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Insights at the Edge
Tami Simon's in-depth audio podcast interviews with leading spiritual teachers and luminaries.
Listen in as they explore their latest challenges and breakthroughs—the leading edge of their work.
Being With Dying
Tami Simon speaks with Joan Halifax, who is an anthropologist, Buddhist teacher, and the author of The Fruitful Darkness, Shamanic Voyages, and The Human Encounter with Death, co-written with Dr. Stanislav Grof. In 1994, Joan created a project called "Being with Dying" to help health care professionals learn how to care for dying patients in a compassionate, mindful fashion—and which was the source for her Sounds True audio training course, Being With Dying: Contemplative Practices and Teachings. In this episode, Joan speaks about the powerful insights on living that she has learned from her years of caring for the dying—including the greatest gift that we can give another person. (67 minutes)
Joan Halifax Podcast
Tami Simon: You're listening to "Insights at the Edge." Today I am speaking with Joan Halifax. Joan Halifax is an anthropologist, Buddhist teacher, and writer. She founded the Ojai Foundation, an educational center, in 1979, and also the Upaya Institute and Zen Center, a Buddhist study center in Santa Fe, New Mexico, in 1990. In 1994 she created the Project on Being with Dying in order to train healthcare professionals in the contemplative care of the dying.
Her books include The Human Encounter with Death, which she wrote with Stanislav Grof, Shamanic Voices: A Survey of Visionary Narratives, and The Fruitful Darkness: Reconnecting with the Body of the Earth. She's also written a book Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death, and with Sounds True has released a six-session audio series Being with Dying: Contemplative Practices and Teachings.
In this episode of "Insights at the Edge," I spoke with Joan while she was at the Library of Congress in Washington, DC, for a period of time, working on a new model of compassion, a model that she shares with us in this discussion. We also talked about contemplative practices one can do at the bedside of a dying person, and the greatest gift that we can give another person: the gift of no fear. Here's my conversation with Joan Halifax.
Joan, I know that you've spent over 40 years working directly with dying people at the bedside and in many different capacities. And to begin with, I'm curious to hear a little bit from your personal, direct experience. Often I've heard it said that when people are dying, that's when they review their life, and that the common theme is that "I wish I had invested more in my relationships, in loving." And I'm curious if that's what you've heard from people, or what you've heard from people when they reflect on their lives, what the biggest themes are that people come up with: "I wish I had done X, Y, Z." What is it?
Joan Halifax: You know, I think that's true on one level. But I think on another level, from a very pragmatic perspective, most people who have a life-limiting illness are frankly more concerned about things that are more practical for quite a while into that illness. You know, how can I extend my life? How do I improve the quality of my life? Is there anything that I can do to keep death at bay? Often they become their own internist, for example, or their own hospitalist. They are engaged in doing whatever they can to deal adequately with the medical issues. So the more subtle and existential dimensions of an individual's life are right there under the surface, and yet frankly speaking, I think that what is foremost in most people's mind is, how do I deal with the physical reality that I'm confronted with right now?
You know, when that level is addressed adequately, when the physical symptoms are addressed, then that gives an individual the room to address the relational and spiritual dimensions. And if those dimensions are explored adequately and are actualized or fulfilled, then the existential questions become more in the foreground.
I think from my point of view, one of the most important dimensions in the experience that people have in a life-limiting or catastrophic illness is, how do you create the conditions for an individual to find meaning in their lives, to have deep questions at least explored, perhaps not answered, but explored? How do you provide the context for a life review to happen, where a person can sit back and really look at the good they've done in the world that they've accomplished, and what has been meaningful to them?
And then the relational dimension is very critical. How do you create the safety and the means for an individual to ask forgiveness, for forgiveness, to be forgiven, to offer forgiveness, and to forgive themselves? How do you create the conditions to express gratitude? How do you foster the ground where a sense of gratefulness for the richness of one's life can be explored? And how do you express love? And how do you bring those into the room with a dying person so love can be directly expressed?
