Mindful Healing

Meditation Contemplation on Working with Pain and Difficulty

Pain and difficulties are learning opportunities. Here’s a basic exploration exercise for getting in touch with what is troubling you and opening to it with wisdom and compassion that I often include in the workshops and classes I conduct.

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Pain and difficulties are learning opportunities. Here’s a basic exploration exercise
for getting in touch with what is troubling you and opening to it with wisdom and
compassion that I often include in the workshops and classes I conduct.

1. Find a time when you have nothing you have to do and when you won’t be rushed
   or interrupted.
2. Sit in a quiet space in a relaxed position. You may wish to close your eyes.
3. Tune in to the rhythm of your breath, being aware of each in breath and each out
   breath.
4. Notice the body relaxing and the mind becoming calm.
5. Allow yourself to be open and receptive.
6. Begin to ask yourself a few questions, and patiently listening for the response from
   your inner wisdom.
   Suggested Questions:
   If my symptom/issue/pain has a meaning and a message what might that be?
   Have I suffered by my reaction and response to it? what have I added?
   Is it asking me to let go of something? can I accept the things I cannot change?
   Is there an opportunity and lesson in this situation? Where’s the healing?
   Ask one question at a time. Don’t rush from question to question. Don’t judge the answer. Know that you may
   get different answers at different times when you do the exercise.
7. When you have asked all the questions you wish send compassion to your difficulty and to yourself.
   Imagine opening your heart to receive and welcome your wounded parts and the burdens they carry.
   Embrace them with mercy and awareness by gently and slowly repeating the following phrases (or
   use your own meaningful phrases)
   I care about my difficulty
   I welcome my difficulty into my heart of compassion
   I accept you, my difficulty, just as you are with unconditional friendliness
   May I have courage and be free from fear
   May I be peaceful with what is happening
   May I be free from suffering
8. Repeat the phrases above as often as you wish.
9. Slowly open your eyes and gently move your body.
10. Take a minute to feel what change, if any, this exercise has brought about in your physical and
    mental perceptions of the pain or difficulty you were working with.

Treating the whole person
by Paul Epstein, NDAs the face of health care continues to change with the increased use and popularity of “natural”, “holistic”, “alternative”, “complementary” medic-ine, the focus of attention is now moving more towards what is being termed “integrative” medicine.The idea is a simple one, (not necessarily easy)how to integrate the best of conventional medicine, the use of drugs and surgery, with the best of “alternative” medicine, natural and mind-body therapies, all within a more comprehensive individualized treatment plan for each person.

In this way, attention is given to how the different approaches and therapies can work together both simultaneously and synergistically if possible to support the health and healing of the patient. In the integrative medicine approach, in addition to proper diagnosis and possible treatment with conventional therapies, the role of nutrition, stress, environment and psychological factors are also examined and addressed.

Appropriately chosen natural therapies are considered and may also be prescribed. For some patients treatment may involve the use of effective natural therapies instead of drugs and surgery. For others, treatment may consist of natural therapies and techniques in conjunction with lifestyle counseling as a complement to drugs and surgery.

These support and stimulate and mobilize each person’s self healing ability. This individualized approach treats the whole person and seaches to find and address the underlying causes which may be present, such as diet, attitude, stress and or exercise or other possible factors. Treatment of each patient is individualized as no two patients (though they may be suffering from the same disease and symptoms) will have the same physical or psychological make-up.

The following is a case study, (cited with the permission of the patient) that illustrates how various therapies and approaches working together and synergistically can successfully manage a health problem. From an Integrative Medicine perspective clinical, psychological and behavioral aspects are all components of a comprehensive treatment program and the engaged involvement of the person in Their health and healing.

A 48 year old attorney was diagnosed as having psoriatic arthritis, This is a progressive disease which involves the joints and the skin, and in our experience has a component that relates to lifestyle and an imbalance in the immune system. His rheumatologist had told him that gold salts, cortisone, and methotrexate (an anti-cancer drug which has severe side effects, such as hair loss) would be necessary to prevent irreversible crippling damage to his joints. He was seeking another approach, if possible.

After a careful history, it became apparent that many of his symptoms were related to stress and the sources of stress in his life were identified. His physical, mental, emotional, familial, lifestyle and environmental history were all evaluated. It was further found that he was suffering from in somnia and other complaints.

Physical exam revealed red, swollen hands which he could not close, and large red psoriatic patches on his skin. Dietary analysis revealed sensitivity to certain foods. Laboratory and blood test evaluation revealed a very high sedimentation rate, indicative of inflammation. The patient was also being constantly monitored by his rheumatologist.

