Wrestling with Hope

I’ll be 50 years old this year. By even the best calculations, I’m closer to death than I am to life. As a cancer survivor, I’ve had my brush with the possibility of a relatively young death. (Although, as a friend once said to me in my 30s, when I expressed the fear of dying young, “Isn’t it a little late for that?”) As the survivor of intense and long-standing abuse and neglect as a child, my odds of surviving long are significantly lower than the average person’s. So recently, as I’ve considered the possibility of returning to graduate school, I’ve had to actively work with the stuff of my life and how I will hold this information in juxtaposition to the opportunities before me. How do I hope? Here are a few ways I’ve worked with this topic, and why I chose to say yes to graduate school at this point in my life.

1. Expanding my horizon. I’m not sure who said it, but someone has suggested that when we become overwhelmed, it helps to expand our horizons. My background and fears (i.e., chronic childhood abuse and neglect, fear of dying from cancer) are aspects of my experience. When I step back from them, however, and take in more of the picture, they become far less portentous and individual aspects of many, many aspects of my life. Many of those other aspects of my life are good, lovely, hopeful and worthy. I gain perspective on the fears and notice, too, that they’re part of shared human experience. All of this gives me peace, despite the occasional dips into distress or anxiety.
2. Bringing my full self into the room. I lived a very divided life before breast cancer. I hid a lot of my thoughts, feelings, and behaviors from myself and those who loved me. Significant childhood abuse frequently leaves children subjected to it  with a sense of shame and deep pain. They internalize the rejection of their parents and carry that breach in family connection with them throughout their lives. This can result in addiction and self-sabotaging behavior. I was no exception. I’d had an eating disorder, smoked, shopped and generally numbed-out for big chunks of my life. When I got my cancer diagnosis, that wound – and the fact that it was unhealed – was the demon with which I wrestled. I had not truly lived, fully, as myself. Right up there next to the fear of my son losing his mother was the fear that I had not truly lived yet. As a result of that awareness, I became instantly and permanently less concerned about what other people thought and about welcoming with love and compassion all the hidden, fearful, shameful parts of myself into my own awareness and into the room. My graduate school hopes came directly out of that drive to bring all the parts of myself into the room.
3. The necessity of an honest goal. Robert Fritz is someone whose writing (The Path of Least Resistance and Your Life As Art, in particular) has inspired and shifted my awareness of what it means to have a goal, something I will call for my purposes in this writing “an honest goal.” I pondered whether or not to pursue my master’s degree at this time, and I realized that I really, truly wanted it. While I do care whether I finish and whether I get to use it, the energy the goal gives me is important to the quality of my life and not entirely about the quantity of life I have in front of me. We all take risks in taking up goals – no one has a guarantee that they’ll finish any goal they start. The important thing is the energy that the goal – one based on our true heart desires – brings to our actions, our lives, our sense of purpose. I imagined a future without this goal, and I felt a sense of collapse and resignation about it. Yuck. I need this goal as much as I hope others need me to shine with my gifts to the world.
4. Present moment inhabitation of my own life. While graduate school and the idea of “hope” are future-driven realities, they are possible for me by cultivating my present moment awareness. I practice mindfulness meditation, and this school year, I have attended a 300-hour mindfulness teacher training. As a result, I’ve been steeped in the practice. And that practice reminds me of the fact that when I am present here and now, I’m okay. The more I can connect with here and now (which is all any of us have), the more I find that, “there’s more right with you than wrong” (Jon Kabat-Zinn).

The program I’ll be attending is a Master’s in Mental Health Counseling with an emphasis in the expressive arts at Lesley University. It’s a program that gives me the ability to work with the creative process in myself and others for healing. I’m excited to continue doing what I love (yoga, mindfulness, writing, art) and to work with these frames for holding, working with and transforming our dark, hidden parts into the art of our lives.

I write this blog for my own expression, but I also have the hope of supporting others in sharing their truth and living in a way that brings their whole selves into the room. Are you middle-aged (like me) and looking at a change in career or continuing education? Have you had a scary diagnosis that makes you afraid to hope or make big commitments? What tools have you found to navigate these paths yourself? I look forward to hearing from you in the comments!

Namaste.

 

 

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Reifying embodiment

(A short essay about one experience of movement from trauma space to embodiment.)
I’m in lockdown mode.

That’s what I call the external rigidity of flesh and bone, facial expression, in crisis.

On the inside, the inmates are screaming, flinging shit at the walls and rattling the bars, but through the glass of my eyes, you would see nothing but your own reflection.

I move, if at all, slowly. There’s so much more to do, and it’s harder, so I should be moving twice as fast. But sometimes I just sit and try to think, while the monkeys create chaos. I just want to sleep, really, and maybe when I awaken, things will be quieter.

I have to do yoga for a class I’m in, and instead of doing it, I think about how I can’t possibly do it three times by Friday (the requirement), and I’m weepy, feeling impossibly burdened.

And I watch that unfold because why is it I can’t do yoga three times by Friday? I have four days, after all.

Oh because I’m in lockdown, and as both jailer and prisoner, I believe it would be imprudent to move my body or to really feel my way into my feet (so far from my head, where all the important stuff is happening!).

I get out my mat, resenting that this is required of me (by whom? Oh, right, I signed up for this).

Moving hurts. My mind wonders if I could make lists while watching a yoga video? After all, if I’m really being mindful, I notice that moving my body feels painful, and it’s not nice to do that to myself, is it?

I notice the justifications, the desire to escape the present moment, and I continue to move, gently but still resentfully, woodenly. Feces from monkeys in my mind leaving tracks down the walls of my inner world. A trickle of sweat rolls down my back, and it feels remarkably like the chaos within me. I am uncomfortable.

But I keep moving. A glimmer of light peeks through, and I feel the strength of my arms holding my body up. Mmmmm, strength. My joints, inflamed, stiff joints – begin to loosen and lubricate. The lunch that was too much but that I hoped would calm my revving mind-body is right there as I fold forward, and I notice that I don’t want more food. A good noticing.

Malignant metaphor melts into hands on mat, toes tucked under to move into down dog, chest stretching open. I notice the sounds of my son singing with music in the next room, and sunlight is literally pouring through the window onto terracotta floor around me. I am back in my body, and I know that I have had a power outage for two days, that power is back, that I am no longer 40 years younger and trapped in childhood trauma. Here I am. I am okay.

I come into awareness of relationship with myself; body, breath, emotion and mind begin to flow as one. I do not banish monkeys or the jailor or even praise my reunited self. I continue to move for a few minutes more, then take the floor as my resting place for five minutes of noticing all of it with kindness.

Recovering trust after cancer

Wherever we go, there we are. Jon Kabat-Zinn said it and wrote a book about it, and it feels apt as I write about trust.

I was diagnosed with stage 2, grade 2 breast cancer a little over two years ago. I had a double mastectomy and reconstruction, and though I was given a 91% chance of no recurrence, I found myself anxious about that nine percent, nonetheless. The younger you are at diagnosis, the (theoretically, at least) longer you have in which cancer can recur. After all the medical interventions, I was left with a scarred body and a deep distrust for whether it could fight cancer off in the future. I didn’t feel I really knew without any doubt what had caused it, and I didn’t know whether all the supplements, lifestyle adjustments and medical interventions would stop me from dying a premature death from cancer. I carried a deep sense of dread that all the early life trauma I’d experienced had so damaged my nervous system and my body that there was nothing I could do to undo that and its ripples in my life.

I teach meditation, something that I restarted after cancer. Given a clean bill of health by my doctors but still deeply anxious, I realized my greatest enemy wasn’t cancer but my own mind. I couldn’t tell you how many days, months or years I had left to live, but I could tell you I wasn’t present for my life now because I was too caught up in anxiety. So I returned to seated practice, to various somatic (body-based) practices to help calm my anxiety, and I recently attended a week-long meditation retreat, including four days of silence, in order to support my practice and my work as a teacher.

I shifted two aspects of my practice, based on the instruction at this retreat, which was based on mindfulness meditation.