And then the final phase really is the existential or the transcendent phase, and that has to do with questions about life, death, afterlife. How do we come to the realization that dying is a time where the most profound developmental phase in the human life can be fulfilled?
As I said, in my experience-it might be that I'm very pragmatic, but this is through the filter of my own experience and pragmatism-unless we're able to deal skillfully with the symptoms associated with dying, which could include pain, nausea, all kinds of GI (gastrointestinal) problems, mental confusion, and such, and also address the fears associated with dying that are pragmatically based, like the fear of pain, which is often foremost in people's mind, then it's difficult to get down to the next layer, which is the psychosocial or the relational, and the spiritual and existential.
TS: You said several things in there that I found extremely helpful and interesting, and I want to try to tease out a couple of them. One is that you referred to death as a "final developmental phase," and I've never heard that before, talking about our death as a phase of development. What did you mean by that?
JH: Throughout the life span, there are phase shifts through which we pass, from the time of our birth to our childhood, through our experience of adolescence, through the first phase of adult maturation, which includes post-adolescence or adolescence, sexuality, to the experience of birth or relationality, having a vocation, being a contributing adult in the world.
And then going into Adulthood II, which is a very profound stage of maturation, which is a kind of mitzvah or gift that's been given to our generation, where the life span has been increased. Mary Catherine Bateson writes about this in her book, Composing a Further Life. And then into the phase of cronos, or into being an elder in society.
And finally into the journey, for those of us who have the opportunity to experience the dying process, not just in terms of a brief catastrophic moment like dying of a heart attack or stroke, or in some kind of violent incident, but where we actually have time in the journey of living and dying to go through what is called the "stage of active dying," which is the final phase. And it is in that experience where one, in a longer span of time, has the opportunity to, in a sort of challenging sense, deal with the psychophysical symptoms, but in the blessed sense, to really reflect back on one's life with the prospect of one's mortality vividly engaged.
And this can be the most fruitful and profound time of an individual's life, a real experience of deepening, of also fundamentally a transcendence when the physical coil, and even the bindings of our relationality, become looser and looser through time being. And an individual has the opportunity to look back through the whole deep view of a life, and to recognize they're in this kind of space, an interworld between living and dying, where the veil is very thin. And it is in that kind of interface, where you can sort of look into the next world, and you're looking into the world that has been your past, and you're able to, in a way, open up to a much bigger vision of who you really are.
TS: Umm-hmm. Now of course, people have heard this term "conscious death." And I'm curious in this developmental phase of dying, what might it mean for that to be a conscious passage?
JH: Well, I think there are quite a few features that we talk about in relation to conscious dying. But I think this is a question that is a little more difficult to address than most people understand.
For example, there are people who are very actualized, if you will, awake, aware, sensitive, wise, but the biological process of actually being consciously engaged-that is, really awake in the conventional sense-might not be as we know it, if you know what I'm saying. In other words, in the latter phases of dying, individuals go through an experience-what can I call it, an experience of unbinding that takes them into a state where they're in a kind of interworld, where they're not conscious as we conventionally know it. So conscious dying doesn't always mean being awake to the phenomenal world.
We do not know, Tami, what is actually going on on the internal level of the individual. We don't know, because even with individuals who come back from near-death experiences, or individuals who move in and out of consciousness as is usually the case, in sort of a wave fashion as the dying process is happening, you don't really know what the subjective experience is, what in fact is going on. And I think there's some research that Richie Davidson and others are engaged in to try to understand what's happening at that threshold. But it's not been sufficiently objectified.
So when we talk about conscious dying, it might be that the latter phases of this journey into the death moment-if there is such a thing actually as a death moment, by the way-but that this journey through the dying and afterdeath process includes a phase of unconsciousness from the perspective of an outside observer.
But I would like to say, it's something more like "wise dying," if you will. I don't know exactly the words that could characterize it, because I haven't been asked this question in the way that you've asked it. But it has to do with a dying person having the wherewithal to actually have a metacognitive perspective on the experience of dying itself, to be in the process in a way that they're not a toy of the process, they're not in a reaction to the process of letting go, as the body and the mind are letting go. That they've actualized some capacity within their own mental continuum, which allows them to feel very free and spacious, and nondual, if you will, in a very- I don't know exactly how I can give the words for this, but there's a deep openness, or a sense of great receptivity to things exactly as they are, as the waves of pain or confusion come and go, as the letting go or the unbinding process is happening.