A whole person approach was used. We developed a health promotion program with his active involvement, not only to treat his psoriatic arthritis, but also to make him healthier in general. .

Botanical medicine was prescribed along with a homeopathy, and other food supplements. Therapeutically, we gave him vitamins, we did guided imagery, a cleansing juice fast and physiotherapy. The patient played an active role by changing his diet, doing yoga and prescribed aerobic exercise, and by utilizing stress management techniques. All of these methods were used to help activate and mobilize his self-healing mechanisms by strengthening various body components, including the immune system and by removing obstacles to proper functioning. We were, in short, addressing the underlying causes and contributing factors of his illness.

His progress was significant over a period of the next six months. Healing and improving a chronic disease is a process and takes time. Just as illness does not usually happen overnight, it develops slowly over time, so too, the healing process too does not happen overnight, it requires patience. His sedimentation rate was nearly normal, indicating that his joint and skin inflammation had gone down dramatically. His grip strength was near normal (enabling him to once again beat his tennis opponents) and his psoriasis had become almost unnoticeable. Upon returning to his rheumatologist it was determined that he had made such improvement that the the methotrexate and gold salts would no longer be necessary; thus he was spared the potentially severe side effects of these drugs. A number of other symptoms improved as well. He also found he no longer had a need for pain killers.

This case illustrates that an individualized whole person approach using natural therapies can be safely and advantageously used to control and improve chronic degenerative disease, to decrease dependency on powerful medications (with side effects) for symptom control, and to enhance general health and well being.

Paul Epstein, ND is a naturopathic physician specializing in mind-body medicine and relationship centered care. He recently returned to the area from a two year sabbatical in Israel where he co-founded and co-directed the Israel Center for Mind-Body Medicine.

“Serenity is not freedom from the storm, it is peace amid the storm.”

Its health benefits in the healing process: mindfulness;
a powerful therapeutic tool of mind-body medicine
by Paul Epstein, ND

There is an ever growing body of evidence pointing to the role of the mind and the healing power of the mind in the treatment of illness. Mind-body approaches such as guided imagery, meditation and relaxation, stress counseling, among others, are becoming more and more widespread as the scientific studies mount indicating that mind-body techniques may not only improve the quality of life for those facing a serious illness, but can also affect the course of the disease itself and actually promote healing as well. These therapies are increasingly gaining more interest and respect from researchers and clinicians in major medical institutions, universities and hospitals in the United States and around the world.

Historical Perspectives
In particular the work of Jon Kabat -Zinn Ph.D. and his mindfulness based stress reduction program is gaining popularity and positive reknown, as it becomes increasingly integrated into the practice of medicine in a variety of health care settings, from hospitals to private clinics. However, before going directly into greater depth on the practice of mindfulness meditation, and its health benefits, as well as the work of Dr. Kabat-Zinn, what follows are some basic scientific and historical perspectives and background information on the whole field of mind-body medicine. Thus providing a broader context from which to explore meditation as a powerful therapeutic tool in the healing process. “Non physical treatments like meditation have been shown to be effective in controlled scientific studies for depression, anxiety, high blood pressure, skin diseases, cardiac pain, insomnia, diabetes, ulcers, colds, fever, asthma, arthritis and alcoholism.” Dr. Anne Harrington, a Historian of Science at Harvard University.

The Body of Evidence
The body of evidence has been built over the past 30 years. Areas of scientific research, investigation and study include the physiological aspects of the mind-body connection and the science of psychoneuroimmunolgy (PNI). There has also been epidemiological research, which explores stress, attitudes, beliefs, emotions and other psychological factors and their connection to and effects on certain illnesses such as cancer and heart disease. And finally, there are clinical research studies testing the effectiveness of applying various mind-body approaches and techniques in the treatment, prevention and healing of specific symptoms and conditions.

