The following is based on a community-interest talk that was themed around cancer. I gave this talk at yoga therapy conference SYTAR in Reston, VA (June 2018).
Pain is something we have all experienced at some point in our lives, but unless you’ve studied it, you might not realize how intricate it is. The biopsychosocial model of pain is a more holistic view of pain than we’ve had in the past, and I like to think of it as having a committee in my brain, made up of members who represent my current state of biology, psychology and social support; when my sensory input (or alarm) is raised, the committee votes on whether or not the sensationisactually pain and if it is, what levelof pain I feel.
For example: when my children were younger, I loved it when they fell asleep on my chest. I felt relaxed, validated as a mother and I didn’t want to move for fear of waking them up – even if they were pressing painfully on my breasts, which happened more and more as they grew older. When my sensory input was sent to my brain, the committee voted for discomfort, rather than pain, because my desire to prolong the moment, coupled with my sense of fulfillment as a mother had more influence than the vote for pain. Fast forward 20 years to a similar sensory experience when I was receiving a mammogram to scan for breast cancer and my committee voted for an entirely different outcome. The environment was cold and sterile, I felt vulnerable and everything in my brain told me to run from the room, because I was frightened of what the scan might find. This time my brain voted for pain and the experience really hurt. In this example, biological and psycho-social conditions influenced my pain experience. These influences can be amplified or dampened, depending on how accurately I see and understand my reality – in order words, how much avidya(ignorance) clouds my worldview. In the Yoga Sutras we find descriptions of different forms of avidya, collectively known as the kleshas, and these kleshas can control us when they are active, but their control weakens as the kleshas dampen or become dormant.
So, in my previous example…
I experienced the klesha called dvesha (rejection of, aversion to what is currently arising or changing) when I wanted to run out of the appointment, but it was a dampened form of the klesha, so it only affected me a little and I stayed in the room.
An example of me experiencing raga (attachment, clinging, desire for things to stay the same) in an active state is when I wanted to keep my child asleep on my chest for as long as possible.
When I identify as a “good mother” I’m acting from a place of asmita (attachment related to my sense of identity or egoism) and when this klesha is active, I cling to actions and situations that feed my identity.
I experienced a diluted form of abhinivesha (fear of death / clinging to life) when I was afraid to hear if my scan is positive for breast cancer.
The more we understand our kleshas and how they affect our view of reality, the clearer our reality becomes; this clarity means we are less controlled by avidya when cancer questions arise, like:
“Does this sensation remind me of treatment?”
“How do I feel about this sensation occurring at this moment?”
“Does this mean the cancer is back?”
“Is this a sign that the cancer will kill me this time?”
As yoga therapists, we comprehend that avidya raises fear, cancer amplifies that fear and fear encourages the psychosocial members of the brain committee to vote for pain… But telling someone who has never worked with the kleshas before that the pain they are relating to their cancer is mostly in their heads is at best insensitive, and at worst, harmful. Instead, I recommend clearing avidya through gentle and undeniable practices.
I teach the following mantra alongside a specific breath pattern to gently introduce my students to the idea of impermanence, which can then be revisited throughout the class: Arising… Abiding... Dissolving
Bringing up the topic of impermanence introduces them to their attachment and aversion patterns, but it also gives me the chance to remind them that even pain is impermanent. I also like to remind them that everything in nature follows this pattern: the seasons, the days and nights, your thoughts, as well as every cell in your body, and I ask them to imagine that their cells are all repeating this mantra Arising… Abiding... Dissolving... so that this mantra echoes through their body and reminds their cancer cells who have forgotten to dissolve.
When illness and pain become chronic, the klesha tied to our sense of identity, asmita, may be activated. I observe this activation when someone tells me, “I don’t practice yoga anymore because I can’t do the poses I used to do.” When I hear this, I explore ways for them to move that don’t involve pain, which helps them remember that they are more than just their cancer and pain experiences. I ask them to think of all the things that are “going right” with their bodies at that moment, instead of focusing on what is going “wrong.” I’m sure you all have language around this idea and this is nothing new, but what I’ve also seen help is encouraging compassionate accepting by asking them to imagine a beloved pet sitting on the area of pain and I then ask them to soften and relax around that area to make it more hospitable. This is a great segue into mettapractices, where we learn to tolerate and hold space for people (situations and sensations) that are challenging, and eventually dampening our kleshas’ influence on cancer and chronic pain experiences.
It gets more complicated when their social setting receives a secondary gain when their loved one remains dependent on them due to their illness or pain; in these situations, caregiver support is crucial.
When I work this way with cancer survivors dealing with pain, they often express a feeling of ease and hope after class; this is the short-term effect. What I’m really doing is planting the seeds so that they can reach for these tools any time they notice their kleshas are influencing their experiences. This long-term effect is slower to mature and much more subtle; I’m typically not around when their “aha” moment occurs, but they will sometimes communicate with me (sometimes years later) how these practices prepared them.