Sick in Body and Healthy in Mind: The Wise Medicine of the Four Noble Truths

One of our VIMS study groups is working with Bhikkhu Analayo’s Mindfully Facing Disease and Death. The book is filled with a great deal of valuable and very practical information, all of which fosters what might be called “everyday compassion,” as well as its related wise action. Though the book’s primary focus is on how to engage wisely with physical sickness and death, the material in it easily serves as a parallel to mindfully engaging with the fullness of our life, in which we know that for all of us (as Tony Bernard puts it):

Bad things happen: The First Noble Truth
We tend to make them worse: The second Noble Truth

First, the Buddha points to the simple fact that things we don’t like and don’t want––things that harm us and harm others––naturally occur in our lives. In Buddhist language, this aspect of experience is called dukkha. Recognizing that dukkha is part of life is very important to our search for wellness. It’s not our fault when an illness, a bodily pain, or any other challenge arises, but often we blame ourselves––or blame others: we search for who did what wrong. Things get complicated when we forget the truth of dukkha. We tend to make them worse. We react to the unpleasantness of the situation with fear, anger, doubt, restlessness, shame, depression, or a strong desire for something else to turn to––some addictive substance perhaps––for momentary relief. In these ways, most often, we become further agitated. We are driven by an almost blind, mindless desire to stop the dukkha. This reactive craving increases the dukkha.

Stop making things worse: The Third Noble Truth

A man in our prison group once wisely said that the most important thing that Buddhism had taught him was “to use the pause button.” A convicted murderer, he talked about how pausing has changed his life and made the world safer for everyone he interacts with, as well as for himself. Pausing, like so many things, is “simple but not easy.” But, whether the dukkha manifests in a diagnosis of cancer, an intractable bodily pain, an extended prison sentence, or the harmful, dysfunctional behavior of our government, a pause will help. The ability to stop is a crucial step in the establishment of mindfulness, and, thereby, in the possibility of relief.

Jon Kabat-Zinn’s response to doctors at UMASS, who sent him their “worst cases”––i.e., the people who did not respond to the standard treatment for their diseases, and, especially, for the associated physical pain––was: “I have the best medicine. I have mindfulness.” And so he did. The Mindfulness-Based-Stress-Reduction program he developed and taught to these and hundreds of thousands of others has helped countless numbers of people to recover sanity, and this sense of well-being has eased their suffering bodies.

A person in our Thursday sitting group once asked me if “not making things worse” was enough. Shouldn’t we try to make things better? In that conversation, it occurred to me that until we stop our involvement in the process of creating more agitation, fear, hatred, and delusion in our hearts and in the world––in other words, until we really stop making things worse––we could not possibly be “making things better.” In addition, by again and again not making things worse, we are indeed making things better. (A more classical statement regarding this third noble truth is, “The end of dukkha is possible.”)

Fourth Noble Truth: There is a way to do this.

The cure for the dis-ease.

Ajahn Amaro, who is now the head of all the monasteries in the Western tradition of Ajahn Chah, was part of the Dalai Lama’s Mind/Life Seminars in the early 2000s. In a conference at which Western scientists and Buddhist scholars discussed health and illness from their different traditions, Amaro said that what the Buddha has offered us is not simply the “ordinary unhappiness” spoken of by Freud but “complete mental health.” “Full awakening is sanity,” he said. Analayo reminds us of this when he says that it is possible––in fact, imperative––to have a sick body and a healthy mind.

Analayo begins the book Mindfully Facing Disease and Death with a metaphor from the Pali Discourse*. In a chapter called “The Buddha as Supreme Physician,” which draws on material from the text, he explains the Four Noble Truths as a medical diagnosis (page 10):

Diagnosis: There is dukkha—agitation, stress, dis-ease;
Pathogen: Reactive craving (for or against the dukkha);
Health: The end of dukkha;
Cure: The Eightfold Path.

The Eightfold Path can be divided into three sections. The first relates to wisdom and has two factors. Wise Understanding reinforces the liberating fact that dukkha arises in every life. It is not just you! I remember a friend who was dying of cancer who said that she finally realized that the real question was not “Why me?” but instead, “Why not me?” Aren’t I just like everyone else? Isn’t it wonderful (and very fortunate) that most of you reading this do not, at this moment, have a toothache?!

The second factor on the path, Wise intention, asks us always to link our intentions to the goal of ending dukkha––the intention of not making things worse. Whether in the hospital or a nursing home, a prison, or in public discourse, always nourish your mental health, sanity, and sense of well-being. Classically, such intentions fit into the categories of non-ill will, non-harming, and letting go. Put in a more positive frame, these mental attitudes––of kind, open-heartedness, of compassion (for others and self), appreciation, gratitude, and rejoicing in the goodness all around us; and in the balanced, steady, settled-back, caring presence of equanimity––protect us from the pull of strong painful feeling-tones and the related, unhelpful tendencies of mind, those tendencies that make things worse.

The next three factors have to do with activities: these are Wise Speech, Wise Action, and Wise Livelihood, a category of activities that can be extended to mean “how you spend your time.” “Don’t make it worse through speech, action, or behavior,” says Tony Bernard. Once again, remember your intentions.

The final three factors of the Eightfold Path––the prescription for the cure of physical illness and other dukkha, and the prescription for the development of sanity––relate to mental development and stability. These are Wise Effort, Wise Mindfulness, and Wise Concentration. I had a serious bicycle accident last September. As I was in midair, falling to the ground at the end of a skid, I had the fully framed thought, “Meditation is mind control.” I instinctively knew how important it was going to be for me to rein in and focus the mind when I hit the ground. Even as I lay waiting for help to arrive, I knew that the body––in pain, and shaking as the evening rolled in and the cold and damp settled––needed the mind’s full support in those moments and in the months of recovery that followed.

Analayo observes:

In addition to looking after the body with the help of modern or traditional forms of medical care, there is considerable scope for training the mind so that it will not also fall sick. Such training not only alleviates any mental distress, but also stands considerable chance of supporting physical recovery. (17)

The first phrase is important: “In addition to looking after the body with . . . medical care.” This essay is focused primarily on a meditative approach to pain, illness, and other dukkha; but it is not at all meant to suggest that we just sit back and do nothing about our illnesses––that we become passive about the need for prison reform or about the precarious state of our country. In fact, it seems to me that dukkha plus mindfulness actually gives rise to the urge that we call compassion––the urge that leads us to do something to stop harm. The desire to alleviate suffering is a potential in each of us, and inherent in its arising is the knowledge that something can be done––that we have something to offer others and ourselves when dukkha manifests. We can do this!

In order for us to stop “making things worse,” we need this embedded-in path, wise mindfulness and its supporting factors of effort and steadiness of mind/heart. In order to see dukkha clearly and fully, and to only then act appropriately, we need to ingest the whole prescription––the entire Eightfold Path. By so doing, our reflective and meditative practices have the potential to help us to be wiser and kinder players in this shared world––both internally and externally.


*The Anguttara Nikaya (AN 3.194 at AN III 238.5) in which the Buddha’s teaching of the Four Noble Truths is seen through the metaphor of a medical diagnosis. This truth is strongly related to the facts that things change (anicca) and that we are not in full control of events (anatta). At the same time, dukkha arises due to certain conditions and ends because of certain conditions. Especially in the teachings on mindfulness, the Buddhadharma suggests ways to engage with these conditioned aspects of mind and body in skillful ways. Part of the Sutta can be found on pages 11–14 in Mindfully Facing Disease and Death, by Bhikkhu Analayo.

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