All this interest and research has followed in the footsteps of the important development of the science called PNI mentioned above. This emerging and evolving medical science serves as the scientific foundation for the growing field of mind-body medicine and is known as psycho-neuroimmunolgy. Psycho for mind, neuro for the nervous and hormonal systems, and immunology for the immune system. Major contributions to the development of PNI came from the scientific studies of researchers Ader and Cohen at the University of Rochester School of Medicine in the mid 1970’s. In experiments with white rats they inadvertently discovered that their immune systems had ” learned “a specific conditioned reaction. In their experiment rats were receiving a combination of a drug lowering the immune response (immunosuppressant) and a sweet drink (containing saccharin), but when saccharin alone was readministered to the rats’ drinking water, they unexpectedly once again exhibited immunosuppression effects, this time it was without the immuno-suppressive drug. Control animals did not show this conditioned response. Thus, coupling a sweet drink with an immunosuppressive drug, evoked the immunosuppressive response of the drug (suppression of T cells and increased susceptibility to disease), even after the drug itself was removed and only the sweet drink was given. It was classical conditioning similar to Pavlov’s famous experiments with dogs. They had developed a learned association between the taste of the sweet drink, and the suppression of their immune systems as they continued to get sick and die just with the sweet drink. That could only have occurred via a brain/nervous system and immune system connection/ communication/interaction, which had been previously thought to be non-existent. The only place where learning could happen was the brain. The brain and the immune system were supposed to function separately! In the scientists’ subsequent experiments they were able to confirm and further demonstrate that the immune system could indeed be conditioned, it could learn.

It did not function in isolation and there were connections to the brain and the nervous system. Ader states “PNI studies confirm that the immune system does not function completely autonomously.” These initial findings opened the door to greater interest and studies of the mind-body connection and communication, its physiological mechanisms, how the mind and emotions may affect health, the stress response and relaxation response and more.

Later experiments suggest that uncontrollable stress can suppress immune function and decrease natural resistance to cancers and tumor growth. Professor Antonovsky from Beer Shiva University in Israel found that a sense of control or “coherence” as he termed it, could strengthen one’s resistance to stressful situations. It is now accepted scientific knowledge that increased incidence and severity of illness occurs following stressful life events. More recent studies are showing the connection and association of stress, a weakened immune system and feelings of helplessness with cancer and depression. Studies also show the connection between hostility and loneliness and heart disease.

Increasingly, the results of these studies have practical and therapeutic implications. This has led us to the present time, where greater emphasis is being placed on continued investigation and application of the role of the mind and the role of mind-body therapies plays in the treatment and healing of a wide range of medical disorders, and where possible their effects on specific diseases.

“Mind and body are inextricably linked, and their second-by-second interaction exerts a profound influence upon health and illness, life and death. Attitudes, beliefs and emotional states ranging from love and compassion to fear and anger can trigger chain reactions that affect blood chemistry, heart rate, and the
activity of every cell and organ system in the body-from the stomach and gastrointestinal tract to the immune system.”, states Kenneth Pelletier, Ph.D, a pioneer in the field, and senior clinical fellow at the Stanford Center for Research in Disease Prevention at the Stanford University School of Medicine, and author of the book “Mind as Healer, Mind as Slayer”. His studies and teachings also focus on how the mind-body connection can be harnessed to help people stay well or recover from illness.

One such innovative and pioneering health professional harnessing and using the mind-body connection, and a prominent leader in the forefront in the areas of clinical practice, research and teaching of mind-body medicine today is Jon Kabat -Zinn, Ph.D. He is the director of the Stress Reduction Clinic at the University of Massachusettes Medical Center, where he is also an associate professor of medicine, and he has authored numerous books including “Wherever You Go, There You Are, Mindfulness Meditation in Everyday Life”. His clinical mind-body work involves the integration and therapeutic application of the practice of mindfulness
meditation in medicine and health care in the facing and healing pain, stress and illness. Dr. Zinn derived and adapted this form of meditation for mind-body healing from a unique and ancient Buddhist tradition and practice known as vipassana. At his stress clinic, patients with a wide range of health problems (ranging from heart disease, cancer, skin disorders, insomnia, menstrual disorders,and chronic pain, irritable bowel to colitis,backache, headaches, diabetes, ulcers, chronic fatigue, asthma, arthritis andanxiety as well as other stress related condition conditions) practice mindfulness meditation as part of their overall treatment plan. Those who practice on a regular daily basis, report a lessening of the effects of the stresses in their life, as well as a reduction and relief of their medical symptoms.