And it might not be that the individual is articulating wisely upon their situation, but rather that there's a kind of field, not only within them, but it's sort of around them as well, that is characterized by a kind of luminosity or openness, which goes right into the dying process.
I want to just mention Tolstoy's extraordinary novel The Death of Ivan Ilyich, where you finally in the twelfth small chapter of the very extraordinary novel, you finally begin to understand that although Ivan Ilyich was just a Russian bourgeois, a mixed-up guy, that in fact even in his own field of delusion he experienced nonduality. He went through the experience of complete liberation in the ultimate phase of the dying process. I think Tolstoy did something that I have really not read anywhere, in any other novel or account, of characterizing this moment of death as indeed liberating.
So from an outside point of view, Ivan Ilyich didn't look like he was conscious, but from his subjective experience, he was. He was fully conscious. He transcended pain, and ultimately he transcended death.
TS: Now, this whole topic is very interesting to me, and of course we can't get inside the dying person's experience to know exactly what it's like. But here you are, you're on the outside sitting at the bedside, but you're in a meditative state, a state of deep spiritual care. And I'm wondering what your experience is when somebody's going through a process that we could call a "liberating death." And I know it's a little weird comparing this kind of death to that kind of death, but I'm curious: you come out of an experience like that, and you feel to yourself, "Oh my God, that was such a beautiful death, such a liberating death," what you experienced as the caretaker compared to, let's say, other kinds of deaths.
JH: Well, you know Tami, I don't want to romanticize the dying process or death.
TS: Very good.
JH: I think that if the truth be told, most of us who work in this field, most of us have observed the moment of death as liberative, but the time preceding the moment of death often is difficult. Death is a pretty gritty experience for many individuals.
And even the description of the Sixteenth Karmapa's death in 1981, where there were all kinds of cascades of symptoms that were so terrible, which he in fact related to in an extraordinarily noble way, but you wouldn't wish this on anybody. What [his death was] like, someone once said-and I think whether I heard it or read it, I don't remember, it was so many years ago-that it's as though all the bad karma of the West was present in his dying process, as if he was burning it up for all of us. And he did that in a noble way. But still, you could say that was liberation with some pretty heavy traces. And one wouldn't wish that on anyone, frankly.
So as I said, I think probably 99 percent of the deaths that those of us who have worked in the field have witnessed, are deaths that are characterized by an absence of symptoms. It's as though as you're getting to the so-called death point, or the place where there's no longer a next inhalation, in general with most individuals there's a quality of spaciousness. It's not like the fingers are clinging at the doorway between the worlds. By that time, the fingers have been peeled away from the doorjamb, so to speak.
But in fact, Tami, maybe the most phenomenal death that I've witnessed was the most difficult death. And that was a woman who had a neurological disorder, and was becoming progressively disabled, and had tried to take her own life a number of times through taking an overdose. And she finally succeeded in taking an overdose sufficient for her not to be resuscitated, but not adequate for her to die.
We were brought to her bedside several days after she had taken all these sleeping pills, all these barbiturates, and she was in a vegetative state. I walked into her room, and she was completely chaotic. She had just vomited on herself, she was being cleaned up by the hospice nurse and by my student, she was sweating profusely-I mean, it was not a good thing.
And the nurse had worked with me before with a number of patients, and she suggested that perhaps I should just sit with the woman, as this might be something she would want. And so my student and the nurse left the room, and I sat down next to the bed of this woman who was dying.
And I said to her as she was chaotically and rapidly breathing, I said, "Dear so-and-so, you are loved by many people, and we completely support you in letting go." And then I said to her, "Thank you for everything you've given to so many of us." And then on every exhalation after that, for 20 exhales, I said to her as I was breathing with her, I said, "Yes." Just with a tremendous sense of love and tuning in to her.
