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Acknowledging Death

Trungpa Rinpoche
In discussing sickness, whether physical or mental, we should recognize the importance of our
sense of survival. We want to survive, and when we talk about healing, we are talking about
how to survive. Viewed from another angle, our strategy of survival is the pattern of our reac-
tion to the fact of death. Our attitude towards death is central to any healing process. Although
it is frequently ignored it is always in the background.
That attitude towards death is the missing point; nobody is willing to face the possibility of
death or even the idea of death. Even a mild sickness points to the possibility of that nothing-
ness; you might lose control of your physical or mental situation; you might become lost in mid-
air. I think we are concerned with that possibility of loss, so we should actually put that ques-
tion into the picture. Facing it will not exactly solve the problem but I think at least the problem
should be faced. Many people are confused in their attitude towards death and towards dying
persons. Should we try to conceal it or should we talk about it?

There seems to be a loss of spirit on the part of both the patient and the physician. We do not
want to talk about what is happening because by doing so we are acknowledging the fact that
something is basically wrong. But by being willing to acknowledge that situation, we pick up
spirit, and buoyancy. One could even go so far as to say that by such acknowledgment, some
kind of sanity develops. So I think it is very important to present the possibility to people that
they might have to face some kind of loss, some sense of bewilderment. In fact the vanguard of
death is uncertainty and complete bewilderment. It would be much better and a lot more
healthy and helpful to relate directly to this possibility of loss rather than just ignoring it. The
physician should encourage people who are sick to confront their uncertainty. This open com-
munication with people about what is going to happen to them allows a final meeting to take
place, and honest relationship. You do not have to try to conceal the unspeakable. On the other
hand, you do not have to push it to the extreme, necessarily, as long as a person has some un-
derstanding of the idea of loss of being, the possibility of nonexistence, dissolving into the un-
The whole point of a relationship, whether between a physician and a patient or whomever; is to
relate with those things, to explore those possibilities, to explore how far you can go with them.
Such relationships become extremely powerful and intense, and very, very beautiful. In some
relationships you might only be able to get a hint of this intensity, to open up just the bare
minimum. And still, even then it is worthwhile. It is a step in the right direction.
In talking about doctor patient relationships we are not talking about trying to change people
particularly. There is no question of that. Sickness and health are not black and white situa-
tions but an organic process. You are working with sickness and the potential of death simply,
rather than relying on any particular doctrine. I am not talking in terms of converting people.
The materials you have to work with are very rich. And if you work with that material you can
see the seed changing into a flower. You do not really change anybody, they simply grow. So I
think we are talking about a very positive attitude, Accepting death does not mean that one has
to face the devil. Instead it is something very positive - conquering the final fear of the unknown
is very powerful.
People seem to feel that their own particular sickness is something special, that they are the
only person with such an illness. But in fact it is not so special - or so terrible. It is a question of
acknowledging that you are born alone and that you die alone, but it is still okay. There is noth-
ing terrible or special about it. We do not take the whole situation of sickness very seriously. It
is taken purely as a mechanical problem; something is wrong with your machine, your body. But
somehow that is missing the point. Once you have dealt with the disease the problem seemingly
disappears, but by pretending that the problem is now over you are only planting the seed for
further neurosis.

