Mindfulness for Pain & Illness | Part 1 with Vidyamala Burch
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Welcome to the mindfulness exercises podcast. My name is Sean Fargo and in today's episode, we're going to be exploring how mindfulness can alleviate chronic pain, not just the perception of pain, but the actual pain intensity itself.

We're going to be hearing from Vijamala Birch, who's the founder of Breathworks. She's a pioneer in mindfulness-based pain management. She's the author of You Are Not Your Pain. She's a hero of mine in the sense that she inspired and informed my work helping thousands of people reduce their pain intensity

through mindfulness teachings. She's been someone I've looked up to for over 10 years in this field. If you yourself struggle with chronic pain,

If you know anyone who struggles with chronic pain or if you want to teach others how to alleviate their chronic pain, then I think this episode is going to be really valuable for you yourself or to share with others. We're going to be talking about how to soften our resistance to what hurts and

how to navigate primary and secondary suffering, how simple shifts in awareness can build resilience in our difficult moments, how to realize that we are not our pain. So we're going to be going into some tips and practices and techniques to help soften the pain.

Vijay Mala Birch led a workshop for us for our mindfulness teacher certification recently, and we host a renowned teachers every month. So for any of you who want to share mindfulness with others, I encourage you to check out our certification. So without further ado, let's hear from Vijay Mala Birch on mindfulness for chronic pain.

Yeah, so I've come to this work through my own life's journey. I'm now 65 and I injured my spine when I was 16. So that is like nearly 50 years ago.

And I've lived with chronic pain ever since. I've had multiple surgeries. I live with incomplete paraplegia, which means I can walk a little bit, but I use a wheelchair for distance. And I've got a paralyzed bowel and bladder with all the complexities that come with that. So my whole adult life, I've lived in this body, which has been challenging, very, very challenging. And for the first 10 years, I didn't cope at all well. I just pretended it hadn't happened. I kept on pushing myself.

which is very typical, I think, when catastrophe strikes humans, it's not uncommon to go into denial and sort of avoidant coping strategies.

Then when I was 25, my condition got worse. Well, when I was 23, I had another car accident and then that made my pain much worse. And then I had a deterioration. I was in hospital. I was in intensive care, very, very ill. And I had an experience in the middle of the night. So I was in absolute hell, to be honest. I had no way of coping. I was incredibly tense.

in what I consider to be unbearable pain. And I got obsessed about how I was going to survive till the morning. How could I get through these hours until the morning? And I was in a state of tremendous conflict. And then, so I was, I can't bear it. I'm going to go crazy. And then another part of my brain or my mind was saying, you have to cope. I can't, you have to, I can't. And it was going on and on and on, getting tighter and tighter, all about getting through till the morning.

And then a voice came in and the voice said, you don't have to get through till the morning. You just have to live this moment and this one and this one. And something in my experience completely changed. It was a bit like the whole structure of resistance and torment fell away when I realized, oh, I can do that. I can live this moment and this one and this one. And the whole agony about the morning fell away. And I suppose in that moment,

intuitively, I knew that that was a kind of mental construct. This whole idea of mourning was something that I was constructing with my mind. And the only moment that I could experience is now, and now, and now, and now. And that that was bearable. So that was a very, I would say that's probably the strongest experience of my entire life.

Sometimes people talk about moments of insight and so on as being terribly blissful, but in my experience, it rose up out of hell. I was in such a state of complete torment that something new broke through

So of course I did get through till the morning and that awoken me a kind of real interest and well, what does it mean to be present? Because there was a very strong knowing that the truth of that, the only life we have is the one that's happening now. So I know I've dedicated the rest of my life to try and figure out what does that mean and how can I live a life that's a series of nows rather than regrets about the past and fantasies about the future.

So it was very significant because it didn't really give me any tools to manage my pain as such. Then a few days later, when I was in the hospital, the hospital chaplain came to see me, very, very kind, elderly man, took my hand and he got me to remember a time and a place when I'd been happy. And I took my mind back to the Southern Alps of New Zealand. I was in New Zealand at this point where I'd grown up.

And before my injuries, I'd been super fit lover of the mountains and the Southern Alps. There's a particular place in the Southern Alps of New Zealand that I just adore. So I took my mind back there. I don't know how long that practice lasted, maybe 10 minutes or something. It wasn't a long time. But my subjective experience changed by what I did with my awareness. So I was still the same girl, same hospital bed.

But my emotional experience and my physical experience to some extent was altered by what I did with my awareness. So that was my first experience really in this life that awareness was a skill or awareness is a quality that I could learn to use.

train. What I do with my attention, what I focused on, what I attended to affected my subjective experience. So that got me really interested. And I thought, wow, I really want to learn how to train this quality that I've got that up till then I'd never at all understood that was this kind of gift that we all have, the gift of attention, the gift of awareness that I could train.

