Sunday, September 30, 2018

7 Tips for Making Peace with Chronic Pain and Illness

Hello everyone. Toni here. Mara is off this week and so I'm going to share a piece I posted at Psychology Today on Wednesday. It's an introduction to the new edition of my first book, but it's intended to stand alone as a "piece for peace" if I may reference the title above!

So, here it is:

I am excited to share that a revised and expanded edition of my most popular book, How to Be Sick, has just been released. Every chapter has been rewritten, expanded, or revised to bring the book up-to-date and to share new ideas and practices to help all of us live well, even if our health is less than ideal.

To celebrate the book’s release (it was a lot more work than I thought it would be!), I’ve made a list of seven suggestions for making peace with chronic pain and illness. All of them are explored further in the new edition.

1. Blaming yourself for what’s happened is misguided because pain and illness are part of life.

Once I understood that everyone faces health challenges at some point in life, I stopped blaming myself for becoming chronically ill (chronic illness includes chronic pain). Letting go of self-blame was accompanied by a feeling of tremendous relief, because I no longer thought that life was being unfair to me or that I’d been singled out in some way.

It’s hard enough to handle the day-to-day challenges of pain and/or illness. When we add self-blame to the equation, our mental suffering multiplies several times over. But this is one type of suffering we can do something about. We simply need to be honest with ourselves about the human condition: everyone is subject to injury and illness; it’s a condition of being alive. For me, being alive is a gift (even if a mysterious one!) and that means I want to find ways to live as rich and fulfilling a life as I can within my limitations. There’s no way around it: chronic illness has drastically limited what I can do but it’s not my fault.

2. Accepting that life is uncertain and unpredictable is the first step toward making peace with your circumstances.

If we had control over our lives, we’d make sure that all our experiences were pleasant ones. But the fact is, more often than not, we don’t get what we want (or we get what we don’t want). At first blush, this may sound like a dark view of the world. It isn’t to me, though, because I’d rather know what to expect than to live in ignorance and be continually disappointed when things don’t turn out as I wish they would.

Accepting that life is uncertain and unpredictable, and that one consequence of this is that we won’t always get our way, opens the door to a living with equanimity. By equanimity, I’m referring to a calm and balanced state of mind that is able to accept with grace whatever comes our way. This is a tall order but, in my experience, it’s also the path to peace. “Path” is the operative word here. I’m not always equanimous, but I’m committed to the path.

3. It’s natural to feel lonely when you suddenly become isolated.

Many of us have been forced to give up active work and social lives for relative isolation. Such a drastic change can be traumatic and bring on a loneliness we’ve never felt before. With time and an effective set of practices, we can turn that loneliness into a feeling of peaceful solitude much of the time. That said, there’s nothing wrong with feeling lonely at times. I still do, even though I’ve written extensively about it. When loneliness pays a visit, I treat it as an old (if uninvited) friend and do something soothing until it passes.

This next tip can help alleviate loneliness.

4. If at all possible, connect with others via the Internet.

Late into the last century, people who were chronically ill only had letter writing, the telephone, or in-person visits as a way to connect with others. I’m unable to do much of the last two and so, had I become chronically ill several decades ago, I’d be almost completely isolated. Today, people who are partially or wholly housebound can connect with others personally, using email, texting, FaceTime or Skype, online forums and groups, etc. 
In addition, the Internet allows us to keep up-to-date on medical news that relates to our specific health challenges.

6. Learning to pace yourself may be the best treatment you’ll find.

Pacing is so important that in the new edition of How to Be Sick I’ve added a section on it, including four suggestions for how to effectively integrate pacing in your everyday life. Perhaps I didn’t include it in the first edition because I still struggle to master this skill. And it is a skill. That said, it remains the best treatment I’ve found, and so I’ll be re-reading that section of the book myself every once in a while!

5. Learning to be happy for others makes your limitations bearable, and can even make you happy too.

If the idea of feeling happy for others who are out and about, having a good time, sounds foreign to you, it’s not a surprise: the English language doesn’t even have a word to describe this feeling. I hope you’ll try it, though, because it can help you feel better about your limitations.

Start by bringing to mind someone who’s happy about something that you don’t crave yourself, such as winning a sporting event or an academy award. As you think about that person’s joy, try to feel happy for him or her. Once you’re able to do that, move from there to feeling happy when a loved one is joyful over something.