1. Rather than observing sensation in the body as if one were standing on a river bank watching the river (which I had done previously), work to be in the flow of the river itself, experiencing the sensation moment to moment.
2. Practice compassion and welcome toward whatever arises. I’d previously practiced non-judgment, but this shift involved cultivating a sense of warmth and kindness toward the experiences that I had.

On a retreat, we have a rather intense opportunity to observe ourselves without distraction to an extent that is generally not possible. Without electronic devices and social interactions, I had the opportunity to be social with myself.

As we sat in meditation, and I began to doubt that all the work I was doing really had a purpose, our instructor (Fleet Maull) encouraged us to trust. He asked us to consider who might need us to “deepen,” a shift of perspective that helped me immensely. Who in my life could benefit from me deepening my consciousness, my compassion, a shift out of reactivity? I could think of many, and it buoyed me.

I returned to my practice, and I found so many arguments arise, though. Trust? Why should I trust? Life feels inherently unsafe. Spiritual, medical and intellectual leaders betray us all the time. I don’t even trust that there’s a religion that has answers; each religion seems to get in its own way at some point, taking a good message and using that message to control people and further an agenda that seems far from God. I could say more, but I think this was representative of my arguments against trust, representative of my fear.

So I sat with my fear. I felt it as it coursed through my body, twisting my intestines, creating a sharp pain in my upper left chest (right in the spot where my cancer started). And every time I became aware of it, I met it with compassion. I welcomed it. I “invited it to tea,” as Tara Brach suggests.

Silent sobs wracked my body. I went back to childhood and infancy in my mind. I felt my mother’s profound disconnection from me; as a paranoid schizophrenic, she was utterly incapable of seeing my needs as what they were – normal, human, baby/child needs for attunement, care, nurture. As I felt those childhood wounds, the pain in my chest resonated in response: yes, here is where that pain wounded me. I held it with all the intensity of a mother holding her wailing, inconsolable child. Every mother who ever inspired me with her example of tenderness (and I have been blessed to learn from many good mothers in my life), was with me now as I held that younger self and soothed her. I witnessed her suffering with compassion and tenderness. I acknowledged the depth of her suffering.

I don’t know how long this took, how many days of sitting passed with the waves of this process coming up, receding, returning, receding. Eventually, they calmed. I could still see that child in my mind’s eye, and I continued to honor her experience, but she receded, as well. She became smaller and less central to my awareness. Fleet told us at the beginning of the retreat that we would have “front row seats” to our own minds, and I envisioned it as a circus. The wounded child was in her own ring of that circus, but others began to arise in my awareness.

At some point, I found myself asking who I was before the abuse and suffering of my early life, and immediately an image of my earliest self appeared in my mind’s eye: a radiant being with wise eyes and an easy smile. Oh, that’s who I am! I thought. I was also flooded with warmth and love for my mother, something that had been twisted and flattened by the tortured years of our relationship. I loved her so much! Of course, I internalized all that pain – what else could I do? I loved her and protected her, and we both did the best we could. I was also inundated with gratitude for all the people and resources who had given to me over the years: examples of loving kindness, of generosity, of teaching, of mentorship. What had seemed like not enough for decades shifted to feeling abundantly filling and satisfying. As this process unfolded, the pain in my chest ceased, and I felt a shift in my body’s energy and my alignment; I envisioned a stream of river that had been diverted to the left side of my body by trauma. Now it was back to the center and flowing upward from there.

I saw one other thing: I saw that I had never been separated from the fabric of the Universe. I lost my bearings and felt I was separate from God, from others, from myself. The analogy we hear in meditation instruction is that of the ocean and the waves: our thoughts and emotions are the waves, and we can feel that they are real. However, if we drop below the surface a bit, we find the stillness and calm of the ocean. In my practice, I’ve begun to contact that ocean and to realize it’s much bigger than my own experience. It is the nature of God Himself/Herself, and I am never disconnected. I may become distracted by a lot of shiny objects, but I can awaken again and again and again to this connection.

I began this blog talking about trust and restoration of trust after cancer, and this process has been key for me personally. The biggest fear I had after diagnosis was that I would die soon, and that I would leave Isaac without a mother. The terror of him going through that pain was unbearable to me. What I didn’t see two years ago and for awhile beyond was that cancer was giving me a chance to re-explore the wounds from my childhood – the terror of separation from Mother and all she represented – and to heal. To find my place in the fabric of things, and by extension, Isaac’s and everyone else’s place in that fabric. The deep anxiety in my gut that is very tied with real fears in my childhood is no longer necessary; it has permission to soften, to relax, to allow others to have their own experience. I no longer need to control that, or control my own experience. I am inherently safe and inviolable.

Though I do not agree with everything the Apostle Paul said, his letter to the Romans (Chapter 8, verses 38-39) came to mind during my meditation, and I felt the truth of the words in a way I struggled to for decades after I first read them:  

For I am convinced that neither death, nor life, nor angels, nor principalities, nor things present, nor things to come, nor powers, nor height, nor depth, nor any other created thing, will be able to separate us from the love of God, which is in Christ Jesus our Lord. (New American Standard Version)

I don’t know what anyone else’s healing looks like, and I can’t recommend that everyone do what I have done. But I share my own story to give others hope that deep healing is possible; that cancer and its terrors and pain are not forever or all-encompassing; that healing is more than recovery from the cancer, surgeries and medical interventions. We are more than our suffering. May we all find our way home.

 

 

Heavenly Father v. the Earth Goddess: cosmic battle or splitting hairs?

I’ve been a religious convert in my life. At 13, I invited Jesus into my heart, and I had a genuine religious conversion: I felt my connection with God and knew, finally, that I was not alone. After a childhood of increasing alienation, pain and abuse, I needed that sense of connection in a profound way, and I still see that conversion in a positive light.

But evangelicalism adds a layer to the spiritual experience that I only later discerned wasn’t actually a necessary part of my religious life. When my church friends and ministers said (all of them) that it was necessary to study the bible, pray, do missions, give 10% of my income to God (that would be gross income), remain a virgin until I was married (and keep my thoughts “pure,” as well), evangelize, not swear, respect my parents, be a submissive woman (and not speak with authority to men), dress modestly (whatever that means), and so on, I did my best to comply. I also became aware over time that there was no chance of actually living a life that was pleasing to God.

Now, I know what an evangelical would say: that’s the point! We can’t possibly live a life that is pleasing to God, which is why we need Jesus and his substitutionary death on the cross. However, it seemed that most Christians were pretty intent on having both: living a perfect life – or at least projecting one – and Jesus’ grace. It was like super-sizing your grace experience: God’s grace + your own awesomeness = even more grace! Woohoo! Keep striving for perfection, and keep your eyes on a Heavenly Father who will make up for your faults in heaven.

Eventually, it became obvious to me that what I’d heaped onto my own experience of God’s grace at the beginning was actually soul-killing. It added to my sense of shame and worthlessness and kept me from thinking of anyone but my own image. I left that faith in 1992, at the age of 23.

I’m 48 now. I’m not actually a convert to the earth religions, but it becomes clearer and clearer that we are intrinsically connected to the earth. Everything we put into her, we get back. We quite literally reap what we sow. Pour chemicals into the earth? We get chemicals back. Pump chemicals into the sky? We breathe them in. It’s karma: we get back what we give. The Earth Mother cannot give us nutrients from anything other than her own body, and we have callously poured filth into her. Some of us wonder why we get sick, why people suffer. It’s as if we have a very strange sense of amnesia about actions we continue to take in which we are actually poisoning ourselves, here and now.

What if “sin,” or “missing the mark” is not about some abstract concept – some stamp on the soul that is unseen but makes every action we take incapable of pleasing God; and sin is, rather, that we do the very thing that harms us and others, with impunity? If we fling our filth all around us and wonder why we and those we love suffer?

I understand why a miraculously interventionist, above-it-all Heavenly Father is attractive at this point. “God is in charge,” my evangelical friends say. We really, really want to be rescued from our own destructive actions. I get that. I really wish that we would not have to reap what we’ve sown and what we continue to sow. I wish we could get a heavenly squeegee to suck up oil spills out of our water – or lead, for that matter. I wish that years of spreading glyphosphate on our plants and earth had not caused our food supply to be contaminated. I look at my child and the children of my friends and wish for them to have safe food, air, water. And these are the privileged children! What about all the precious children who do not have the resources of filtered water, good healthcare, expensive organic foods?

