears.
The experience of wholeness transcending your problems comes naturally
out of regular practice of the body scan. It is nurtured every time you
breathe out from a particular region and let it go.
Another way of
dealing with pain when it comes up during the body scan is to let your
attention go to the region of greatest intensity. This strategy is best
when you find it difficult to concentrate on different parts of your body
because the pain in one region is so great. Instead of scanning, you just
breathe in to and out from the pain itself. Try to imagine or feel the
inbreath penetrating into the tissue until it is completely absorbed, and
imagine the outbreath as a channel allowing the region to discharge to the
outside whatever pain, toxic elements, and "disease" it is willing to or
capable of surrendering. As you do this, you continue to pay attention
from moment to moment, breath by breath, noticing that even in the most
problematic regions of your body the sensations you are attending to from
moment to moment change in quality. You may notice that the intensity of
the sensations can change as well. If it subsides a little, you can try
going back to your toes and scanning the whole body, as described above.
ACCEPTANCE AND NON-STRIVING IN
THE BODY SCAN PRACTICE
When practicing the body scan, the key
point is to maintain awareness in every moment, a detached witnessing of
your breath and your body, region by region, as you scan from your feet to
the top of your head. The quality of your attention and your willingness
just to feel what is there and be with it no matter what is much more
important than imagining the tension leaving your body or the inbreath
revitalizing your body. If you just work at getting rid of tension, you
may or may not succeed, but you are not practicing mindfulness. But if you
are practicing being present in each moment and at the same time you are
allowing your breathing and your attention to purify the body within this
context of awareness and with a willingness to accept whatever happens,
then you are truly practicing mindfulness and tapping its power to heal.
The distinction is important. In the introduction to the body-scan
practice tape, it says that the best way to get results from the
meditation is not to try to get anything from it but just to do it for its
own sake. When our patients use the tape, they hear this message every
day. Every person has a serious problem for which he or she is seeking
some kind of help. Yet these patients are being told that the best way to
get something out of the meditation practice is just to practice every day
and to let go of their expectations, their goals, even their reasons for
coming.
In framing the work of meditation in this way, we are
putting them in a paradoxical situation. They have come to the clinic
hopeful of having something positive happen, yet they are instructed to
practice without trying to get anywhere. Instead, we encourage them to try
to be fully where they already are, with acceptance. In addition, we
suggest they suspend judgment for the eight weeks that they are in the
course and decide only at the end whether it was worthwhile.
Why
do we take this approach? Creating this paradoxical situation invites
people to explore non-striving and self-acceptance as ways of being. It
gives them permission to start from scratch, to tap a new way of seeing
and feeling without holding up standards of success and failure based on a
habitual and limited way of seeing their problems and their expectations
about what they should be feeling. We practice the meditation in this way
because the effort to try to "get somewhere" is so often the wrong kind of
effort for catalyzing change or growth or healing, coming as it usually
does from a rejection of present-moment reality without having a full
awareness and understanding of that reality.
A desire for things
to be other than the way they actually are is simply wishful thinking. It
is not a very effective way of bringing about real change. At the first
signs of what you think is "failure," when you see that you are not
"getting anywhere" or have not gotten where you thought you should be, you
are likely to get discouraged or feel overwhelmed, lose hope, blame
external forces, and give up. Therefore no real change ever happens.
The meditative view is that it is only through the acceptance of
the actuality of the present, no matter how painful or frightening or
undesirable it may be that change and growth and healing can come about.
As we shall see in the section entitled "The Paradigm," new possibilities
can be thought of as already contained within present-moment reality.
They need only be nurtured in order to unfold and be discovered.
If this is true, then you don't need to try to get anywhere when
you practice the body scan or any of the other techniques. You only need
to really be where you already are and realize it (make it real). In fact
in this way of looking at things there is no place else to go, so efforts
to get anywhere else are ill conceived. They are bound to lead to
frustration and failure. On the other hand, you cannot fail to be where
you already are. So you cannot "fail" in your meditation practice if you
are willing to be with things as they are.
In its truest
expression meditation goes beyond notions of success and failure, and this
is why it is such a powerful vehicle for growth and change and healing.
This does not mean that you cannot progress in your meditation practice,
nor does it mean that it is impossible to make mistakes that will reduce
its value to you. A particular kind of effort is necessary in the practice
of meditation, but it is not an effort of striving to achieve some special
state, whether it be relaxation, freedom from pain, healing, or insight.
These come naturally with practice because they are already inherent in
the present moment and in every moment. Therefore any moment is as good as
any other for experiencing their presence within yourself.
If you
see things in this light, it makes perfect sense to take each moment as it
comes and accept it as it is, seeing it clearly in its fullness, and
letting it go.
If you are unsure of whether you are practicing
"correctly" or not, here is a good litmus test: When you notice thoughts
in the mind about getting somewhere, about wanting something, or about
having gotten somewhere, about "success" or "failure," are you able to
honor each one as you observe it as an aspect of present-moment reality?
Can you see it clearly as an impulse, a thought, a desire, a judgment, and
let it be here and let it go without being drawn into it, without
investing it with a power it doesn't have, without losing yourself in the
process? This is the way to cultivate mindfulness.
So we scan the
body over and over, day by day, ultimately not to purify it, not to get
rid of anything, not even to relax. These may be the motives that bring us
to practice in the first place and that keep us at it day after day, and
we may in fact feel more relaxed and better from doing it. But in order to
practice correctly in each moment, we have to let go of even these
motives. Then practicing the body scan is just a way of being with your
body and with yourself, a way of being whole right now.
Any merit accrued from this effort is dedicated to all sentient beings.