In fact a person cannot get sick without some kind of loss of interest. Whether you are run down
by a car or you catch a cold, there is some gap in which you do not take care of yourself. An
empty moment in which you cease to relate properly to things. There is no ongoing sense of
awareness of your psychological state. So, to the extent that you have to invite it, all sickness is
psychological, not just those diseases traditionally considered to be psychosomatic. All diseases
are instigated by your state of mind.
There seems to be a general avoidance of the psychological responsibility, as though diseases
were external events imposing upon us. There is some quality of sleepiness, gaps in the seem-
ingly solid structure of our life, in which a person invites illness. And out of that sense of care-
lessness comes an immense message. Your body is demanding your attention, demanding that
you actually pay attention to it and what is going on with your life. It brings you down to earth,
making things much more direct and immediate.
We can talk about healing in a magical sense, as when so-called healers put their hand on a sick
persons body and miraculously heal them; or we can talk about healing in the psychological
sense of relating with a person so that as they develop insight they can begin to help them-
selves; or we can talk about the physical approach to healing, using drugs, surgery and so forth.
But I think the important point is that any system of healing has to come out of some kind of
openness. There are constant opportunities for such openness, constant gaps in our conceptual
and physical structures. If you breath out, then you create room for fresh air to enter. It is a
question of psychological attitude rather than being taken over by external powers which pos-
sess you in order to heal you. Openness seems to be the only key to healing. And openness
means you are willing to acknowledge that you are worthy; you have some kind of ground to re-
late to whatever is happening to you.
The role of the doctor is to cut through your tendency to see disease as an external threat, not
just purely to cure you. By providing companionship and some kind of sympathy he creates a
suggestion of health or underlying sanity which tends to undermine our nave conception of dis-
ease. It is not the sickness that is the big problem, but the psychological state behind it, which
wants to be cured. So the physician deals with our mishandling of the gaps which occur in our
life, that is our losses of spirit.
The presence of disease is a direct message to develop a proper attitude of mindfulness: you
should be more intelligent about yourself. Both your mind and your body are very immediate to
you. You alone know how your body feels; nobody else cares, nobody else can know but you. And
so there is some kind of natural wakefulness as to what is good for you and what is not. You can
feel how your body reacts to your state of mind. Because of this the practice of meditation may be
the only way to cure yourself. Although the attempt to use meditation as some sort of cure may be
materialistic, once we are into the practice we may find that that materialistic attitude is cut
through. Basically, in talking about mindfulness I am referring to a sense of composure. In medi-
tation you are not accomplishing anything; you are just there - seeing your life. There is a general
sense of watchfulness or awareness of the body as an extremely sensitive mechanism which gives
you messages constantly. And finally, when you have missed all the rest of the opportunities to
relate with these messages, you find yourself sick. Your body forces you to be mindful on the spot.
So it is important not to try to get rid of the sickness but to use it as a message.
We see our desire to get rid of disease as a desire to live. But instead it is often just the opposite,
an attempt to avoid life. You want to get rid of the intensity of your disease and although you
seem to want to be alive, you in fact simply want to avoid intensity. It is an ironic twist: you
really want to be healed in order to avoid life. So that hope for a cure is a big lie, the biggest
conspiracy of all. In fact, any entertainment, whether the movies or various programs for so-
called self-growth, lures you into feeling you are in touch with life while in fact you are putting
yourself into a further stupor.
Since I am inclined towards viewing healing psychologically rather than as an external power
descending on you mysteriously, I would like to focus on the notion of relationship in discussing
the process of healing. The point of the healing relationship is a meeting of two minds, the phy-
sician and patient, or for that matter, the spiritual teacher and student. If you and the other
person are both open, some kind of dialogue can take place which is not forced. Communication
takes place naturally because both of you are in the same situation. If the patient feels terrible
the doctor picks up that sense of the patients wretchedness: for a moment he feels more or less
the same as if he himself were sick. For a moment they are both the same and sense of authen-
ticity takes place. And then communication. From a patients point of view that is precisely
what is needed - to acknowledge his or her existence and that he needs help very badly. Some-
one has actually seen through his sickness, acknowledged it beautifully.

Then the healing process can begin to take place in the patients state of being, because he real-
izes that somebody has actually communicated with him completely. The psychological under-
pinning of the sickness begins to come apart, to dissolve, which automatically is a physical
change as well. So the healing process can only take place if there is a true meeting point be-
tween the physician and the patient in a very intense situation. A mutual glimpse of their com-
mon ground. The same thing applies to meetings about meditation practice: the meditation
teacher relates to his or her student in exactly the same way. There is a flash of understanding,
nothing particularly mystical or far out, as they say, but very simple, direct communication.
The student understands and the teacher understands at the same moment. In this common
flash of understanding knowledge is imparted.