At the Medical Center and his Stress Reduction Clinic, Dr. Zinn has treated over six thousand patients (referred by their physicians who were skeptical at first and later learned to appreciate the benefits of mindfulness), trained hundreds of health professionals, and conducted many scientific studies
and controlled experiments. Among the studies conducted at his Stress Reduction Clinic, was a clinical experiment he led in collaboration with the departments of dermatology and behavioral medicine, involving 23 patients suffering from a skin disease known as psoriasis. In psoriasis, the skin cells rate of growth is
increased producing scaly itchy patches. Many factors can affect and influence the course, extent and severity of the disease and its accompanying recognizable symptoms, including emotional stress. Conventional treatment usually involves the use of ultraviolet light (UVL), phototherapy, to slow down the growth of the
skin cells producing the psoriasis. A large number of UVL treatments is often required for the complete clearing of the scaly patches during an exacerbation of symptoms. In Zinn’s study the 23 people with psoriasis were divided into two separate groups. He was looking at the question of whether the mind can be shown
to have a direct effect on a well-recognized and definable healing end point, in this case the clearing of these scaly patches of skin. One group of thirteen used UVL treatments together with practicing mindfulness meditation. The other group of ten, as a control, used UVL treatments only. Over a twelve week period
of therapy in the experiment, those in the meditation group had their skin patches clear up more rapidly. And at the conclusion of the experimental treatment period, ten of the thirteen in the meditation group had clear skin, while just two of the ten receiving phototherapy alone were free of their scaly patches completely. Thus, the rate of healing was affected in a positive way, by the addition of meditation as a therapeutic tool. This simple and scientifically controlled clinical study, just one small example out of many, demonstrates,
illustrates and points to the potential and powerful effect the mind and meditation practice can have on the healing process and as well the course and symptoms of disease. Many such studies and experiments have been and continue to be conducted, all serving to increase and reinforce our understanding, knowledge and trust of the mind-body connection, and how to harness its therapeutic power, meditation as medication, as an integral component of overall treatment plans.

Jon Kabat-Zinn’s work has evolved on the heels of many other outstanding and dedicated professionals. From the pioneering and popularized work of such notables in Mind-Body Medicine such as Dr. Bernie Siegel, cancer surgeon and author of “Love, Medicine, and Miracles”, and Dr. O. Carl Simonton, oncologist and author of “Getting Well Again”, and Dr. Herbert Benson, Professor at Harvard University School of Medicine and author of “The Relaxation Response” and “Timeless Healing”, and Norman Cousins author of “Anatomy of an Illness” and “Biology of Hope”, we are pointed to the healing power of the mind and heart. Speaking of the heart, included in the above list is also Dr. Dean Ornish and his research and clinical practice with heart disease patients, he has authored the book “Reversing Heart Disease”, his program is based on a comprehensive
approach involving diet, love and meditation.

What is mindfulness meditation (as practiced clinically by patients at Dr. Zinn’s Stress Reduction Program)(and offered here in Israel at the israel center for Mind-Body Medicine) and what are its benefits?

Sit quietly in silence and stillness, comfortable and relaxed and yet alert, begin observing your breathing process with the mind’s awareness using a gentle and kind and careful attention, as you follow the sensations of the natural rhythm and flow of the air entering the body as you breath, either at the nostrils as the air goes in and out, or at the abdomen and chest as it rises and falls. These are the beginning basic instructions of mindfulness sitting meditation, one part of the practice of mindfulness, an approach that helps people who practice to face, and cope and heal one’s stress, pain and chronic illness, as well as enhance their quality of life. Mindfulness is similar to other forms of meditation practice in its ability to induce deep states of relaxation, in itself a powerful support to health and healing. It does not involve focusing on a phrase, sound or prayer to keep out unwanted thoughts and feelings. Rather the practice develops to teach us how to open directly to the
full range of human experience as it arises and passes away, moment to moment. Helping us learn to live each moment of our lives, even the painful ones, fully with a welcoming mind and heart. Sensations in the body, thoughts in the mind, and feelings in the heart.

The Insight Meditation Center in Barre Massachusetts, a major retreat center in the West for the intensive practice and study of mindfulness (also known as insight and vipassana which stems from the Buddhist
tradition and is 2500 or so years old) defines the practice as ” a simple and direct practice..the moment to moment observation of the mind-body process through a calm and focused awareness. Learning to observe experiences from a place of stillness enables one to relate to life with les fear and clinging. Seeing life as a constantly changing process, one begins to accept pleasure and pain, fear and joy, and all aspects of life with increasing equanimity and balance. As insight deepens, wisdom and compassion arise. Mindfulness meditation
is a way of seeing clearly the totality of one’s being and experiences. “The practice is also reflected in the sayings “Serenity is not freedom from the storm, it is peace amid the storm,” and “The journey of discovery consists not in seeking new landscapes but in seeing with new eyes” which express the potential and power of mindfulness to cultivate inner peace and serenity and new perspectives and views of our life, both of which can be life transforming and healing in its cumulative effects.