What if God would, with a sweep of his hand, create a new heaven and a new earth and wipe away our sins – our flagrant disregard for the equation: reap = sow?

Religious leaders play off this division of an abstract Heavenly Father and the very concrete Earth Mother. It’s like the children whose father is off to work, taking advantage of their harried mother. These leaders will parse the scriptures to undermine the Mother’s significance, will tell us that they alone understand the precise way in which we must approach the throne of God in order to be right with him. “Reaping what you sow” becomes a mysterious accounting system, behind the veil of our earlthy ignorance, and they speak as if they had had a peek behind that veil.

I’m a cancer survivor. I also have family members and friends who have had cancer, some of whom have died. I frequently work with cancer survivors. I hear and read cancer-related information all the time, ranging from the personal devastation of the diagnosis to the medical perspective on its causes and treatments, to the complementary medicine perspectives on the same. I see over and over how it impacts individuals and their families, their extended communities. Its tendrils extend far and wide.

Some people try to deny that our explosion of cancers has anything to do with the poisons in our environment – our food, our air, our water. We throw up our hands: it’s just some random genetic anomaly. What can we do? But when you add carcinogen after carcinogen into everything we consume and interact with, eventually, it’s hard to deny that it may have a role in our cancer rates.

It would be nice to have a Heavenly Father – someone above and outside this earthly existence who can and will sweep away all our sins and leave us pure as snow, the earth returned to her previous glory. Silly us, for ever doubting that it could be so! Silly us for thinking we sinful beings could do anything to change the inexorable will of God regarding the number of days of our lives. Silly us for thinking we are powerful and could do anything to shift the course of our own futures.

But what if that is a convenient construct that allows us to sin with impunity against the earth on whom we depend for every breath, every bite of food, every sip of water? What if she is not a “thing” God gave us, a commodity we will throw out in order to get a new one in the future? What if she is, rather, a precious gift, given to us to be tended, to be loved and cared for, her dust the very thing that makes our flesh, her resources a metaphor for the tender care of the Divine for Her children?

I understand the desire for an intervening Heavenly Father, but I fear we have desecrated the Mother and will continue to suffer until we have learned our lessons and changed our ways. And what Good Father would be pleased with children who violate the Mother? It’s an important question with which to wrestle. What if it’s not “Earth Goddess vs. Heavenly Father,” but rather two parents united, and we not only need to face the music in the future (in a wait-until-your-father-gets-home sort of way) but are facing it more and more loudly every day?

Holding diagnoses with a loose fist

Words. Diagnoses are words, and they can either serve us, or they can bring us to our knees. When I try words on for size, any labels at all, any lists I make, I ask myself who is serving whom. Do the words serve me, help me to do better, help me to find my wholeness? Or do I become enslaved to the words, afraid of their weight?

Cancer was a diagnosis that gripped my heart, guts and mind for many months. It grabbed them and gave them a twist, often at 3:00 a.m. I used meditation and journal writing (and still do) to pry each talon out from the tender flesh of mind and spirit and to tame the words of that diagnosis into something I could use as information for my own good, rather than as a curse.

I wrote a blog post a few days ago about my back pain, for which I was finally able to get into the chiropractor/acupuncturist’s office. I’ve gotten a lot of relief from that appointment and am very hopeful about the care I’m receiving. But I also find myself back in the seat of “patient,” and making decisions about how I hold the various labels, the bits of information I glean from that time.

With every new practitioner I meet, I repeat my history. I’m reminded that I have genetic, environmental, and behavioral factors that could set me up for failure in the health arena. When I first started to name those things in decades past, to put labels on them, it distressed me greatly. Each one felt like a fatal flaw. I could never be perfect like so many other people seemed to be. I decided to overcome, to fix, to heal.

Cancer came along and was a blow to that effort.  At first, I thought, “Wow, all I’ve done my whole life to try to fix myself has culminated in this. That didn’t work out quite the way I’d hoped and planned.”

But it also set me free.I got a flash of insight during those early days of diagnosis and surgeries that I’d been wasting my time with self-hatred and efforts to fix myself. What I needed was to love myself. Absolutely every part of myself, without reservation. Whether I had weeks to live or decades, I knew that I didn’t want to waste my life on earth in self-hatred.

Back pain was a temptation to return to the urge to try to crawl out of my own skin. It can be frightening to be in pain and not know when it will end, in much the same way  it can be frightening to inhabit a life with what feels like a death sentence hanging over it.

I have learned to hold all the words, all the labels, with a loose fist. They don’t define me; they can help me to make choices, but they aren’t me. I am more than the categories of my ailments, and if my care providers don’t understand that, I need to do my best to either educate them that that is so, or I need to move along.* If a label doesn’t help me, I let it go. If it helps me to care tenderly for myself, to love life and life-affirming action, then I use it for that purpose.

 

*Dr. Janine Pulley, North Andover, Massachusetts is the chiropractor/acupuncturist I went to, and she is awesome. I don’t have any criticism of her care or her attitude about me as a patient.

Layers of Healing (and tools for the archeological dig)

I’ve been back to meditation and yoga since shortly after my cancer experience in 2015. I got back to meditation first, and when I’d healed from my surgery, I returned to yoga. I’ve had generally good progress in feeling well and strong. I teach yoga now, and each time I teach, I leave feeling invigorated and satisfied.

So when my back started hurting a few weeks ago, at a time of increased stress, I wasn’t too worried. It felt like muscle tension in response to stress. (John Sarno’s Divided Mind and Gabor Maté’s When the Body Says No have been wonderfully helpful in my understanding of psychosomatic influences on the body, and I highly recommend both books). I practiced mindfulness in response to the discomfort and tried to understand the nature of the tension, how I was “holding” the situation in my body, and tried to give my body what it required. It led to a deep exploration of body dialoguing, “contracts” and familial ties, and ultimately led to a shamanic journey. I still have some back pain, and yes, I’m going to the acupuncturist later this week. As a cancer survivor, I am always aware that aches and pains, fatigue and the like could be a cancer recurrence, and I want to attend to both the metaphysical and the biological needs of my being. In the meantime, this is what I can do. I think the cancers and other illnesses with psychosomatic origins come in layers of energy and behavior and environmental stressors. I’m picking away at the layers I can influence directly myself. I share here the story of this part of the healing journey. May it assist you with yours, particularly if the path is not straight, obvious or short!

 

***

I sit in therapy with my therapist, Jasmin.* I describe the sensation in my shoulder and my pelvis.

“It sounds like you’re being pulled in two different directions,” she said.

Her comment felt right. My pelvis seemed to be settling down. I want to sink into my own gravity. I thought. As I heal from complex childhood trauma and the retraumatizing nature of medical interventions, I sink deeper into my own body and inner truth. I used to be able to deny my feelings or perceptions, tamping them down with excess food or shopping or “zoning out.” The deeper my practices get, the less ability I have to separate myself from my truth. For that, I’m grateful and feel more deeply myself with each passing day. It’s a homecoming, and it’s generally joyful. But right now there’s an opposing energy.

It’s in my left shoulder. While my pelvis says, Let’s sink in deeper, my shoulder says, Oh no, oh no, oh no!

“Let’s go there,” Jasmin prompts.

I close my eyes, and I connect with the voice and the energy that are pulling me in the opposite direction. I feel very young, an infant or toddler. My eyes are closed. I can feel my mother’s presence. I can hear her saying, “I hate you. I wish you would die.” And in response, I made a vow, I’ll die for you, Mother.

I start to cry at the memory. I don’t know, and it doesn’t matter, if the memory is a literal, one-time event. The energy of it smacks of truth. The evidence of my life is quite clear: not only did I strive throughout my life to try not to make my weight felt by anyone, not to lean too heavily, even on those who offered, but I also subtly and not so subtly engaged in self-negating behaviors. In answer to the on-going mystery of why I would undermine myself, self-sabotage my successes, lay a vow.

The wave of grief and awareness that came with that realization grows, crests. Finally it passes.