And within a very few breaths of doing this, her breath became more normalized. And 20 exhales later, she died.
And it was really quite extraordinary. I then did phowa practice with her.
TS: Can you explain that?
JH: I did phowa, which is consciousness transference at the time of death, a practice I learned from Chagdud Tulku Rinpoche. And then I sat with her, and then invited her partner and the nurse and my student into the room.
And I will tell you, I was a little blown away. I really-you know, I don't know if my presence had some influence on her experience, or whether it was coarising, my presence and her experience flowed into a unity. I didn't know if causality was there or not. But I was deeply aware that there was a moment of such profound attunement where I felt she was free.
And also when I look back upon this, Tami, I thought it was a great privilege to share that moment with her. That perhaps she would have journeyed on for a few more hours in chaos and confusion, but in fact she was able to regularize or somehow, if you want to call it "normalize," through the sense of love between us.
So it's not a death I would wish on anybody. It certainly was a wake-up call for me, to think that suicide is an easy way out. I think those days from the time that she took the barbiturates until her final respirations were not days that many of us would want. But in fact, those last 15 breaths were breaths of freedom, if I look at it from my perspective. Of course, one can't really know what hers was, except there was a felt sense of things. And there was also [the fact that] she was no longer in the chaotic state that she had been in, [at least] up until the point where I could feel that attunement happening.
TS: The question I have is, you mentioned phowa practice, and you defined it as this transfer of consciousness. Can you tell us a little bit more about what you actually did, what you visualized, how that works?
JH: Another way of calling phowa, other than consciousness transference at the time of death, it's also called the "compassionate hook." And it's where you hook your consciousness into the consciousness of the individual who is immediately deceased, or can be deceased for a while, which is visualized to be in the heart area of the deceased individual. And you hook your consciousness into theirs.
And then through visualization and breath, as well as phoneme that you utter-and by the way, this practice is on the Sounds True DVD, which you all have that I did for you some years ago-the consciousness is then propelled, by virtue of the visualization of the practitioner through the central channel of the deceased individual, into a visualization of Amitayus. And this is all described, actually, in the CD.
TS: Yes. Being with Dying.
JH: It's a very powerful practice. I was extremely lucky to learn this practice through the late Chagdud Tulku Rinpoche, whom I practiced with over a number of years, from I think 1980 or 1981. And he knew about the work that I was doing with dying people, and felt that one of the most important practices that people in this field can do, those who are caring for the dying-and I would suggest not just healthcare professionals, but all of us-is this practice of phowa, or consciousness transference.
TS: Now Joan, a couple of times you've mentioned the moment of death as the so-called moment of death, or if there is such a thing as a moment of death. And when you said that, I thought of a television show, a medical show where they say, "Declare the moment of death," and it's a time that then is written down in the person's medical records. So clearly, the medical world thinks there's a moment of death, when the heart stops, and so on. What is your sense of this?
JH: I have to say that this notion of a moment of death is not actually a moment of death; it's not actually in medicine, per se. Our organs die at different velocities. Brain death can happen, but all kinds of stuff can help our organs keep going, even though we might not be aware that that's happening to us, and such. So I think it's kind of a dramatic notion that we think that there's a kind of moment of death. But I think death is a little bit more subtle.
You know, I'm a Zen practitioner, but I've been engaged in Tibetan studies and practice for many decades, and I think Tibetans have explored this in a way that is quite important for us to consider. So it's not only from the point of view of Western science, that there's not an actual moment of death; I think the Harvard definition on this is pretty clear. I don't remember off the top of my head the particularities, but whomever is interested can look it up.
But also there is what is described in Tibetan texts as the inner dissolution. And those dissolutions have to do with states of, processes of the mind that are characterized by profound clarity, and also profound bliss. [These states] unify in the dying process through the phase of inner dissolution, and [this] gives rise to a moment of unconsciousness, and then what is called the presence of the pure light of our liberated mental substrate, or the pure light or dawning of our primary awareness.