The tougher challenge (which is why it takes practice) is to feel happy for someone who is doing something you wish you could do but can’t because of limitations imposed by your health. I give several examples of this in the new edition of the book. One is of my husband taking our granddaughter Malia to see my favorite musical. 

At first, all I felt was envy and resentment. But because I’m committed to this practice, eventually I was able to turn those painful emotions into joy for them. And when I did that, I actually felt happy myself, as if they were going to the musical for me.

I still occasionally get envious or resentful when I hear about people doing things I wish I could do, but at least I have a tool for turning those emotions around. It’s worth the effort because envy and resentment feel awful, physically and mentally. With practice, we can go a long way toward eliminating them from our emotional lives.

7. Make self-compassion your first priority.

I’ve saved my first priority for last. I get a lot of emails from people who’ve read the first edition of How to Be Sick. The most common remark is that, until they read the book, it hadn’t occurred to them that they could—and should—be kind to themselves. And that’s all that self-compassion means: being kind to yourself; being nice to yourself. It’s the best way to ease the mental suffering that comes with chronic illness.

Many people find it easy to be compassionate toward others, but when it comes to themselves, they are their own harshest critics. They don’t think they’re deserving of their own kindness. In my view, there’s never a valid reason to be unkind or harsh with yourself. Of course, you can learn from your mistakes. But learn…and then move on. Don’t get stuck in negative self-judgment over what you said or did. It’s hard enough to struggle with your health every day; don’t force yourself to struggle with self-criticism too.

Self-compassion is so important that I’ve expanded this chapter in the new edition, including adding a new practice on how to tame your inner critic—that unworthy opponent that so many of us have to contend with.


I hope these tips have been helpful. Never forget that despite your health challenges, you’re still a whole person, and don’t let anyone try to convince you otherwise.

Sunday, September 23, 2018

It's Here: A Revised and Updated Edition of "How to Be Sick"!

Mara here:

Most of our blog readers are familiar with my mom's book How to Be Sick about her experience of becoming chronically ill and then the mental and spiritual journey she went on to live with her illness.

It's hard to believe that it's been over eight years since she wrote it.

The fact that she wrote a book has never been surprising to me. She's always been a great writer. I lovingly tease her about the fact she talks slowly and a lot. It was difficult when she used to have to leave me three phone messages because my answering machine would always cut her off.

But her words become magic when she writes them down. It's part of what made her 1st in her class at law school. It's part of what made her a fantastic law professor. It's part of what made her a great Dean of Students at the law school. And it's what has made her book a long-standing best seller.

If you think she sounds like a person you would want to be friends with when you read her writing—it's because it's true.

And she's the most thorough researcher I have ever met. She honestly goes crazy when she researches things. This came in handy when she got sick because most general practitioners don't have time to research unknown illnesses. And it really paid off when she was able to basically diagnose her own breast cancer when the doctors failed to notice an unusual lump in her x-ray.

So when she decided to explore Buddhism, of course she dove in with the energy and enthusiasm she does everything she enjoys. It was a complete immersion.

Honestly, when my parents first became Buddhist, I thought it was a little strange. But the more I learned about it, it really made sense. I was surprised when my dad was attracted to Buddhism because it seemed to be the opposite of his nature, and it has really given him a new perspective on life. For my mom, it seemed very much in line with how she had always been. She's always had Buddha nature. She's always been very accepting and loving. She's always been someone who makes you feel better after you've spent time with her.

When she became ill, she was able to really utilize her spiritual practice to come to terms with the changes she faced. And in documenting her own journey she's been able to help others.

It was not a surprise that when she decided to write a book, she did it with her whole heart and it instantly resonated with people.

The same goes for the new edition. She put months of work into revising and updating her previously crafted words to reflect her new experiences and knowledge.

I had the privilege of reading an early copy and all these years later, How to Be Sick is still compelling and reassuring, but most of all it's helpful. She's still the teacher and the loving parent giving guidance. The new version simply has the benefit of eight more years of life experience and, of course feedback, from readers of the first edition.

I know everyone will enjoy the updated version of How to Be Sick.