So that was what got me started with meditation. I had a really good social worker. When I came home from hospital, she got me lots of cassette tapes from the library. This was in the era of cassette tapes. That's how we got what's 1985. And I read books and I tried to teach myself to meditate. And I always like to say that I had the gift of time, which of course many people never get. I had months lying on my bed, looking at the ceiling.

So I had this opportunity to really examine my mind, examine what I did with my mind, learn how to think.

learn how to choose what I attended to. Then I learned yoga, which was very, very good for my rehab. And then about a year later, I was, I went on a Buddhist meditation retreat with a friend. And that's when I thought, oh, fantastic. This is, this, this is, if I stay with these people, I'll actually get the skills. I'll get the training. I'll get the sort of the, the kind of spiritual context, if you like, the sort of vision of what,

what do we do with this mind? But I would also get the path. I get the training. I really liked the people, very warm and friendly. Then a few years later, I moved to the UK and I lived in a residential retreat center in the country for five years with about 12 other women. So that again was a period of very intensive training. Um,

coming closer and closer to, you know, what is my actual experience and how can I learn to alter my reactions to my experience, which is what I'm going to be talking about later. And then in about 2000, I decided it would be interesting to see, could I develop a program that would help other people like me? I've been meditating for 15 years by this point. You know, I've

With what I've done with my life, I generally wait a long time until I feel I'm ready. Partly because, you know, I just can't bear that sort of bullshit factor. You know, when you think, I don't really know what I'm talking about. It's so uncomfortable. I generally wait until I'm not going to have too much of that.

So I waited a long time, started Breathworks, this charity that I founded way back in 2000 with a couple of friends. And we started experimenting, drawing on Jon Kabat-Zinn's remarkable work, but also adapting it specifically for people with quite severe physical impairments. And then we started training other people and we gradually developed a mindfulness-based pain and illness management. So that's the background. It's been...

completely life-changing for me, completely. I now have a good life.

Even though I'm aging, I've got other health things arising. Inevitably, when you have my body, you start to get secondary things arising over time. But, you know, I'm pretty positive, pretty content on the whole. And it is because of both the Breathworks program and I'd also say my Buddhist practice has given me this richness over all these years. So everything I'm going to tell you about has been hard won.

It's been road tested intensively over decades. And one of the things that I've really tried to do with our program, and I'm sure, you know, the programs that you've learned from very similar, is how do you communicate these quite sort of subtle and sophisticated approaches and really grounded, practical, accessible ways, very simple ways. If people have got pain and illness, you know, you don't want lots of conceptual complexity.

Often you're on medication, you can't really think very clearly, you can't retain information very well. So I've tried to make it all very, very practical and experiential. So, yeah.

Let me begin. So mindfulness for pain, managing pain and illness with mindfulness. So yes, I'm going to talk about from resistance to resilience. That's the first theme and the suggestion that a lot of our suffering when we've got pain and illness is through resistance. And then we're going to look at breathe for ease. How can we harness the power of the breath?

Something I always like to say at the beginning of any workshop or session on Zoom is please move around. I always like to say we haven't had millions of years of evolution to sit slumped in front of a computer. Some of you here may have health conditions yourselves. So please take care of yourselves. I'll stand up myself at some point. So please just take care of your physical needs during the session.

And actually there's an interesting rule that I've recently learned called the 50-50 rule, which is very, very good for Zoom, where we have 50% of our attention on the screen and then 50% of our attention in our own experience. So we're monitoring, you know, how do we feel in the body? How's our breathing? All that kind of thing, whilst we're also attending to the input. So it's a nice balance. So what is mindfulness? Now, of course, mindfulness,

this is going to be familiar to many of you but you can't ever have enough of this basics so there's the the age-old evocation from john he calls it an evocation not a definition

particular way of paying attention on purpose, in the present moment, and non-judgmentally. So we can also see that as attention, intention, and attitude, which I think is very good. Yeah. So we kind of know why we're attending, which is the purpose, in the present moment, attention, and then a non-judgmental attitude. This is a definition that I've included in my first book, which is called Living With Pain and Illness.

which is quite a behavioral definition. Live in the moment, notice what is happening and make choices in how you respond to your experience rather than being driven by habitual reactions. Yeah, so I like that. So we're present, we notice what's happening

physically, mentally, emotionally around us and the world around us. And then mindfulness gives us this point of agency where we can make choices in how we respond to experience rather than being driven by habitual reactions. So that's the training, moving away from autopilot, just bouncing off experience into either craving or aversion and learning to bring choice.

I've got pain, how can I choose to respond to that compassionately and with attention rather than just tensing and fighting it? So in terms of pain and illness, the real issue is that it hurts. So we've got this experience and we don't like it. And in many respects, it's the not liking it which causes us all the difficulty. So we've got these two cartoons here, someone screaming, I can't stand it.