We can't scientifically validate any of this at this time. There's a lot of speculation with regards to what is the subjective experience in this interworld. But I think we have to be very open to the possibilities of what might happen, and take these speculations or the insights of these yogis into the realm of possibility, and not just say, "Oh, you're dead, [then] you're dead."
I mean, I have no idea myself, Tami, of what happens after the moment of so-called death, when the next inhalation does not happen. But I'm interested in the informed speculations of those who have done deep inner work in training their minds to look into the realms of consciousness that most of us do not have access to.
TS: Umm-hmm. From talking to you, it seems that the part of the dying process that you have a great deal of confidence and knowledge about is actually what helps, from the perspective of sitting at the bedside, what's helpful to somebody. And you've made references, helping someone feel forgiveness, knowing that they're forgiven, and you talked about helping that person feel gratitude. And I'm wondering if you can say more. This is kind of a crude way to say it, but what are the dos and don'ts when you're sitting at the bedside?
JH: I think the first thing that is really important to look at is our own capacity to have a mind and a heart that is steady enough to be able to recognize the truth of what's going on around us. And this has to do with our experience of mental training. How many filters do we have between us and the person who could be suffering or dying? Are we able to really perceive their experience clearly? Are we suffering from burnout, or secondary trauma, or pathological altruism, or other ways that limit our capacity to really see clearly?
So [we can do] practices that really train the mind, like focused attention or concentration practices that emphasize the relationship between equanimity and compassion, [or practices that] cultivate the investigative faculty within our own mental continuum, so that we have the ability to have insight around values, around altruism and pain and the experience of suffering, what death means in our lives, the truth of impermanence, what our priorities are, and such. [So it's the] development of our capacity to have a metacognitive perspective.
Another practice that I think is really critical is our ability to presence pain and suffering without personalizing or consoling, being able to really listen deeply to what the dying person is going through, in terms of both the explicit and the implicit level of their experience.
I'm just focusing right now on practices, but I want to break out something in a minute for you, which has to do with components of compassion. But another set of practices that I think are really important is the development of prosocial mental qualities, including empathy and altruism and kindness, compassion, sympathetic joy, equanimity. Buddhism calls the last four things I mentioned-loving-kindness, compassion, sympathetic joy, and equanimity-the brahmaviharas. There are many other prosocial mental qualities, including forgiveness and including gratefulness, which we were speaking about earlier.
And then there's a set of practices related to us becoming familiar with the psychophysical aspects of sickness, dying, and death. And these are skillful means that utilize visualization and imagination.
And then perhaps the most difficult of all practices for us to accomplish, because it's more of a bottom-up process, is that of open presence, or choiceless awareness. And that is developing a quality of attention that is broad-based, is panoramic, receptive; it's fundamentally nonjudgmental.
And there are certain benefits that I think are really important for us to consider in terms of enhancing our capacities as caregivers. I'll break this down in another way in just a minute, but looking at the role of our ability to actually be able to perceive accurately what an individual is going through, and also our own responses to this. This takes a great deal of attentional balance. In other words, are we able to have an attention that is sustaining and vivid and stable and effortless, a kind of nonjudgmental attention, an attention that is not reactive, that is not contracting in relation to adversity, or grasping in terms of our desire for things to go another way? Meditation practice has a very profound effect on our capacity in these areas.
Another area is emotional balance. I spoke earlier about prosocial mental states, and this has to do with us actively cultivating those mental qualities that are wholesome, which are nourishing for us and also nourishing for others.
Then another area that I think is really critical, but is probably not explored so much, but I think is really important in relation to the cultivation of both attentional balance and emotional balance, is our ability to have control of our cognitive continuum. And that is, can we guide our thought and behavior in accord with our intention? Our motivation is really important, but sometimes we have really good motivation, but we get way offtrack. And it's important for us to then learn to override our habitual responses, and learn how to downregulate, learn how to not go into habitual reactivity, but to say, "You know, I don't need to go there today."
Another area has to do with mental pliability, or mental flexibility, our ability to really be able to shift our mental state. And I've seen the Dalai Lama do this so brilliantly, where he'll be with a Tibetan refugee, somebody who's just come over the frontier under great duress, and there will be tears in his eyes. And then two seconds later, he's in a scientific conversation. That kind of mental pliability is really important.