Here's the (US) link to the updated version: Amazon.Com

Here's the Barnes & Noble (US) link to the updated version:
Barnes & Noble

I thought people would be interested in knowing more about the updated version of the book, so I asked my mom some questions about it.

1. When will the new edition be available?

The release date is this Tuesday, September 25. I noticed that on the book’s page at Amazon, U.K. and the Book Depository, the release date is listed as October 25. My experience with the other books I’ve had published is that sometimes they become available before the official release date. The nice thing about pre-ordering is that it locks in that price. Right now, Amazon in the U.S. has great pre-order price.

2. Just curious: why did you title the book How to Be Sick?

This is one of my favorite questions! Here’s how the title came about. After I’d been chronically ill for several years, I realized that I needed to learn how to be sick and so, from my bed, I slid my laptop over and opened a Word Document, titling it “How to Be Sick.” Over the next few months, every day or two, I opened the document and added my thoughts or wrote up a practice that I thought would help me adjust to my new life. I sent what I had to a few people I’d met online who were struggling with their health and they said, “There’s a book here.” And so, unlike with my two subsequent books where it took months to come up with a title, for me, this book could only have that title. Kudos to my publisher for agreeing to it!

So, in short, a bunch of notes, originally intended to help me and then intended to help a few friends, turned into a book with a worldwide following. I’m still amazed that this happened. Last month, a pharmacist in Iraq emailed me, asking how she could get a copy.

Every once in a while someone objects to the title, saying, “I don’t want to know how to be sick; I want to know how to be well.” But they’re far outnumbered by those who tell me that they bought the book because of its title!

3. Why did you write a new edition?

Early in 2017, my publisher asked if I’d prepare a second edition. At first I thought "no" because I know how hard it is to write a book—and, after all, I’m still sick. But when I read over the manuscript, I saw so much I wanted to add or improve or update—and even some things I wanted to delete—so I said "yes." 

I added a lot of new practices. In addition, I omitted almost all the Buddhist terms. They simply weren’t necessary because it turns out that only a small percentage of my readers identify as Buddhist. (I’d like to add that I don’t practice Buddhism as a religion. For me, it’s a practical path, which is why the book is intended for people of all—or no—religious persuasions.

Preparing this second edition turned out to be a lot more work than I thought it would be, but I enjoyed it because the basic organization was there so I didn't have to start from scratch. All I had to do was make the book better and I’m confident I’ve done that. 

4. You said you added a lot of new practices. Is there a theme running through them?

I counted the new practices the other day and there are over a dozen of them. I admit, it even surprised me! I would say that the new practices emphasize self-compassion, mindfulness, and equanimity. Those first two terms are thrown around so much these days that they can feel stale. My intent with the new practices is to make self-compassion, mindfulness, and equanimity come alive for people by suggesting very specific ways to integrate them into their lives.

5. In the new Preface, you say that the new edition will place more emphasis on chronic mental illness, such as anxiety, depression, bipolar disorder, and PTSD. Is there a particular practice that would be helpful to people who suffer in this way?

There are several that would be helpful. One is called “Disidentify from Your Inner Critic.” We could all use help with that! Another one is called “Three-Breath Practice.” I have to give your Dad credit for that one because I adapted it from a mindfulness practice he teaches to inmates at Folsom Prison where he’s a volunteer chaplain. It’s a simple practice where you take a moment throughout the day to switch your attention from whatever you’re doing (or thinking) to the physical sensation of three in-breaths and three out-breaths. 

This simple practice grounds you in your body and brings your focus to the present moment—that is, to what’s going on around you right now. This helps relieve mental suffering because it takes you away from being lost in that constant chatter in your mind—chatter that often consists of stressful thoughts and the emotions that go with them. I use this practice myself, randomly throughout the day. It’s very helpful.

6. Do you have any other new books on horizon?

No. People tell me that I should write a book called “How to Grow Old.” (My publisher wanted to keep “How to” in the title, which is why all three of my books start with that phrase.) But that’s not a book I plan to write. A large part of the reason is that many people tell me that How to Be Sick was helpful even though they don’t have health problems because they simply treated illness as a metaphor for the difficulties everyone faces in life. And so, I think How to Be Sick pretty much contains what I’d want to put in a book called “How to Grow Old.” In fact, I’m sure of it because, as I age, I find myself picking up the book for help!