I sit in silence, observing inward sensation and awareness. This is not the end. This is the beginning of a shift. What antidote do I need? What antidote do I possess?

Through the years I have been a parent (almost 11 as I write this), I have learned how to be a good parent. If my own son ever felt such a deep grief, I would wrap him in my arms and hold him close. I would affirm his drive to live, his right to exist. I would defend him against anyone who threatened him. The Good Mother in me is available for this part of the journey. I share this information with Jasmin.

I let the reality sink in. I am here for myself in a way my mother never could be, and I am here for myself in a way I could never before be. The pain diminishes, though it does not go away entirely. For the moment, this is complete.

***

Later, I think about that vow. Am I truly released? Or is a vow I made binding? It has surely felt binding.

Two lines of answer come from this inquiry.

First, I am aware that vows are binding in some way. Who will free me from this vow? Whose power do I call upon? I think about my early religious experience. Do I need a God who will step in and free me? Then something in me rebels. Vows made by infants are not legally binding; while that vow may have colored my existence for years of operating out of a childlike space, the Mother in me stands fiercely in my defense now. She advocates for me now and declares me free. 

Next, I am aware of the ways in which I have, sneakily, not quite fulfilled my vow. I remember all the times I let my mother know how I suffered, whether from depression or an eating disorder or financial distress, letting her know that I was suffering, I was dying, I was playing small. See, Mom, I’m still loyal to you and not leaving you behind, my words and actions seemed to say.

But I was, actually, trying at every turn to find a way out, trying to find a loophole. How can I be fully myself, hear my calling, step fully into the Light and out of the shadows of this curse? I wondered.

Myth is a topic that arose in my inquiry. I thought of the classic Trickster. I was the kid who, when cornered by bullies, burst into genuine tears of fear and seeming submission. But as soon as the bullies abandoned their tormenting of me, and I’d gotten a block away, I turned and stuck out my tongue and cursed them, then took off running. Ha! Got away, and I got the last word in, I thought. I was submissive on the outside and scheming on the inside.

My evangelical roots would have called that deception and maybe even sin. I don’t call it that anymore. I find it to be one of the energies of life that makes me laugh now and ties me to life in a way that all my submission did not. I am alive today partly because I embody The Trickster. I am grateful for that force of life in me that strove for more, that was creative.

The earnest nature of my childish vow making – a vow which gave me a strategy for survival but which ceased to be workable beyond my childhood environment – touches my heart, and also falls into perspective now.

My back pain remains, dull now. Not too troubling, but an annoyance. I really hope it’s not cancer, I think, and wish I didn’t even have the thoughts.

***

I’m doing a mindfulness program (www.palousemindfulness.com) these days. In the middle of this back pain incident, I am practicing serious mindfulness, trying to stay present to what I feel and not check out.

In week three, I am doing “mindful yoga” as part of that program. In the middle of the first mindful yoga session, I am alone in my home office, doing yoga, feeling my still dully aching shoulder, and I want it to go away. I want to be done with this pain, done with the psychological, spiritual archeological dig that is my life. I want to move on, get busier with work, make more money, be hardier. Suddenly in my practice, I know what this feels like.

It’s like when I was a single mother to baby Isaac. A few weeks into parenting, it hit me: this whole “parenting thing” wasn’t going away any time soon. Sleepless nights and long days of full responsibility for another human being weren’t going to end soon. The full weight of my new role hit me. I am not going anywhere for a long time, I thought.

I lay on my yoga mat and felt the pain in my body, which got worse as I practiced, my chafing against my limitations and struggles and wept. I can’t abandon the baby, I thought. I am the baby. I am the child who wakes me in the middle of the night and who needs my kind attention by day, and I don’t get to leave her. I may want to “check out,” but there is nowhere else to go.

I feel a small sense of relief as I surrender to this reality. The resistance to reality adds to the suffering that only increases the pain.

***

The next day, I sit in meditation again. My pain has actually gotten worse. I have intense muscle spasm. I try to simply observe my discomfort, but it seems to require more of me. I expand my awareness and call on my “Team,” my spiritual guides, ancestors and teachers. I climb a tree in my mind’s eye. I sit on a branch and wait.

A large female gorilla comes to me. She sits and takes me in her arms. I see the type of gorilla I have seen in movies, but now I feel her energy in a very personal way. She is the type of mother I didn’t have and frankly am not: she is content. She chews on a leaf, eyes soft. She is heavily, bodily present; she doesn’t strive to be anywhere else, and she is not the least bit burdened by my presence. She holds me like a tiny monkey in her arms. She tells me with silent words that she will hold me; she does not mind. She is quite happy to be where she is.

I let that sink in.

***

Later, as my husband hugs me and gently strokes my tender back muscles, I let him. And let him. Tears well up. I let them flow, and I sink into his arms. The gorilla Mama comes to mind. She invites me to let the nurturing in. It’s not a burden to those who love me.

My back still hurts. I am not done. One reason I need to publish this piece is to help other trauma survivors know that it’s okay for there to be layers and iterations. If and when we begin to look at the psychological and spiritual influences on our body’s symptoms, it’s easy to feel some level of self-blame for our pain and suffering. I share this story because it has taken decades of therapy and my own professional studies and reading to learn the tools I employ, and even that doesn’t “fix” everything all the time. Sometimes, things resolve very quickly. Sometimes, like now, they do not.

Some of our answers come from within; some come from other people and other people’s gifts; some come from spiritual guides. And we don’t get a guarantee that “healing” will mean we have no pain. My suffering has diminished. I feel so much more able to be with myself, as I am, and with my life. Between these meditations, prayers, therapy sessions, and yoga practice times is life. I cook meals, eat with my family, go to work (or find a sub because I can’t teach right now). Life goes on, but I’m not making my pain worse by my resistance to it. I am not entirely well, but I feel so much more healed than when I began to deal with this a couple weeks ago.

Wishing you peace on your own healing journey, whether it is simple and clear or something else today.

*Jasmin Cori is a psychotherapist in Boulder, Colorado with a deep understanding of trauma. She has written multiple books, including, The Emotionally Absent Mother and Healing from Trauma: A Survivor’s Guide. Her contact information and books may be found at www.jasmincori.com.

 

The Wisdom of the Mother (alternately entitled: Don’t Shit Where You Eat)

I am a woman. I am a mother. I am a cancer survivor. I have been a body worker, a meditator, a yogini. I have participated in Gender Reconciliation work, M. Scott Peck’s Community Building work. I have walked a path of inner healing and physical healing, and I have shared that path with others in my work. I have a particular perspective on current political events and broader world events.

I am very aware that our culture not only undervalues women; it doesn’t actually perceive the Divine Feminine in men, women, children, or the Planet. The Feminine is quite literally invisible. Machismo, brute force, power over, individualism are a comic book version of Masculinity, and they are exalted and revered, separated in some sort of sick, psychic surgery from any balancing power. The Mother, whether she washes dishes, soothes a sick child, or resides beneath our feet as the Planet who feeds and holds us, is invisible. We step on her without awareness for her consciousness. We don’t say thank you. Her work is not valued. God help us if we have emotions or intuition! Because no outside authority stamps them as “Truth,” they are fluff; they are a mere distraction from productivity and consuming. Story is seen as child’s play, rather than as our creative force expressed in the world. Our art is entertainment, rather than the means by which we digest life and use its nutrients to heal and grow. The power of attention and deep listening is something we feel but have so few words to express. The ability to hold experience – our own or someone else’s – takes our breath away when we experience it, yet it is so hard to find language to describe.

 

I come from a patriarchal, Christian religious background. It never occurred to me when I was in it to question where the Mother was. It was a given that God was our Father, but the marked absence of the Mother was never spoken, seen, acknowledged. It strikes me as the height of hubris to assume God would declare himself Father without a Mother. I don’t think it was God. I think it was men who didn’t value the Mother who decided anything that smacked of feminine religious experience would be demonized. Divination? Satan. Intuition? Witchcraft. Emotion? Sin. (I am not saying that these things are the realm of women only; I am saying that if it was considered to be “of women” by those in power, it was historically branded as evil by those who could not control it.)