And they're going, oh, oh, oh, ouch. So we have the experience and then we don't like it.

Of course, we don't like it because it's painful, but that's, you know, we don't like it and it hurts. So it's the hurting, which is the thing we can begin to navigate with a little bit more grace and skill. And the way we do this is by dismantling the suffering using awareness into these two components of what we call primary and secondary suffering. So for example, you know, I used to have a narrative, my back is killing me.

That's the kind of thing I would say to myself, my back is killing me. It was very global. You know, there was a whole just big mess of sensation, thoughts, emotions, and my whole back. With awareness, with kindness, with more precise investigation, of course, my back isn't killing me.

I've got some unpleasant sensations in my lower back. That's a very, very different narrative. So the primary suffering is the basic unpleasant sensations and experience in the moment. So that's the thing we keep coming back to. What is actually happening? What am I actually feeling? So that's the primary. And then what happens if we're not aware of

if we're not awake to our experience is we automatically resist that. And it's, you know, just so quick. We don't notice that we've got these unpleasant sensations and we automatically tense, hold our breath, contract, worry, and so on. And we get this tight ball of resistance and resentment. And before we know it, we've got a whole load of secondary suffering. And the secondary suffering is all the mental, emotional, and physical reactions. So now you've got unpleasant sensation, pleasure,

plus resistance. It's not fair. I can't stand it. And then we get a whole load of secondary suffering. As soon as you hold your breath, which is why we're going to be doing the breath work later. But as soon as you hold your breath, you're going to get more tension and you're going to get more pain. So you've got unpleasant sensations, breath holding resistance, more pain, more tension, more unpleasant sensations. You're going to get fear, anxiety, worry, going to have catastrophic thinking. It's never going to end. I can't stand it. And so on.

So the experience of pain is this big, it's a complex mixture of these different components, the primary, the resistance and the secondary. There's a really lovely parable from the Buddhist tradition called the parable of the dart or the arrow. Probably many of you know this already, but I think it's very, very good.

And the Buddha says that when we experience physical pain, it's as if we've been pierced by an arrow or a dart, suggesting you've got this direct experience of discomfort. And then the person who hasn't trained their mind knows of no other response than to resist and resent

their arrow and then it's as if they're pierced by a second arrow so now they have the pain of two arrows. Whereas the person who's trained their awareness, they still have the first arrow because that comes with the human condition. We're all going to have discomfort at one time or another. So the person who's trained their mind, they have physical discomfort and it's as if they're pierced by an arrow. They do not resist and resent the arrow and so they are not pierced by a second arrow.

And I think the Buddha's being very generous when he talks about two arrows, because in reality, it can feel like you're impaled on a hundred arrows. So this is a lovely metaphor. And so we learn to let go of the second arrows and to be with the first arrow.

So primary suffering, mindfulness helps us to accept that first arrow, to accept the primary suffering in any given moment. So this is where mindfulness is also very courageous. Sometimes people talk about mindfulness as if it's a bit soft and hasn't got sort of power to it. But mindfulness is very, very powerful and very, very courageous. Because if we can learn to be with unpleasantness as it arises without being sort of knocked about, that is a very powerful way to live.

Very brave way to live. Mindfulness softens and dissolves.

resistance and resentment and mindfulness helps to reduce or even overcome the secondary suffering and of course this is a moment by moment experience you might let go of one moment and the next moment all kind of piles in again and then you learn to let go of that so it's quite dynamic and I'll say a bit more about that in a moment. So on our programs we use this really wonderful teaching method of what we call the cushion exercise so we get people in the class to

have the first cushion. So on the image on the left, you can see that woman there's got a blue cushion on her lap. So that blue cushion represents the unpleasant sensations and we get them to name what that is. So in my case right now, that would be

unpleasant sensations in my lower back that are stabbing and burning. And then somebody comes and places another cushion on her nap and with the people name what that is. So the first one might be, it's really hard. I can't bear it. The second one might be, oh my God, I'm not going to sleep tonight. The third one might be, I can't go out. So I'm going to lose all my friends. The fourth one might be, I'm so tired.

And you just pile these up. And then, of course, people are getting this felt experience that the burden you're carrying isn't just the blue cushion, but it's all those cushions. And, of course, you can see on the top one, she can't see out. So we've lost all perspective. And then what we do is we invite the person to just tip the bottom cushion so all the other ones fall off. And then what does it feel like to just be left with that first cushion?

the primary suffering. And then we get people to be very gentle with the primary, like to stroke it and be kind towards the primary. So it isn't that you're just sort of rejecting the secondary and tolerating the primary, but we're learning how to let go gracefully.

and then to be kind and tender. So it's a lovely exercise, lovely thing to do. There's a little video that we've made, the primary and secondary suffering of pain, and there's a YouTube, but I would recommend that you look at that if you're interested in this whole model of

primary and secondary. It's a lovely little animated video that we made. So the secondary, let's look at this for a minute, because this is very interesting. What happens when we're resisting our pain? And what I've observed through my own experience and the many, many people that I've taught is the secondary tends to manifest in two poles.