Meditation helps people learn to deal with stress more effectively and to activate, mobilize and utilize their inner healing resources and capabilities as evidence and research shows in all the mind-body studies. Mindfulness can be helpful if we are experiencing health problems and serious illness, as well as if we are struggling to deal with difficult and stressful life circumstances, again, or also to improve our general quality
and outlook on life regardless of our situation. It is a wonderful complement to and component of any other medical treatment and a wide range of medical diagnoses. An important part of the therapeutic value and approach involved in meditation practice as medication, is that the person/patient becomes a responsible participant in their treatment and in so doing is actively and consciously engaged in their healing process. Making a commitment to meditate regularly enhances the intention and sustains the effort to get well. One need have no prior knowledge or experience to begin to practice, only a beginner’s mind, and a willingness to learn and a commitment to practice regularly is all that is required. Regular practice helps us develop patience as we open to see clearly what’s really happening in our lives, once we finally ready willing and able to stop and look and listen inside, the essence of meditation and mind-body medicine. As meditation can generate deep states of relaxation and inner peace, both very pleasant and healing feelings, it makes practice seem easier at times. However, mindfulness is about more than just a technique causing pleasant relaxed feelings, it is a way of relating to, seeing, feeling, and being with our experience just as it is. Sometimes, as it is, is also very unpleasant feelings. Ultimately it can teach us to face and open to all of lifes challenges and experiences, “the good, the bad and the ugly”, the pleasant and the unpleasant, the painful and the joyful, the happiness and the sadness, all that life has to offer, in sickness and in health, in life and in death. The inner balance of mind cultivated and developed by consistent practice of mindfulness meditation allows us to face all of lifes situations with greater,clarity, wisdom, compassion, understanding. We can then live our life and respond to life from the depths of this inner awareness, peace and balance, natural human qualities, ready and waiting to be tapped and realized and lived. We respond to life instead of being caught in the traps of our persistent and conditioned knee-jerk reactions to the stresses of our life.

Imagine what the streets, and roads and highways of Israel would be like if more people drove their cars with mindfulness, awareness, patience, a kind and careful attention, from a place of peace and inner balance inside, able to respond from that place and not reactwith frustration and “road rage” and conditioned patterns when they are stuck in traffic, not react with anger and hostility to the unconscious driver that cuts them off, and not to react impatiently with constant horn-honking to the car that stops in front of them momentarily, this alone could transform improve the quality of each of our individual and collective lives. All it takes is a little
mindfulness. Imagine being able to respond to the other difficulties and challenges of life from this place of inner stillness.

Therapeutically, this ability and quality cultivated by mindfulness directed to pain and stress and illness, helps us to face, and cope and heal more effectively. We learn to face, accept and even welcome our tension, our physical pain, our fears, anxieties, our shame, our wounds, our shadow, our anger …whenever they are present, just is we welcome and open to our joy, our love,and our happiness. Facing things in this way by acknowledging and being with our experience just as it is, shifts our perspectives and relationship to our reality, and helps to transform our experience of it. We get less caught up in, stuck in, identified with whatever
comes up in our experience, we have the space and awareness to respond and make choices from a place of mindfulness. By observing our thoughts and emotions and mind states as they arise and giving them the space to be, without automatic unconscious conditioned reactions, as if you took a step back from them, we see
them more clearly, gaining insights and free to choose wise and compassionate responses and ways of being that do not perpetuate our old stucknesses. The important aspect of mindfulness is not what’s happening, it is the quality of awareness we bring to each moment of experience, kindness, care, patience, non-judgement, and acknowledging acceptance. We observe whatever comes up in the present moment. Acceptance means opening to and living life more fully. Thinking of our minds and hearts as the ocean or the sky, and our thoughts and feelings as waves or clouds, as a famous yogi once said, “We can’t stop the waves but we can learn to surf. ” This is the spirit of mindfulness.

Dr. Stephen Fulder, teacher of insight (vipassana, mindfulness) meditation in Israel, and author of 12 books on alternative and complementary medicine, will be co-teaching (with the author of this article Dr. Epstein) a year long systematic and intensive course in meditation. I asked him how mindfulness practice helps in our life. He states “Many of us find ourselves packing our lives so full that we feel it is all rather pointless and mechanical, at times, not to also say very stressful. We lose touch with ourselves, becoming a “human
doing” rather than being a “human being”. We may carry with us a heavy bag of unsolved physical, mental or emotional problems. In insight meditation we stop and begin a deep meeting with ourselves. It is a journey back home, to a place of truth and integration from which we can heal ourselves and inspire our lives.
There is no need to believe in any credo or new set of concepts about life. We have too many of them already. Rather it is to bring freshness and freedom to who we are at this moment. It does not require a change of direction-our family relations, religious worship, work and activities can stay the same, but become
less habitually conditioned and stressful. Instead we can discover and experience a true lightness of being.” In conclusion, mindfulness meditation practice can help us mobilize our inner resources for self healing.
Therapeutically it increases our ability to relax, let go and let be. It helps to deal more effectively with stressful situations. It can teach us to cope better with pain. It can reduce both the physical and psychological symptoms of illness. It supports us to relate to life with less fear and clinging. And can provide us with increased equanimity, balance and serenity.