Another thing about cognitive control is our capacity to actually reappraise situations. Instead of saying, "Oh, this is how it always is" or "This is terrible," to be able to see things in a light that is more liberated.
And then of course there are the aspects of mental training related to health and resilience or hardiness, where of course mental training in the best of circumstances reduces stress and enhances our immune response. And I think in our culture we don't have an adequate idea of how plastic or pliable the mind is. And also [how pliable] the brain is, that the actual structure of the brain will change depending on whether or not we're expanding or strengthening certain circuits, and weakening those circuits that we don't engage so much.
This is really important, that when we're speaking about mental training, particularly around an experience where there is usually so much emotion and there's such mental perturbation. Are we in fact able to use this [experience] as a context for the practice of strengthening circuits that are more affiliative, less adversive, less threat-based, less reward-based, and so on? And we can do that based on our intentionality.
So I want to just for a moment, if you don't mind, Tami, talk about a kind of model, which I've been working on. And I've been at the Library of Congress here in Washington now, in this protected space, the distinguished visiting scholar, so I could have some time to really think about things. It's been wonderful, and I want to talk a little bit about some of what I think are essential components of compassion. And they're reflected in what I just spoke about in terms of attentional balance and so forth, but in a slightly expanded way.
I call it the A-E-B axis. That is an axis where there is attentional balance, kind of like a vertical axis, where there's mental stability sufficient that we're able to recognize suffering. And there's emotional balance, which is a kind of horizontal axis, where we're involved in mental qualities that are fundamentally positive, or prosocial. And these would include qualities that also entail the actual positive regard for others, including kindness, which is a very proactive or active dimension.
Now, one of the things about this model. There's a piece of this model that came to my attention through Tania Singer and her work on empathy that I'd like to mention. And that is that Tania Singer was at a small meeting with the Dalai Lama, Richie Davidson, neuroscientists were there, also Matthieu Ricard, Joseph Goldstein, and myself. And I pointed out during this meeting that many caregivers speak about compassion fatigue. And I thought this was not an appropriate term; that it was not compassion that fatigued others, in fact, it was empathy.
And then Tania Singer pointed out something very interesting to me and to the group, which I just want to mention here. And that is, she had noted in her study of individuals who suffer from an autism-related disorder called alexithymia, that these individuals have a very low capacity for empathy, and these individuals also suffer from a low capacity for inter-receptivity; that is to say, they're not really attuned or in touch with their own insula processes. [So] the brain circuits associated with empathy are essentially the same brain circuits associated with inter-receptivity, our ability to be attuned to our insula processes, and this is sort of our sensory-somatic functions.
And so I began to think about all of the caregivers, the physicians, the nurses, that I've worked with for over 40 years now, and realized that often there was a very deep disconnect between the mind and body. And the more stress they experienced, this disconnect was stronger and stronger, and it was in fact accompanied by feelings of empathic overarousal, leading to personal distress, and ultimately to withdrawal or to kind of numbness.
So I put this element of inter-receptivity into the model of the components of compassion; that is, somatic sensory attunement, feeling it was really important for us to be attuned to our own somatic processes. [And it's] because this would prime our experience of empathy, and allow us to have both affective and cognitive attunement to the suffering of those who are around us. So that's the content of what is called the A-E-B axis, the attentional balance axis and the emotional balance axis, which include prosociality, inter-receptivity, and empathy.
The second axis is the cognitive axis. I call it the I-I axis, and it has to do with two cognitive dimensions. One of those dimensions is the dimension of insight. That is, our insight that allows us to actually be aware of ourselves upregulating, so we know to downregulate, know not to get either overexcited or overaroused or overstimulated [and therefore not go] into a state of personal distress.