And now we face a United States in which our religiosity has led to Donald Trump. He is the expression of evangelical Christianity and its immoral angling for power at the expense of integrity and the common sense of the body. When we are aware of and in connection with our bodies, we don’t pollute our water and our air. We don’t poison our soil. Or, as my own mother would have said, “You don’t shit where you eat.”

But we seem to have a deeply held belief that drives our actions that says we can take without giving; we can have power over without responsibility for care.

Breast cancer was a deeply physical and spiritual disease process for me. My breasts being cut off felt like both a physical violence and a metaphor. The bar is closed, folks. Back off from the nurturing of others at your own expense, mother. You need to protect your own resources, or you will die. You will have nothing left to give, my cancer experience seemed to say.

I dove down deep, went inward. I found there the wounds of my earliest childhood, wounds passed down from an equally wounded mother. She could not validate my feelings, my experience, my existence, and so I walked through much of my life with a gaping hole where the validation of my being ought to have been. After cancer, I dove down into that wound, feeling instinctively that healing that energetic part was essential to my greater healing.*

Then Donald Trump became the president elect. As I write this, he will be inaugurated tomorrow. Every intuitive cell in my body says he is dangerous to our survival, not only the United States but also the whole interconnected world in which we live. He’s the proverbial drunk, molesting uncle you shouldn’t leave alone with your children, and his own words indict him as such. But his over-masculinized form of power and control – so valued by a vocal minority – have positioned him to rule.

I dive down deep into my own healing again. I am learning as I get older that all my grief and fear is something I need to own and love. But I cannot stop there, not if I take seriously my responsibility as a mother who simultaneously protects The Mother and depends upon Her. I must protect the sanctity of my inner wellbeing.

Light bearers right now are something like a single parent. The father figures at the helm have power, but they take no responsibility, and they aren’t living in the trenches. We need to dig deeply into our known experience; heal our wounds; love life; and love powerfully, love deeply, love wisely. We must say no to the violence, even the violence we perpetuate against ourselves. Maybe especially the violence we perpetuate against ourselves. We need to dig deep and find words to bring our divinity to awareness and to own its power, the legitimate power of fierce, gritty love; the transformative power of quiet presence; the healing power of embodiment. Let us all find within us the Good Mother, and in so doing protect The Great Mother.

 

*A great body of research and literature exists on the role of early life trauma and its impact on life expectancy and disease processes. Two great books on the topic include Gabor Maté’s When the Body Says No and Bessel Van Der Kolk’s The Body Keeps the Score. This is not to blame anyone for their individual diseases, but rather to show that generational trauma impacts generational health. Personally, I empower myself to know that I am not helpless in the face of those traumas; I release blame, as it does not help me to love whatever lifespan I am given on this earth.

Spiritual practice: loving all our parts

Out of my cancer experience, I developed a personal practice in my meditation that has come back to help me over and over again. I’ve shared it with meditation students, and most recently, I shared it in the context of a sermon at North Parish Unitarian Universalist Church, where I attend with my family. One of the lessons of cancer was that hating parts of myself was not getting me anywhere, and life was too short to spend trying to fix myself any longer. What to do, then, if I was not trying to fix myself?

While those who are familiar with IFS (Internal Family Systems) therapy will find this meditation to have overtones of that system, I did not start with IFS in mind. I simply sat with the stark awareness that my anxiety, defeatism, self-pity, collapse (and so on) were there, and I wasn’t pleased with my relationship to them.

What follows is the text from my sermon. In order to experience the full impact of the text, however, I would suggest reading in a quiet place, with a 2-minute timer (or longer), and engage with the practice. An intellectual reading of the text will not have the same impact.

What is the sound of one Unitarian loving?

My husband, John, and son, Isaac and I moved to Andover in December 2014 from Boulder, Colorado. We knew we wanted a church community that gave us a place to explore our questions, form connections and provide an opportunity to serve. This was one of a number of places we visited in spring of 2015, in between snowstorms.

In late spring, we had a huge shock: I was diagnosed with breast cancer and told I would, at the least, require a mastectomy. I didn’t know right away about whether chemo or radiation would be suggested. I chose to have a double mastectomy because of questionable spots on the right side that turned out not to be cancer.

We were here then, and this congregation became one of our anchors through a very difficult time. We were used to being the ones who were at church all the time, serving others, and we were in the unusual position of needing to be served for a while. The Caring Team brought us food. Lee and Wendy spent time talking with me over coffee. Our whole family went to Ferry Beach about two months after my surgery and before my reconstruction was complete. It was a surreal and strange time in my life, and North Parish Church was a place to help anchor me, a place where I could be while I got my sense of orientation back.

I felt disoriented for a long time, and I was deeply anxious and depressed, despite a good prognosis. I didn’t need chemo or radiation, but like every cancer patient, I have a statistical chance of that same cancer coming back. I had to face that I might have encountered the thing that would ultimately bring me down. If you’ve ever had a cancer diagnosis, you know that from that point on you are a “cancer patient,” and your chances of recurrence are always something you ponder.

My ponderings were the kind that woke me up at 2:00 in the morning for months, and through the recommendation of a therapist, I returned to meditation practice, something I had not done consistently for a number of years. I found that my strategizing, logical mind had reached something of its outer limits: it could not give me certainty, and it most certainly could not give me peace. I realized that if cancer didn’t kill me, my anxiety was destroying my life.

Rather than speak too much about the stories of things, though, I want to move into the reason I’m standing here this morning and my hopes for the rest of our time together.

Fast forward to this spring, and I was in a much different place within myself. I was sitting with Wendy having coffee and talking about my recent return to work, this time as a meditation instructor at the YMCA (Andover/North Andover). I told her about a meditation practice I worked with frequently within myself, and how I liked to share that with students when appropriate, and she asked if I would speak to you about that.

Speaking is great, and I could talk with you about the practice at some length, but practices are best experienced first, and perhaps spoken about later, if at all. A weekend seminar isn’t satisfying if you don’t walk away with a 500-page binder to digest later (and the binder seldom gets opened after the fact). A simple practice is different: it’s about selecting one of those lessons from the binder and working with it over and over, until you’ve thoroughly explored its depths. Let us move together into practice, and I will help you transition back into the room when we’re done.

Position: sit upright but relaxed, hands loosely in lap. Breath naturally. 

Your awareness is in your body. The breath is a good access point. Turn your senses inward.

I will speak a little as you sink into the awareness of your body and breath.

Please continue to keep your attention within yourself, with body sensation and the breath, and simply allow my words to guide you. (Sit for 2 minutes of silence, sinking into this awareness. Ring singing bowl to indicate the end.)

Regarding the nature of distractions: they are normal. Let your many thoughts and the sounds in the room be like scenes on a movie screen, passing by, and return to your breath.

Imagine if you will that who you are is a busload of children. Many of them are the parts of you that you like very much: the part that plays piano, is good at your work, is a good parent, the person who makes friends easily. These are the children who often sit toward the front of the bus.

But moving back on the bus, we find the parts of ourselves that are perhaps a little less well behaved. They’re the parts of ourselves that we can’t seem to control, even after decades of self-help, shame, self-discipline, therapy. In truth, we wish we could eject them from the bus, but we all know that’s not legal (and it’s impossible when they’re part of yourself).

In your mind’s eye, select one of these “children,” that is, a thing you do not like about yourself. Walk through the “bus” of your life and select one thing for the purpose of our meditation.

This is controversial – we are often encouraged to focus on what we like, or to quickly transition away from our negative interpretations of ourselves into something positive. If you end up not liking this practice, you can avoid ever doing it again. But for a moment, please choose a thing you do not like about yourself. One of mine from last summer was my anxiety. Another was how easily I felt defeated and hopeless. Another was how I missed the joyful things of my life because I was obsessing about possible future scenarios. Pick just one item from your list.

For those of you who cannot find one thing you do not like about yourself, first of all congratulations! Some people have worked on this a long time, and they no longer reject parts of themselves. You can help everyone else in this room out by focusing on a loving heart and radiating that out to the rest of us. And thank you.

For those who have a “thing,” I want you to think about it for a moment, but without judgment. Notice when you think about that thing, where you feel it in your body. Notice the sensations. Notice if in your mind’s eye if that sensation has a size, shape or color.