A famous Vietnamese Buddhist Monk Thich Nhatat HanH says in his teachings on the practice of mindfulness “The Present Moment.” “The present moment is where life can be found, and if you don’t arrive there, you miss your appointment with life. You don’t have to run any more. breathing in we say, “I have arrived.” Breathing out we say, “I am home.’ This is a very strong practice, a very deep practice.” A very healing practice.

Paul Epstein, ND, Naturopathic Physician, Co-Director, Israel Center for Mind-Body Medicine, practices, studies and teaches mindfulness meditation and integrates it in his life and work. He leads courses, workshops and retreats for the public and trainings for health professionals. He is coordinating plans for a conference in Israel on meditation and healing in medicine and psychotherapy.

Where’s the Healing?
By Dr. Paul Epstein

“While we all acknowledge the value of a holistic approach as an integral part of naturopathic medicine, not enough recognition is given in our curriculums as to how we can best integrate holism into our role as naturopathic physicians. In order to go beyond the password “holistic,” this course has been designed to explore the deeper issues of how to address these aspects of mind-body-spirit in yourself and with your clients. Being “holistic” can go beyond finding the right supplement, botanical extract, homeopathic remedy or point. It is being able to contact the deeper essence of a person, whether you call it the spirit, soul or vital force. In contacting this deeper essence, the holistic physician is to tap the person’s true source of healing, and initiate a process of both healing and transformation.”

The above paragraph was taken from a 1984 course entitled Healing, Consciousness and Transformation that I co-designed and co-taught with Nimrod Sheinman, ND (currently director of the Israel Center for Mind-Body Medicine) and others. While the course occurred 23 years ago, the questions that it raised are still relevant: “What’s the connection between vis medicatrix naturae and the deeper essence?”; “What is healing and how does it happen?”; “How can we deeply support our patients’ healing from within?”; and “Where’s the healing?.”
These questions have been part of my life’s quest for the last 20-some years, both personally and professionally. On the surface, our naturopathic tradition emphasizes the understanding that healing comes from within. Yet, on a deeper level, I have been dissatisfied with our curriculums, conferences and journals, where too little space has been devoted to the patient’s inner and deeper world. Intuitively, I have been drawn to search for ways to engage people’s consciousness, and to support them in a more full and direct involvement and participation in their healing process.

Living Questions … Where’s the Healing?
Prior to my naturopathic training, I witnessed first-hand the healing power of nature as a yoga and meditation teacher. Through yoga, I saw people changing diets and lifestyles, dealing with their stresses, learning relaxation, and studying philosophy and new ways of viewing reality. As their consciousness and life changed, their health inevitably improved, as well. Observing this became a prime motivation to become an ND. But I wanted more of a role as a healing coach, one that practices this statement from Joseph Califano in the 1976 Surgeon General’s Report, Healthy People: “You, the individual, can do more for your own health and well being than any doctor, any hospital, any drug, any exotic medical device” (Surgeon General’s Report, 1979).

When I helped develop a Portland naturopathic clinic’s lifestyle change program, integrating diet, exercise and stress management, I realized Califano’s quote, and sensed that the less I would act as a prescriber, the more my patients could and would act as self healers.

Healing: Treating the Whole Person
The following case study taught me an important lesson: As a naturopathic resident, I worked with a patient who had high blood pressure and diabetes, and for whom a lifestyle change, and diet and stress counseling would be appropriate. After six months of visits, treatments and weight loss, his clinical symptoms and tests normalized. We had a very successful outcome, or so I thought. The patient returned a year later, however, with all of his symptoms and clinical diagnoses we had treated and “cured.” While everything was different about his lifestyle, something very important to his transformation and healing process hadn’t changed. So, what had been missed?