Also, I’m busy with other writing—my online Psychology Today blog and the blog that you and I post once a week.

Sunday, September 16, 2018

And the 2018 Emmy Goes To...

Mara here:

It's Emmy time again. Tomorrow (Monday September 17th—why Monday???) the Television Academy voters will decide the winners for the best television programming for the past year.

If you've been reading the blog, you know that the awards are not just about winning a statue. Winning an Emmy means money for the shows in terms of advertising dollars. (Or for shows on HBO, Netflix, and Amazon, it's about attracting more subscribers.) Yes, the status of winning doesn't hurt the actors or the productions, but it's all about bringing prestige to the show so it will get more viewers and make more money.

Here are the nominees for best shows in the drama and comedy categories:


Game of Thrones
Stranger Things
The Crown
The Handmaid's Tale
This is Us


Curb Your Enthusiasm
Silicon Valley

The Marvelous Mrs. Maisel
Unbreakable Kimmy Schmidt

Unfortunately I don't watch much regular network television, so I'm only familiar with the shows that are on HBO, Netflix, or Amazon. But here's my opinion of the shows I have seen:

Game of Thrones: Great show. I've loved it from the beginning. But I can see how it's not for everyone because it contains a lot of violence. And you have like the fantasy genre. But it's one of the few shows that I think has gotten stronger over the years. Strong acting, strong production values, and always an adventure.

Stranger Things: Really fun show. Love the characters, but not a "best show" contender for me. I just think it's fun. And Brad loves the 80s so that's an added bonus.

The Crown: Stunning production and the acting is wonderful. I also love learning some of the lesser known bits of history that the show featured. 

The Handmaid's Tale: This is a really well done production. It's dark and it's violent, but not in the same way Game of Thrones is violent. This is more emotionally violent. The acting is really superb and the dystopian world they create is frightening.

Westworld: I like this show, but it's a little hard for me to watch because it's a show that is confusing on purpose. The acting is very good and the production is beautiful, but I don't love the show. I don't get lost in the plot because it's confusing and I know they're trying to trick me.

Barry: This is a quirky little show on HBO. It's being categorized as a comedy, which it is, but it's a definitely a dark comedy. The lead character is a hitman who decides that acting is his calling. We watched it because we're fans of Bill Hader and it's filmed around the L.A. Valley where we live, so we thought we'd give it a try. And we ended up really liking the show. The characters are surprising, but likeable, and if you have ever lived in L.A., you will get some of the inside jokes.

The Marvelous Mrs. Maisel: This show is great. I started it thinking I wouldn't like it. It looked like fluff. It's so charming and funny and smart. Rachel Brosnahan and Alex Borstein are fabulous. The whole cast is great, but the two leading women are really what make the show come together.

Toni here:

I'm afraid I can't contribute much to Mara's analysis, although I've now put some of the shows she discussed onto my list of things to watch. (Right now I'm semi-binge watching episode after episode of The Great British Baking Show on Netflix.)

I did watch Curb Your Enthusiasm (good, but not its best season in my opinion) and The Crown, which I loved. I'm particularly looking forward to the next season of The Crown because I love the actress who will now be playing Elizabeth (Olivia Colman). And, Helen Bonham Carter (another favorite of mine) will be playing Princess Margaret. 

I read an analysis of The Crown that described exactly how I watch it: watch; pause; google; watch; pause, google, etc. I had so much fun reading online about the various characters and how the show sometimes stretched or altered the facts. And I learned a lot about British history, which was nice because I love books by British authors (including Scottish and Irish authors).

Two more things. In my opinion, Better Things should have been nominated for Best Comedy. At least its star, Pamela Adlon, was nominated for Best Actress. It's my favorite TV show. Second, I hope Julia Louis-Dreyfus is back soon. Her comedic rendition of Selena in Veep is incredible.

Mara and I would love to know: What was your favorite show from last season?

Sunday, September 9, 2018

Sometimes We Need to Lose Sight of the Big Picture

Mara here:

Sometimes, when I'm feeling contemplative and have a moment of peace, I feel as if I've really accomplished some growth in my life. I feel like I've done some soul searching and really made progress toward understanding what the important things are to focus on and sorting out some of the clutter that doesn't need my attention.