Let us take a moment or two to just sit next to it in our mind’s awareness. Notice it. Don’t judge it, move toward or away from it. Just stay with your awareness of it. Breathe. Stay with the sensation that arises from it. If the sensation changes, allow it to do so, but please do not try to do anything to change it at this time.

Meditate for two minutes. I will ring the singing bowl at the end of two minutes.

Let’s take the meditation a step further.

If you could have changed this thing in yourself through self-hatred, self-improvement, shame, self-discipline, you probably would have. Of course, you’re welcome to keep trying. But for the sake of our meditation, I would like you to imagine an ideal observer: a dear friend, a loving family member, a compassionate, skilled therapist – someone who is kind, loving, an excellent listener. Imagine then that person coming onto the bus and sitting next to the part you’ve chosen to focus on. You are intent on listening to this anxious, undisciplined, rude, critical, slow, not-so-wise part of you to understand it rather than change it.

With this type of awareness, sit with that part of yourself for two more minutes. I will ring the singing bowl at the end of two minutes.

Before we emerge completely from the meditation, I would like you to scan the area of your body where you first focused on sensation. Notice if that has changed size, shape or color. With all eyes closed, please raise your hand if you noticed some type of shift.

Thank you.

Just a few closing thoughts..

Another analogy gave me a mantra I use frequently. Are you familiar with the ad campaign “Don’t shake the baby?” Why would we have to create ads to tell us not to shake our babies? Because we know that when we are frustrated and super tired, even the most caring amongst us can lose our cool and become less than our highest selves. Lack of sleep and time to ourselves can make us violent in words and in deeds.

When it comes to our inner selves, we can be very tempted to become violent because our behavior within is invisible. We’re angry that we couldn’t control and change what we don’t like within ourselves.

I have learned to make it part of my inner practice never to “shake the baby.” Yes, there are things I wish I could change, but becoming angry with them never makes them better. If anything, war breaks out within me, and I become even more destructive.

The practices I’ve shared with you today are simple: sitting beside the parts of ourselves we dislike; reminding ourselves not to “shake the baby,” even if the baby is the part of ourselves we can abuse in the darkness and privacy of our own minds.

The title of this message was “What is the sound of one Unitarian loving?” Today, each of you took a moment to “love” yourself; loving is not always (and according to Scott Peck, rarely) about a feeling. It’s an act of will. Some of us assume we do not love ourselves because we don’t feel warm and fuzzy toward ourselves. The act of paying attention, of deep listening, of cultivating patience in our approach to these parts of ourselves we don’t easily make peace with is, itself, the act of love. As we spend time with ourselves in this type of experience, we become more skillful at loving the “other,” the actual rowdy child on the bus; the co-worker who behaves in annoying or even destructive ways; the politician who betrays our trust. Loving ourselves changes everything.

(Readings from M. Scott Peck’s The Road Less Traveled were read from the chapter entitled “Attention,” as well as excerpts from Richard Rohr’s The Illusion of the Autonomous Self.)

Yoga for Breast Cancer

The following is a research paper I wrote for my yoga teacher training. In it, breast cancer patients, survivors and their families may find some helpful resources and approaches to finding stress reduction and health-promoting tools for mental and physical well-being. I referenced many books and research articles in the “Sources” section, and I invite those who are interested to look for good resources there. Namaste. 

 

Yoga is one of the means by which cancer patients and survivors can actively take a hand in their own healing. They have the ability to manage their mental and emotional landscape through a potentially traumatizing situation; they have the ability to re-center and tune in to body wisdom when the entire healthcare system encourages them to look outside themselves to (sometimes conflicting or ambiguous) data and experts for guidance; they are able to actively cultivate an attitude and perspective of empowerment rather than helplessness; and they can actively work their bodies to prepare for surgery/treatment, to remain strong and healthy through treatment and surgical recovery, and to maintain their health after their active treatment has ceased. With awareness and sensitivity, a yoga teacher can adapt the yoga class to meet the needs of breast cancer patients before, during and after treatment to be a powerfully supportive experience.

This author will attempt to answer the following three questions regarding yoga for cancer patients in this paper:

1. What are the some of the key challenges the cancer patient faces for which there is evidence that yoga can make a positive impact?
2. How do we adjust the yoga practice for patients prior to treatments (after diagnosis), during/after treatments in order to make the practice effective, safe and meaningful?
3. What particular cautions should teachers have in terms of their own boundaries, emotions and agendas?

The challenges and the evidence

The cancer patient yoga student potentially faces a number of challenges to the body and mind.

• Trauma: A sense that the body is no longer a safe place, that the body has betrayed the person. It’s difficult to feel “normal,” and a state of hyper-arousal occurs, making it difficult to find a sense of wellbeing.
• Loss of a feeling of personal power. Doctors and “experts” will tell the patient what treatments or lifestyle changes they should make (whether allopathic or holistic doctors); the patient may lose a sense of having meaningful choices.
• Existential concerns: Anxiety about the future – biopsies, surgeries, chemotherapy, radiation, reconstruction, lifestyle changes, impact on one’s partner, children, extended family, impact on career and finances; even after one is done with treatments, there is statistical chance of recurrence to contend with. Awareness of a desire for lifestyle changes, enhanced enjoyment of the life one has left (whether that appears to be a long or a short time), the uncertainties that exist in terms of prognosis, coming to terms with one’s own mortality (whether it is an imminent threat or an existential coming-to-terms) and a desire to be proactive in one’s healthcare landscape and live a meaningful life.
• Physical: Maintaining physical health leading up to surgery and treatments, despite sleep disturbance, appetite changes (from anxiety), and depression; maintaining physical health despite the pain, sickness and fatigue from chemotherapy, radiation, steroids and/or surgical interventions. Recovering a sense of physical wellbeing after treatments are complete; scars, limited range of motion, pain, lymphedema, body consciousness (feeling damaged), neuropathy, and hormone therapies (sometimes including induced menopause).

 

*This list of factors comes from my own personal experience; interaction on cancer support groups; much general reading (specifics are cited later in this paper). It is not a complete list but should at least serve to provide a sense for the complexity of what the cancer survivor may encounter.

Trauma

Jayan Landry and Jasmin Cori are two therapists who work with trauma survivors and encourage their clients to use somatic practices to regain and maintain a sense of safety in the body.

Cori defines trauma in laymen’s terms when she says, “Trauma is by nature terrifying and completely overwhelming. Something is happening that you can’t control, and it feels big enough to destroy you. In fact, your awareness that you are endangered is an essential ingredient of trauma. It is the perception of a direct threat to your life, well-being or sanity that marks trauma. Freud recognized this when he said that in trauma a person feels completely helpless and ineffective in the face of what is perceived to be overwhelming danger.” (Cori 2) Jayan Landry echoes Cori’s definition, and adds “diagnosis of terminal illness,” specifically to the list of potentially traumatizing events. (Landry 22-23) Cancer is, frequently, a traumatic diagnosis, followed by traumatizing treatments, which themselves have the power to kill along with their promise to cure or at least prolong life.

Cori also points out that people who have been traumatized often see the body as the “scene of the crime,” and she specifically recommends yoga as one type of exercise one can use to regain a sense of restored safety in the body. (Cori 184-5)

When one navigates the healthcare system with a breast cancer diagnosis, one rather quickly finds out, if she** didn’t know it already, that her body is divided into parts that are treated as separate entities. Even the same body part (breast) may have at least two surgeons: the cancer surgeon and the plastic surgeon. There are many other professional caregivers who get involved in the care: pathologist, anesthesiologist, oncologist, nurses, physical therapist. However, unless the woman shows obvious distress or requests specific help, it’s unlikely that anyone will ask how her spirit is, her heart, her intuition, what her inner wisdom is telling her, and what her mind needs in order to not drive her crazy in the middle of the night.

**(Breast cancer affects women primarily, though a percentage of men will also receive a breast cancer diagnosis. For the purposes of simplicity, I will use the pronouns “she” and “her” throughout the remainder of the paper to refer to breast cancer patients, but the reader is invited to substitute the appropriate pronouns for male yoga students/breast cancer patients.)