It reminded me of my mother’s chicken soup: All of the ingredients can be there, but without the right touch of salt at just the right time, it can be flat. I would later come to understand and realize that we didn’t engage this patient’s consciousness. We did not treat the whole person … we missed an underlying cause. To paraphrase Einstein: You can’t solve a problem with the same consciousness that created it.
The question we should have asked that patient, and that I always ask my patients now, is “How did you come to be this way?” I want to know what happened, why they came to my office, what they think contributed to their illness, disease or pain.

Mind-body medicine became my main therapeutic approach to living and answering that question with clients. Clinical guided imagery, mindful inquiry, Buddhist psychology and perspectives, and various psychotherapies became my tools for finding the meaning and message of illness, listening to symptoms and inner wisdom, and engaging the person’s conscious and unconscious awareness into the healing process.

Biography Becomes Biology
Through the years, I began asking a second question, one that came from a vision quest experience and American Indian saying: Am I willing to listen with the ears of my heart to the other voices of myself speaking?

This question encourages people to look inside, listen and observe. As Marc Barash, author of The Healing Path said: “Our disease may tell us a story, not just of our cells, but of ourselves. By taking the risk of listening, we may be led to the emotions that lie at the core of our authentic being” (Barash, 1995). Dr. Leslie Goldschlager, colleague and friend, corroborated this when he said, “Illness and symptoms have a message. Understanding and discovering their meaning can be the key that unlocks the door to healing and recovery.”
Listening to symptoms for their meaning and message is the essence of learning how biography becomes biology. One patient’s case illustrates this well. Sara had been trying to lose weight for 20+ years. During those years, she had lost and gained weight, and lost and gained again. Using guided imagery and exploring her body fat, she evoked the image of a down comforter. With it came the awareness of childhood abuse and the down comforter as an ally - protecting and defending her, covering a part of her that was still frightened and vulnerable. Once she consciously realized her obesity had been serving a purpose and wasn’t the real issue, her weight loss process became very different. We were able to address the painful feelings she had buried; and this time, the results of her weight loss were permanent.

While other naturopathic therapeutics can and do address and provide the missing ingredient in the healing soup, mind-body medicine seems to be particularly effective for people with chronic issues and stress-related, lifestyle and autoimmune processes and diseases, and those carrying burdens of trauma from their biography. This perspective on healing is also defined by Stephen Levine, a poet and teacher of guided meditation healing technique: “If there is a single definition of healing, it is to touch with mercy and awareness those pains from which we have withdrawn in judgment and dismay.”

Awareness is the Healer
To help further my quest for “Where is the healing?,” I explored various counseling and psychotherapy models, including interactive guided imagery, insight meditation, mind-body psychotherapy and internal family systems therapy.

In addition, my personal path had shifted to studies and practices of Buddhism, including meditation, mindfulness and compassion, which helped me learn how to further facilitate deep listening, cultivate unconditional presence and embrace the truth. The following case study provides an excellent example.
An anxious and neurotic young man presented with an array of symptoms, from allergies to asthma to a slew of phobias. However, he refused all treatment options I offered. He wouldn’t change his diet; take the homeopathic remedy I prescribed; or talk about any biographical, spiritual or mind-body issues. As I became more and more frustrated, I realized that my own dismay at the situation kept him from living the questions. I was about to recommend him to another doctor, when Buddhist insights came to me: “Be,” don’t “do.” Stop trying so hard. Just be present and accept him unconditionally.

Integrating the teachings of Buddha led me to re-focus on healing, not just curing. In curing, we are looking for answers, and our efforts are designed to make something happen. In healing, we live questions (instead of answers), trust the unknown, and allow and welcome the emergence of whatever will come. The issue is not healing vs. curing; we need both.

When I let go of my attachment and “need” to cure this patient, he let go of his resistances. He began to change his diet, talk about his past (he’d been physically and emotionally abused by his father) and take the homeopathic remedy. He began to break open his shell, engage in his healing journey and touch his wounds with mercy and awareness.

Homeopathy Without the Remedy
A mindful mind-body healing approach, involving listening to and being with our pain with unconditional presence and radical acceptance, is somewhat like homeopathic medicine and true to its philosophy of “like cures like.” In homeopathy, we subtly intensify a symptom or malady to activate and mobilize the organism’s natural healing responses. With mindful awareness, healing and mind-body medicine, when patients are unconditionally present with their dis-ease, they amplify their awareness of what they are stuck in - which usually arouses a deep-felt desire to move in a new direction. In 12-step recovery programs, this is “hitting bottom” and step one of radical acceptance.

