FULL CATASTROPHE LIVING
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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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.
Reformatted public domain text taken from: http://satipatthana.org/kabatzinn.html
Any merit accrued from this effort is dedicated to all sentient beings.