Yoga is a tool of empowerment –

an ability to control your own recovery plan.

(Prinster 110)

 

GlobalCures is a not-for-profit and free resource (located near Boston) for cancer patients of all kinds (not only breast cancer), and they research and share data with cancer patients regarding the “global” cures that have supporting data of their efficacy. They have published a blog based on the existing research to support the role of the mind-body connection of yoga and meditation that also touches upon the link between stress hormones and tumor growth (to date, no one has proven that stress causes cancer; however, stress hormones do cause existing tumors to grow; this is of particular importance for our post-treatment cancer patients, whose stress levels may be high for any number of reasons, and we will want to support them in reducing the emotional aspects of a life post-cancer). (Brown Web)

One author says, “While many members of the general public believe that stress can cause cancer, there is little scientific evidence to back this notion,” (McCall 208). That is technically correct: we don’t yet have scientific evidence that it causes cancer; however, we do now have scientific evidence that strongly suggests it causes tumor growth once a person has it. (Lutegendorf Abstract) There’s a compelling argument that the stress reduction benefit of yoga (and meditation) can be an important adjunct to one’s cancer care strategy for preventing recurrence or for managing a chronic condition.

William Broad has done a great deal of research on yoga’s proven (and disproven) claims. He noted a study on GABA (gamma-aminobutyric acid), a neurotransmitter and helps regulate the nervous system. “Many reports have linked depression to low GABA levels…[and] high levels of the neurotransmitter have a calming effect.” (Broad 99)

One research study showed that “brains of yoga practitioners showed an average GABA rise of 27 percent. By contrast, the comparison group experienced no change whatsoever.” (Broad 100) These results were published in 2007. In 2010, another study showed results that were not quite as striking, but were still notable: “The average GABA rise was less than in the previous study – 13 percent versus 27 percent, or about half as much. Still the new yogis did better than the walkers. And, judging from the evidence, they felt much better about themselves.” (Broad 100)

Often in the breast cancer journey, women only find out after the fact what exactly the consequences will be for their various treatment options, or even what options will be offered to them. This happens for many reasons: many things are not known by doctors except step-by-step. Biopsy indicates grade; surgery indicates part of the staging (and sometimes reconstruction paths won’t be known except one surgery at a time); pathology report and scans often help complete the staging picture; in hormone receptor positive cancers, the “oncotype” score can indicate whether or not chemotherapy or hormone therapies will be advised; other types of testing of tumor-specific treatments are available and require that the patient wait for results. Essentially, there is a decision tree, and each branch determines the branch that will next be explored. It’s not possible – or even desirable – to explore all the possible options before one has been completed, and there isn’t much a cancer patient can do to hasten these processes. Unfortunately, it can be even more disturbing to realize, if one obtains second or third opinions, that even among the best doctors and facilities, there is different opinion on the same patient’s disease diagnosis, recommended treatment and prognosis.

What the cancer patient/yoga student can do is stay in the present moment with her body, her breath and her awareness. Yoga, meditation and pranayama can support this goal, and we’ll discuss the specifics of this in the next section on specific adaptations for the cancer patient yoga student.

“For women with breast cancer, yoga has been shown to reduce mood disturbance, anxiety, depression, anger, stress, and confusion, and to improve sleep quality, cancer related distress, and cancer related symptoms. Women participating in yoga programs during treatment reported improvements in their quality of life – for example, there was a significant reduction in nausea, vomiting, and fatigue during chemotherapy…yoga significantly boosted energy and helped the women accept their condition.” (Kollak 11)

“[T]here is evidence that yoga can enhance many physiologic processes of the body, including immune function, digestion, circulation, and sleep.” (Geffen 118)

Lymphedema is one possible side effect of mastectomy, even if only one lymph node (usually the “sentinel node) was removed (and sometimes many are removed from both axilla and arm). (Mclaughlin Web) Yoga can specifically be used as a therapy for moving lymph.

Regarding hormones: some types of breast cancer are hormonally caused, particularly those caused by estrogen dominance. We know from scientific studies done so far that yoga can shift hormone balance. How specifically this happens and whether or not yoga can be used so precisely as to reduce hormone production/receptivity for hormone receptor positive breast cancers is beyond the scope of this paper. However, this paper will give us a glimpse of what little we do know and what that information might lead to in future study.

It’s very important to ask if there has been research to show what effect the practice of yoga can have on the hormone system because many breast cancers are linked with estrogen dominance.

One test that came out of the feeling of invigoration Katil Udupa got from his own yoga practice, involved a dozen men who were tested over six months of progressively more difficult yoga practice. Broad says that the first postures were Cobra, the Spinal Twist, the Wheel, and the Full Lotus. “New poses added over the months included the Plow, the Locust, the Bow, the Shoulder Stand, and the Headstand. The pranayamas included Bhastrika and Ujjayi, or Victorious Breath. Overall, by modern standards, the training was fairly rigorous.” (Broad 168). On average, urinary excretion of testosterone rose 57 percent. “The results, the scientists wrote in 1974, suggested that yoga could prompt a ‘revitalization of the endocrine glands.’’

…”the little molecule can influence behavior and sexuality – doing so in both males and females. Not the least significant, studies showed that it acts to improve mood and a person’s sense of well-being. It seems likely that the hormone forms a significant part of yoga’s cocktail of feel-good chemicals.” (Broad 169)

Currently, there is not a lot of research about estrogen and yoga, but one small study in post-menopausal women (not breast cancer patients) showed “an abnormal estrogen-level increase after 4 months of yoga practice and showed QOL [Quality of Life] improvements.” That would be great, if one’s tumors were not estrogen-receptor positive! (Alfonso Abstract)

Further research on hormones talks about metabolic syndrome and estrogen. “There’s a relationship of metabolic syndrome/insulin resistance and estrogen receptor positive cancers, and one study showed that there is reason to believe even a very modest yoga practice (60 minutes, one time per week) positively affected factors in metabolic syndrome: In conclusion, this study showed that a 12-week Hatha yoga program for Chinese adults produced beneficial changes in waist circumference, fasting glucose, triglycerides, MetS [metabolic syndrome) z score, and HRQoL. The reductions in waist circumference and MetS z score did not differ between MetS subgroups. Given the low-to-moderate intensity feature of yoga, the high adherence rate, and the encouraging results of this study, yoga may be a promising alternative form of exercise for Chinese individuals with or without MetS.” (Holger Abstract)

Bottom line: we know that yoga can and does change hormone balance; we don’t know enough at this point to know whether that can be used specifically to enhance (or harm) the health of yoga patients. There is no known contraindication for yoga and hormone-receptor positive breast cancer at this time, and we should be aware of any research that comes out on this issue. (One could argue that increasing testosterone would help estrogen-dominant cancer patients; however, testosterone can “aromatize” into estrogen in both men and women, and so simply increasing one’s testosterone is not clearly good in the overall.)

Systematic reviews are very useful articles, as they look at all the available applicable publications on the topic in question, and they sort out the poorly designed studies and collect the best in order to make reasonable conclusions. One such review concluded, “Yoga appeared to be a feasible intervention and beneficial effects on several physical and psychosocial symptoms were reported. In patients with breast cancer, effect size on functional well-being was small, and they were moderate to large for psychosocial outcomes.” (Buffart abstract)

Yoga also was shown to reduce inflammation for breast cancer patients: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060606/ There is reason to believe that inflammation can actually be one of the factors that promotes metastases post-surgically, so reducing inflammation not only promises to reduce immediate discomfort but may actually reduce one’s chances of recurrence. (Sukhatme YouTube Video)(Forget Abstract) While we don’t know if yoga is as effective as the NSAID (non-steroidal anti-inflammatory drug) Ketorolac, as Dr. Sukhatme proposes in his video, the inflammation-reducing effects of yoga pre- and post-surgically might very well be helpful and could arguably be examined as a topic for future research.

“What’s the best exercise?”

The class asked one of my now forgotten instructors.

His answer?

“The one you do!”