As we get in touch with the truth of our pain, it moves us to our healing.
Many problems ultimately are spiritual issues, symptoms of separation from our true nature or essential being.

Healing, ultimately, is also a spiritual journey, a process involving change and transformation on all levels. Mind and body, heart and soul are indissoluble; a change in one is a change in all.

Stress and the Mind-Body Connection
A 1998 study from the American Academy of Family Physicians said that 75% to 90% of visits to the family physician are for stress-related complaints. Sam Keen, author of Your Mythic Journey, states that “80% of our dis-ease is psychosomatic in origin, the result of unresolved conflicts, unconscious anxieties and unfulfilled potential … the self at war with itself; thus, most physicians are practicing philosophy without a license.” (Keen, 1989). This understanding is at the core and heart of mind-body medicine and the importance of fully addressing and integrating therapeutically stress and the patient’s biography as key aspects of etiology, healing and curing. This also led me to my third question for patients to ask themselves: “How can I be with my pain, symptoms and illness in a way that is wise, compassionate and healing?”
The following case study illustrates use of this question. A 75-year-old woman presented to my office with severe back pain from osteoporosis and arthritis of two years’ duration. She was severely depressed after two years of treatments involving drugs, surgery, painkillers, anti-inflammatory medications and antidepressants, all to no avail. I asked her the three questions that have become a foundation for my practice. She replied that her husband of 55 years had died. He had Parkinson’s disease and Alzheimer’s disease, and had had a stroke. She had decided to “pull the plug.” She also said she didn’t want to “fall apart,” as all her friends did when they lost their spouse.
I learned that she hadn’t really grieved, hadn’t been able to face the pain of her loss or even the sadness, guilt and shame that she carried. However, during the course of her therapy, she chose to listen, engage and face her truth, practice forgiveness of herself (from God, her husband and herself) and participate fully in her healing. While she still had symptoms of arthritis and osteoporosis, she was able to function, and no longer required painkillers or antidepressants. She began writing poetry again and seeing friends. In her book of poetry, which she signed and gave to me, she wrote, “Thank you for saving my life. You were the only one who listened to me, the only one who helped me face the truth I was carrying and covering up and burying.”
As Krishnamurti, philosopher and author, says: “… It is the truth which liberates, not your efforts to be free.”
From living the question, “Where’s the healing?,” through my career as an ND, I have learned that: 1) who we are and how we “be” is often more important than what we know and do; 2) healing really does comes from within and requires the engaged conscious awareness of the person and connection with essential being; 3) there is a mind-body-spirit connection; and 4) in the heart of the pain is the healing, and in the heart of the healing is the pain.
People have always asked me who I am, what I do and how I practice. The answer I give has changed over the years. Now, I say that I guide people to open up and listen inside; I support them to be with their pain and embrace their truth; I encourage them to live questions and see with new eyes; I help them engage their healing journey with their spiritual path; and I try to bring them home, to their true and authentic self. My sense is that each physician is seeking and exploring how to integrate mind-body healing perspectives and questions within the practice of naturopathic medicine and all our therapeutic modalities. This article shares my quest, where it has taken me and how I practice living these questions and staying true to naturopathic principles and ideals.

Paul Epstein, ND is a 1984 graduate of NCNM, specializing in mind-body integrative medicine and mindful healing. He is featured in the May/June issue of Spirituality and Heath Magazine, and is being sponsored for a national workshop tour called “The Healing Journey.” He is a co-founder of the Israel Center for Mind-Body Medicine; maintains a private practice in Westport, Ct.; travels extensively, leading workshops and retreats worldwide; and offers imagery and mindfulness healing seminars. Dr. Epstein offers professional mentoring services to support, train and coach health professionals wanting to integrate mind-body medicine in their therapeutic work.

References
U.S. Public Health Service Office of the Surgeon General: The Surgeon General’s Report on Health Promotion and Disease Prevention, Rockville, 1979, U.S. Public Health Service, pp. forward.
American Academy of Family Physicians: Survey 1988.
Barasch M: The Healing Path: A Soul Approach to Illness, New York, 1995, Penguin.
Keen S: Your Mythic Journey: Finding Meaning in your Life Through Writing and Storytelling, New York, 1989, Jeremy P. Tarcher/Penguin Group.

Mind-Body Medicine Resources

• Academy of Guided Imagery: http://www.academyforguidedimagery.com/
• MBSR Mindfulness Based Stress Reduction: http://www.umassmed.edu/cfm/mbsr/
• Internal Family Systems Therapy: http://www.selfleadership.org/