The point is that the physician and the patient are sharing their sense of pain and suffering,
their claustrophobia or schizophrenia or whatever. The physician feels himself a part of that
whole setup. I think that many physicians avoid that kind of feeling; they do not want to get
involved in such an intense experience. Instead they try to play extremely cool and uncon-
cerned, taking a more businesslike approach.

At this point I am not making any distinction between physicians and psychiatrists: whether
you are dealing at the psychological or the medicinal level the relationship with your patient
has to be exactly the same. This atmosphere of acceptance is extremely simple but very effec-
tive. We all speak the same language: we experience a similar type of birth and a similar expo-
sure to death. So there is bound to be some link, some continuity between the other and you. It
is something more than just mechanically saying, Yes, I know. It hurts very badly. Rather
than just sympathizing with the patient, you actually feel his pain and share his anxiety. You
can say it in a different way, Yes, I feel that pain. You can experience this sense of common
ground to a greater or lesser extent: you may just relate to it out of politeness or boredom or
sometimes you may actually feel it. To relate with total openness means that you are completely
captured by somebodys problem. There may be a sense of not knowing how to handle it and just
trying to do your best, but even such clumsiness is an enormous statement. So, complete open-
ness and bewilderment meet to form a very fine point. It is not just a matter of going by the
books, looking up the appropriate medicine for a particular symptom. There is much more than
that involved in the physician-patient relationship. The Buddhists would say that the human
essence is compassion and wisdom. So you do not have to acquire a sense of communication
from outside yourself, you have it already. This has nothing to do with mystical experience or
any kind of higher spiritual ecstasy; it is just your working situation. You can involve yourself
constantly. If you have an interest in something, which means openness, if you have an interest
in peoples suffering and conflicts, you have that openness constantly. And you begin to develop
some sense of trust and understanding, so that your openness becomes continuous. you can
work with sixty people a day and have something click with all of them, doing exactly the same
thing without being bored.
That requires a sense of complete dedication. You are very alert, but at the same time you are
not particularly trying to achieve a specific goal. If you have a goal then you are trying to ma-
nipulate the interaction and healing cannot take place. You understand your patients and en-
courage them to communicate, but you cannot force them. And then the patient, who is feeling
the separation, which is a sense of death, begins to feels that there is hope. At last somebody
really cares for him, somebody really does listen to him - even if it is only for a few seconds -
which allows intense, very genuine communication to take place. Such communication is very
simple; there is no trick behind it or any complicated tradition to learn. It is not a question of
learning how to do it, but just to go ahead with it. Such compassion and wisdom is the essence
of being human.
If you have that experience of openness you do not have to solve a persons problem completely.
That approach of trying to repair everything has always been a problem in the past, creating a
string of successive cures and successive deceptions, which seem to work hand in hand. Psychia-
trists and physicians as well as patients have to come to terms with their sense of anxiety or the
possibility of nonexistence.
Once that fear is acknowledged, continuing with the treatment becomes very easy, because as a
professional you have countless opportunities to relate with all kind of disease, old age, suffer-
ing and death. As a possibility of acknowledging that fear in each moment of your life, the path
comes to you; there is no need to try to create a path for yourself. Of course it is always easier to
look down on your patients and their predicament, thinking how lucky your are that you do not
have their diseases. You can feel somewhat superior. But the acknowledgment of your common
ground with the patient brings a sense of humility, which is the beginning of the healing proc-
ess. The rest seems to follow very easily. This is not particularly mystical or spiritual; it is very
simple, ordinary human experience. The first time your approach a person in this way it may
seem to be a problem. But you just do it on the spot. That sense of identification with their pain
and sickness constitutes the openness.
But finally what does it mean to say that a person is healed? To be healed, ironically, a person
has to give up the notion of a cure. Since such a person is no longer embarrassed by life, he or
she is able to face death - without resentment or expectation.
The advantage professionals have is that they can develop themselves by working with the
great variety of situations that come to them. There are endless possibilities for development,
countless reminders of the necessity of developing some sense of awareness or heedfulness. In
relating openly with patients, you automatically learn how to train yourself.