This is actually partnered with another ability, or dimension of insight, and that is to actually be able to distinguish self from other. And I know this is counterintuitive, because mostly in the nondual state we're supposed to-you know, we're advised to be in this nondual state with all beings in pain. But in fact, that's on the level of, you would say, the ultimate or the absolute. But from the relative point of view, it's important to understand that at some level, I am not you. At another level, I am you, but from one point of view, I am not you. And that distinction is important, because it allows us to not go into a state of overarousal into personal distress.
It's also important from the point of view of insight to recognize the truth of impermanence. And another dimension of the I-I axis is related to impermanence, is to actually be relatively at ease with the experience of uncertainty.
The second dimension in the I-I axis is intention. So we have insight and intention. And here what is aroused is the intention to actually transform suffering. So this distinguishes compassion from empathy. In the experience of empathy, the intention to transform suffering is not necessarily engaged; rather, it's a cognitive and affective attunement that's empathic. And as a result of that, unless we regulate the experience of empathy, we can go easily into empathic overarousal and into personal distress.
And I want to refer here to the work of Nancy Eisenberg, who is a social psychologist who's done really important work in this area concerning empathic overarousal. So the intention to transform suffering is really critical in this whole conjuring of facets, or dimensions, or valences that arise in the very complex experience of compassion.
And the third axis, the physical axis. And this is what the neuroscientists have seen, which is that one of the elements that distinguishes the neurosubstrates of an individual who is experiencing compassion as distinct from empathy, is that an individual who is experiencing compassion has lit up the premotor cortex. In other words, the brain knows the potential action for transforming suffering, sometimes even before the mind knows. So there's the potential for embodiment there.
Now, Tami, there's a fourth axis here, and this has to do with a motivational circuit in the brain called the "reward circuit" or the "seeking circuit." And it's that from one point of view, there's the deep aspiration to transform suffering. That's there, and we know that through the premotor cortex, and the intentionality to save all sentient beings from suffering, which is the great vow of the bodhisattva.
But from another point of view, we cannot be attached to outcome. We really have to be able to let go of any desire for a particular outcome. No gaining idea, as Suzuki Roshi has called it. Because if we're seeking an outcome that we think is desirable, we might begin to start manipulating the individual's experience, and that is truly unhelpful.
So we're working in a paradoxical situation, which again is related, if we're going to go into brain anatomy, to the insula cortex. Here we are, on one hand, deeply dedicated to the transformation of the individual's suffering, which is an essential component of compassion. And by the same token, holding our heart and mind open to the truth that we might not get the outcome we want, and [to do that] we have to really presence emergence, or not be attached to outcome.
These are four axes that are interwoven, I think in a way that-I'm just beginning to understand a little bit about these axes. The A-E-B axis, the cognitive axis, the physical axis, and then no seeking, no reward.
Well, I know that's a lot to hold, but I'm just sitting in my office at the Library of Congress consuming journal articles and social psychology neuroscience, and also looking at my own experience of many decades of working with suffering, and trying to, what can I say, develop a model that is as granular as possible, [a model] of something that we don't understand very well, which is compassion.
TS: It's wonderful, Joan. It's wonderful to hear you talk about it, and really a kind of neuroscience of compassion, bringing in recent discoveries to help us understand this feeling, this act, that feels so spontaneous, being compassionate, but it's actually quite a bit more complicated than that, as you're describing.
Now, I want to ask you just two more questions. One is that, in addition to the Sounds True learning series Being with Dying, you have a book called Being with Dying, and the subtitle is Cultivating Compassion and Fearlessness in the Presence of Death. And I'm wondering what you could say to us about fearlessness, related to our dying?
JH: First of all, I think fear is a kind of an ally. I don't want to make it out to be all bad. I think what fear does is it wakes us up, and it also assists us in really reordering our priorities.
But there are also a number of aspects of fear that are problematic. In Buddhism, we say that there are four great gifts. One is the gift of giving material things, food, shelter, money, so people do not suffer as much. The second is the gift of giving consolation, psychospiritual support, love, kindness. The third is the gift of the dharma, giving the teachings as a means of liberation. The fourth, however, is the most precious, and probably the least well understood, but it is the deepest of all gifts, and that is giving no fear.