I have a great marriage, my daughter seems reasonably well-adjusted for an almost adult teenager, and we live a comfortable life.

And then I hear a noise. It's a little clicking noise. Click. Click. Silence. Click.

And I slowly start lose my mind. I can ignore the first time I hear it. Even the second and third times don't cause me to stop what I'm doing. But after the fifth or sixth click, I can't stop thinking about it.

It's a fly.

The click is the sound of a fly bouncing off the long closet mirror doors we have in our bedroom.

It's a very distinct sound, like someone delicately throwing a small pebble at the window. And for some reason, this sound absolutely makes me crazy.

I know it's not very Buddha of me, but if the fly doesn't figure out within about a minute that it can't fly into the mirror, then I have to try and kill it. If reincarnation exists, I will be coming back as a fly.

The other day, as I was reading a book, a fly made the unfortunate mistake of getting trapped in our room. And sure enough, the clicks began pinging. This particular fly also made a very loud buzzing noise as it would swish by the bed on it's way to and from the mirror. Buzz, click, silence, buzz, click, silence, click, click, buzz, silence.

I felt my blood pressure rise, and my face flush. My mind raced into a blur of nothingness.

For an instant, I lost sight of the world around me. It felt a bit like the movie "The Matrix," where time actually slowed down and I had a split second of awareness outside of body.

Then as quickly as it happened, I snapped back into reality.

I felt a little shaky because I wasn't sure what had happened. The only thing I could feel was this overwhelming sense of not having any control.

In this whole big wide world, something as small as a fly could shift my entire being in just a few moments.

I'd love to be able to say that somehow that moment changed my entire outlook on life. I would love to have had a Byron Katie or Ekhart Tolle "Ah ha!" life-changing experience that suddenly made me a pillar of peace and well-being.

I didn't.

But it did remind me that I can't be so focused on the big things in life that I forget that small things also need to be attended to. It doesn't take much sometimes for small things to throw life out of balance. Sometimes I get so focused on the big picture, that I forget the big picture is just a million small pictures that make the whole image.

Here's what I asked my mom about this subject:

It would have been easy for you to have lived your life with your chronic illness, letting being sick dominate your existence. How were you able to get past the big picture of "being sick" to just being?

Great question. To be honest, some days being sick still dominates my existence. But I have some "go to" reflections and practices that help me get past the big picture to, as you call it, "just being."

First, a few years ago, I wrote a piece for Psychology Today on the very subject of thinking small! Here it is if people would like to read it: "What to Do When Gratitude Is in Short Supply." I give lots of examples of how thinking small can be helpful.

Also, I rely on the books of Zen teacher Charlotte Joko Beck. One thing she says is that the only thing we can truly rely on in this world is life being as it is. This has been helpful to me so many times. On days when I'm stuck in that the big picture of having been chronically ill for over 17 years, I remember her words and say to myself: "All I can rely on is life being as it is at this very moment. This moment, I feel sick; so be it. But there are other things going on in this moment too—my sweet doggie is by my side, my bonsai looking beautiful in the sunlight."

This allows me to let go of the "big picture" (years of life-dominating chronic illness) and let the small things of the moment that are a source of joy and happiness enter my heart.

Sunday, September 2, 2018

College: The First Day of the Rest of Your Life

Mara here:

If you're a regular reader of the blog, you already know that my daughter, Malia, is a senior in high school. Senior year. It's finally here.

For years, my daughter has talked about this moment. When she was younger, she was mostly enamored with the idea of being older. She was anxious to be "an adult." And as she got older, the excitement was less about being older and more about going to college.

My memories of being Malia's age are fuzzy. I was already taking classes at U.C. Davis and I was not involved with the process of trying to decide about colleges. And even if I had gone through a more traditional process, I'm not sure it would have helped me prepare for what Malia is now going through.

The vague memory I do have about deciding about college is that if you were a good student then you knew you would get into a good college.

This doesn't appear to be the case anymore.

Malia is currently ranked #5 in her class. She's 5th out of almost 600 seniors in her class. You would think this means that she would have her choice of schools to go to.

It doesn't.