So we either go into overwhelm, drowning, or we go into denial and blocking. I think we all do this and we flip-flop between the two, either on a long cycle or even moment by moment. So the overwhelm is things like catastrophizing, depression. We tend to be overwhelmed by the body, so very dominated by the body. Exhaustion, giving up, and there can be self-pity. There's no judgment here, it's just an observation. On the other hand, denial and blocking are

tends to be becoming very controlling. If I can control my whole life, then my pain will go away. Very restless because we're not with our experience. We tend to split off from the body and go into the head. So the overwhelm tends to be a bit overly dominated by the body and the blocking, the denial, we just exist from the neck up. We can't stop because of course, if we stop, we might feel something. So we have to keep on running. We tend to get rather brittle and edgy.

There's no sort of stability to our experience. And I think most addictions are a way of trying to avoid our experience. So it's very interesting. This is what I've observed. Some of us have a kind of favorite that we go into first and then eventually we'll go into the other one. So I'm a blocker. That's my favorite.

default setting is to harden, split off and push. And I used to do that for months and months at a time. And then of course I get completely exhausted and I collapse for months and months at a time. Luckily, I don't do that anymore. It's much, it's a much shorter cycle. Some people will tip straight into overwhelm.

And then eventually they'll crawl out of overwhelm and go into pushing for a little bit and then collapse back into overwhelm. So it's good to just be curious about what your personality is as much as anything.

But the way to work with it is the same. So if we are feeling a bit hard, we're in denial, we're a bit blocked, then the mindfulness practice is to come closer. And I'm going to lead a little practice in a moment to explore this. So come closer to the body, breathe, release into gravity, let awareness into the body, soften, soften, soften. So that's the practice of where blocking.

On the other hand, if we're overwhelmed, we need to broaden our awareness. This is very, very important. We need to know the correct strategies. So if it's all too much and it's awful, it might be that you open your eyes. It might be that you look around. Feel into other parts of the body that aren't hurting. So broaden this.

Then, of course, you might go a bit too broad and start blocking. So then you come closer. So the practice itself is quite dynamic. I really love to say this, that mindfulness isn't a static exercise. It's not like trying to get to some state of perfect equilibrium in a sort of abstract way. It's very dynamic and responsive. And this image of the surfer, if you watch a surfer, they're continually listening to the water, listening to the board, moving their body,

in order to stay, to ride the wave. And in a way, we're trying to learn how to ride the wave of our lives. So we're looking for balance. Do I need to come closer? Do I need to broaden it?

and just playing around with that. And of course we always do it with kindness. This is really, really important. It's not a kind of aloof, cool observing, but we're deeply in our experience with kindness and with the attitude that's like a natural response to a loved one. This can be quite helpful for people because sometimes if you've got pain and illness, there's a lot of despair,

lack of confidence we don't really care about ourselves perhaps but most people will know what it feels like to soothe a pet or a child or a loved one so we turn that kind of attitude back towards ourselves and we really rest into this knowledge that it's never only happening one moment at a time so we just with the present moment as much as we can

And then what happens is our experience of pain becomes more fluid. This is really, really important. So what we're doing with our awareness, with our practice, with our compassion is we're breathing and softening, breathing and softening. And we're feeling into how this experience that we label pain is actually quite fluid.

It's not a static thing because, of course, when we're not aware, pain becomes an object. We objectify it in the body. We turn it into a thing. We turn it into the enemy. Then we go to war. Very understandable, but not helpful and not necessary.

So we're beginning to rest inside the experience as fluid and changing and ever only momentary. And for myself, that's been completely central to my journey. So we learn to experience pain as a river, not a rock. That's the phrase that I like to use.

It's a river, not a rock. If I go inside these unpleasant sensations in my back at the moment, which, you know, when I'm not really attending can feel quite static, but I attend and there's a sort of pulsing quality, slightly moving around. And if I, if I, if I sort of imagine that as a river rather than a rock that has a very big effect, it all starts to loosen and soften a wee bit. All right. I hope that this conversation with Vijay Mala is,

give you a new lens for understanding pain and how mindfulness can help us to alleviate pain, not just as something to endure, but something that we can meet with kindness. In our next episode, we'll go deeper into the body where we'll learn how breath and even gravity can help us to soften tension, regulate our nervous system,

and come home to in a more fluid, caring, and embodied way. Thank you for listening, and I hope to see you in our next episode with Vijamala Birch. Until next time, stay present, stay grounded, and continue showing up with authenticity and compassion. Thank you for listening.