So there are three fundamental fear responses: fight, flight, or freeze. And the fight response, in terms of the experience of caregiving, is often expressed in terms of moral outrage. The flight is often expressed in the caregiving experience in terms of abandonment or withdrawal from the patient. And the freeze dimension of fear is often expressed in terms of simple numbness.
I don't understand fear that well. I've gotten more granular around compassion. And one of the things I want to study more is the threat circuit and the fear circuit, partly because it's been something that's been a bit in my life, I think it's in most of our lives. I've also seen it in relation to fear of the unknown, or fear of pain, or fear of loss of identity, which is typical for dying people to go through. I also thought very much in working in the prison system, which I did for six years, working with men on death row and in maximum security, where flight and freeze and fight were very much a part of the experience of being in a maximum-security facility.
So I think fear is something that is prevalent throughout our global society. I mean, the word "terror" is one of the most used terms in global discourse. And that factors right into our psyche, right into our media, right into the lives of our children. And I fear that we've not really unpacked it sufficiently. And I can't say that I myself have given it sufficient discernment to say more than what I am saying here, except that it's the next frontier that I personally want to look at, because I think it is a virus in the world today.
TS: As a caregiver sitting with someone and wanting to give them this profound gift, the gift of no fear, how might I do that?
JH: Tami, this is really the question of how we have worked with our own past, our mind, and our heart. And this is why practice is so terribly important for us. If we are sitting there without equanimity and compassion, [if we're not sitting with] strong back, soft front, fully engaged, but rather strong front, soft back, I think we're putting ourselves into a situation that is not generative or helpful for ourselves and for the person with whom we're sitting.
So part of the work has to do with, how do we develop equanimity and compassion? And I think the most powerful way to do that, frankly, is to do meditation. It is something I feel that all healthcare professionals should engage in, in the training of their own mental continuum. I feel that all children should be trained in prosocial mental qualities and attentional balance. And I think this will also make an enormous difference in how we approach not only our dying and those who are dying, but also in how we live.
TS: Joan, just one final question. I know preparing to talk with you, I spent some time with your Being with Dying materials, and I felt that at those moments preparing to talk to you, death was right there in front of me, and I was thinking about my own death, reflecting on death. But most of the time, death recedes into the background, and I'm not thinking about it. I'm deeply engaged in life, and it's the furthest thing from my mind.
And yet, clearly a big part of your Being with Dying work is helping people understand the importance of living "in the presence of death." And I'm curious what you have to say about this as a final answer. How important is it that we live with an awareness of death, and how do we keep that awareness alive when we're in the midst of the busyness and the richness of our life, [when] we're not thinking about dying at all?
JH: I think that one of the most important things that we can do as individuals is to come to the realization of the truth of impermanence. And the contemplation of our mortality, this limited life span, has a very profound consequence of bringing us into the present moment.
And it's not just a tragedy that our life span is limited. As a matter of fact, as somebody who has worked with this issue of morality for a year, two years, forty years, whatever, but a long enough time, it's never far from my conscious awareness. It helps me to appreciate this moment, the miracle of this moment, this present moment as it is.
But another thing it has done is to make me not just appreciative, but it makes me want to use my life well. And it reminds me of the evening chant that we listen to every night during the time of intensive meditation practice in our Zen temple. And that chant goes as follows:
Life and death are of supreme importance.
Time passes swiftly, and opportunity is lost.
Let us awaken, awaken.
Do not squander your life.
That's a good thing to be reminded of every evening after a day of meditation, right before you go to bed, how precious this life is, and let us not squander it. So that's a seed.
TS: Thank you so much! I've been speaking with Roshi Joan Halifax. Joan Halifax has created a six-session program with Sounds True called Being with Dying, and it contains many guided practices and meditations that you can do at the bedside to be helpful to someone who is in the dying process, and also as a way to cultivate compassion and fearlessness in your life in a total way.
Joan, thanks for being with us. Much appreciation, and good luck with your work at the Library of Congress. Good luck!
JH: Thank you so much, Tami. Bye-bye.
TS: Bye-bye. SoundsTrue.com: many voices, one journey. Thanks for listening.