The reality of college admissions these days is that the competition for the top universities is so fierce that there are no guarantees about anything. Twenty years ago, good grades and good test scores were all you needed. Now, having over a 4.0 grade point average (Malia's is somewhere around 4.5) and good test scores is the baseline for the top-ranked schools.

So what gets you into top university? There's no formula. Too many kids get good grades, and too many kids get good test scores. So, in the sea of academically accomplished kids, how do universities decide?

For some schools it's about extra-curricular activities. Are the kids involved with student government, a sport, a charity? For other schools, it's about the admissions essays.

Unfortunately, for the kids, it makes the whole process unbelievably stressful.

When I was growing up, most of the kids I knew went to a UC (University of California). Sure, there were some UCs (Berkeley or UCLA) that were more difficult to get into, but you could definitely get into one of the UCs if you had decent grades. And there were always the state schools. Schools like Chico State or Sacramento State were great options for kids who didn't have the grades for the UC system.  But even the state schools are now highly competitive.

And the state schools are no longer considered cheap. The average cost for UC in-state tuition is around $30,000, including housing. When I was attending UCD my quarterly tuition was $1200.

This means that more and more kids are going to out of state schools because it's not necessarily cheaper to stay in California. Out of state schools like Texas or Wisconsin are giving scholarships to lure California students to their schools.

My point is that the application process for kids these days is complicated. And it's unnerving for kids to know that no matter what they do, it may not be enough to ensure admittance to their first-choice schools.

For Malia, the stress around being accepted into college started Freshman year of high school. Yes, 9th grade is when the stress starts. Every grade counts in high school. It's also the year we started to get mail from universities marketing themselves.

And because the emphasis of every high school class choice, grade, and activity has been carefully chosen for the purpose of getting into college, now that she's faced with trying to decide which schools she wants to apply for, it feels almost paralyzing. So many years of work have led up to this moment.

For Malia, it feels like the college she picks will determine the course of the entirety of the rest of her life.

And I guess on some level that's true.

But the reality is that Malia is fortunate in that she'll have lots of options. She might not get into her first-choice schools, but she will be accepted into many great schools. And the thing about life is that for many of the moments that feel pivotal, there are no real wrong choices. They're simply different paths.

Malia and her dad are going off this weekend to visit Vanderbilt in Nashville. They're visiting because part of the craziness of college admissions is that many schools are now choosing a large portion of their Freshman class if they apply and commit early. That means she has a much better chance of being accepted to Vanderbilt if she applies early with the understanding that if they admit her she will go. It's binding. If she backs out of the early acceptance agreement, it means her high school will be blackballed from Vanderbilt admissions for a set number of years.

This is what it's come to. Her chances of being accepted almost doubles if she applies early. (This is same for most private schools now.) But that means she won't have the opportunity to even apply to other schools.

So we'll see. For me, I am not concerned about what school she will attend, because I feel certain that wherever she ends up, she will have a great time. It will, in the long run, feel like the right decision. This is because, while going to college seems like a big life decision, it's not a decision that determines the rest of your life. Because every day is the first day of the rest of your life. Every day you have the chance to make different choices.

But it's hard to know that when you're 17 years old. And I don't expect her to. And a year from now, hopefully she'll be excited with the decision that she made.

Did you remember feeling a lot of stress about what colleges you were going to apply to and attend?

It would have been stressful, but my mother had just remarried (after my father's death eight years before) and, unfortunately my new stepfather took over her finances and made it clear to me that they wouldn't pay for private college—that my only option was a UC school. 

In sum, my relationship with him was stressful (to say the least!), but the decisions around college were not.

When Jamal was applying to colleges, was it stressful for you as a parent?

I recall being concerned about how we'd pay for a private college, but it never came to that because he decided to go to a UC.

Thinking about it, our family has been enrolled at a lot of the University of California campuses: I went to Santa Barbara, Riverside, and Davis (the first two as an undergrad and the last one briefly as a graduate student and then for law school); Your dad went to Riverside and Davis (the first one as an undergrad, the last one as a graduate student); you went to Davis; Jamal went to San Diego; and Brad got his MBA at UCLA. That's five different UC campuses!

It's a good thing I transferred from Santa Barbara to Riverside after my Freshman year because it's at Riverside that I met your Dad. But that's a story for another day!