So why yoga rather than any other mind-body integrated exercise? Yoga is not the only therapy that harnesses the power of the mind to heal the body or the power of the body to heal itself, but it is one of the few that has some research behind it to validate its claims scientifically. This is a fortunate thing for the yoga industry. I cannot say that yoga is the only system for whom the claims of mental, physical and spiritual healing are true; only that it has been the one that is lucky enough to have been singled out for a decent amount of study. Of course, not all of yoga’s claims stand up to the gold standard of the double blind study, but so far, a number of them do. Mind-body systems of healing such as acupuncture and herbs, Ayurveda, tai chi, qigong, all promise healing benefits. What I found for myself is what I would encourage my students to do: do their research and listen to their bodies and their intuition in finding a healing system that works for them.

There are a lot of healing modalities a cancer patient can tap into, and they are healing not because they always prevent death from a particular disease (though it’s possible they may) but rather because they affirm the essential wholeness and connectedness of the person to a greater Whole. The spirit, the mind, the heart, the prana are all taken as part and parcel with the body and, in this case, the breast. While one’s medical experience may promote a sense of being sliced, diced and disempowered, yoga is one of several healing modalities that reunites the fragmented pieces into a coherent whole.

One of my favorite books on the topic of holistic healing methods is Remarkable Recovery. While they were able to identify many different factors that contributed to the “remarkable” healings cancer patients experienced, they found that variety of experience was the norm, rather than the exception. “When it comes to investigating the barely delineated realm of mind-body medicine, there is no cut-and-dried methodology. Even accomplished Tiebetan yogis…leave leeway in their colorful descriptions of how mind might affect anatomy…the variations of their description point to the fact that the meditator or adept has to find them for himself.’ In this last sentence perhaps, is one of the great secrets to unlocking the resources of the healng system: No one’s key is identical.” (Hirshberg 95-96)

While the specifics leave room for creativity and individuality, the general scientific findings on yoga and cancer are very promising.

These days, we are fortunate to have yoga classes of every type in every U.S. city, DVDs and Blueray yoga, YouTube, libraries with yoga books and video. Yoga is plentiful here, and probably the most challenging aspect of getting involved is picking between the many teachers, methods and locations while also finding a teacher who understands limitations with compassion and wisdom. A lot of the yoga Americans want to practice is the Ashtanga or Forrest-type yoga, where they’re feeling like they’re getting a “good workout,” but the cancer patient or recent survivor may feel intimidated by that level of athleticism initially and will need some patience with themselves and from their instructors in the transition period. At the very least, they need instructors who understand some of the factors at play for a post-cancer exercise program.

Yoga may have more research and more reputable research because the culture of yoga has invited that type of examination, (Vishnu-devananda 11) (Broad 37-38) but also because it’s one of the modalities that invites a standardized, repeatable effort and result. “This is because it is very difficult to measure the strength or quality of one’s prayers. Meditation studies are easier to design because you can take a group of people and lead them through concrete steps to teach them how to meditate. That does not mean that meditation is the best spiritual practice there is; it just means that it is one of the easier spiritual practices to measure. I hope in years to come, researchers will figure out better ways to measure the effects prayer has on the physical body. Until then, the spate of well-designed studies on meditation, yoga and tai chi have shown conclusively that these spiritual practices improve the health of the body (e.g., improved circulation, better sleep, stronger immune system) and the mind (e.g., less stress, more empathy).” (Turner 229)

William J. Broad has dug deeply into the research on cancer, and while there is active political influence at play to dissuade scientists from studying it further, his conclusions are compelling: “In 2011, the (National) Institutes (of Health) began a new cycle of studies, despite increasingly tight budgets. They include yoga for cancer survivors…Opponents of federal research love to disparage yoga investigations as extravagant wastes of taxpayer money. In 2005, Human Events, a conservative journal, ridiculed yoga studies as symptomatic of the ‘bloated bureaucracy syndrome.’ Such criticism is likely to grow in the years ahead as political battles heat up…” What then are Broad’s conclusions, based on his research? “A much larger investment seems wise, given that yoga’s demonstrated skills at disease prevention might result in savings of billions of dollars in traditional health-care costs. The outlay is highly leveraged, as actuaries like to say.” (Broad 219-220)

Broad’s quote touches on the political environment. It seems a disservice not to mention that in the general population and the political environment, there is some opposition and/or skepticism about yoga. I do not quote from The Death of Cancer (Vincent DeVita) in this paper, but it is an excellent resource to understand the political and economic factors at play in the allopathic cancer industry, from someone who was head of the NCI (National Cancer Institute) for 26 years. For those who have an interest in researching this bigger picture of the dynamics within the cancer care industry in the United States, this is an excellent book. DeVita was not, by any stretch of the imagination, a fringe player in the world of allopathic cancer care. Additionally, I would like to point out that GlobalCures’ (Vikas Sukhatme is the founder and is referenced in this paper in regard to inflammation and metastases) approach to off-label medication and alternatives to existing cancer patient care has recently (June 2016) been endorsed by DeVita.

Specific Adaptations for the Cancer Patient Yoga Student

Overall perspective on the cancer patient as yoga student

The following approach is a synthesis I’ve formulated based on 13 years of massage therapy, often with clients who were physically or psychologically traumatized and dealing with serious physical illness or injury; my own cancer survivorship and yoga practice; a recent (spring 2016) completion of a YMCA LiveStrong cancer survivor exercise program; and a general understanding of how to approach cancer through Yoga for Cancer and Yoga for Breast Cancer; and from my studies and experience as a life coach.

“Without discounting the knowledge of your doctors,

you know your body and mind best.

As a yoga teacher, I can guide you into the pose

with my words and hands,

but I cannot know exactly what you feel…

it’s important to…know your physical limits

and what feels right for you.”

(Prinster 110)

Based upon my own background and experience, I will take the following approach for all cancer patients in my classes, at all points in the process of diagnosis, treatment and recovery:

1. Let the student know that she is in control of what she tries in terms of asana and how quickly or deeply she approaches the topic of mind-body connection (not assuming anything about her needs, but making room for them, if the exist).
2. Ask questions about the student’s goals for body and mind, and support her in her goals.
3. Invite her to pay attention to the breath and breathe into places in the body where she feels tightness or discomfort, as well as paying attention to areas where she might explore feeling her power, groundedness, expansiveness, joy, etc. Invite her to build upon and draw from her positive experiences; invite her to hold her negative experiences with compassion and gentleness.
4. Encourage her to practice equanimity throughout the class (i.e., non-judgment, non-reactivity) regarding whatever may come up.
5. Let her know that all feelings are okay in my class.

Whether pre- or post-surgically, my goal as a yoga instructor has a two-pronged aspiration: to support my student’s physical well-being safely and as effectively as possible, while doing no harm in the process; and to support my student’s sense of wholeness, oneness with the Universal “One” and steadiness/peace of mind.

Yoga asana approaches pre-, during and post-treatment

Regardless of the phase of cancer treatment the student is in, it’s important to remind them that whatever their “new normal” may be, that’s where they are at that moment, and it’s okay. I began writing this paper with the thought that pre-, during and post-treatment stages would be rather obvious. However, there are overlapping categories (e.g., on-going hormonal therapies – often lasting for years; the completion of chemotherapy but the port remains installed for weeks or months). Therefore, I am going to address this as two categories, rather than three: pre-treatment and treatment and beyond. I invite the yoga instructor to use these categories as something of a continuum, not hard-and-fast categories.

First of all, regardless of whether a woman has just been diagnosed or is far into or beyond treatment, she may find herself surprised by the shift in her energy levels and recovery times needed post-exercise. The psychological blow of diagnosis and the physical blow of surgeries, chemotherapy, radiation and hormone treatments can create a “new normal” for what her energy levels will be and her recovery rate may be.

“Yoga philosophy has very practical implications for people with cancer,” offers Timothy McCall, an M.D. who writes about yoga for cancer. “Yoga encourages you to listen to messages from your body (physical, emotional and otherwise) and adjust your practice accordingly. This lesson can be extended to the rest of your life, too. If you tire after less work than you’re accustomed to, yoga would say honor that. Do less. Ask friends and family to step in to help out.” (McCall 209) This message is very important for cancer patients because they may experience massive shifts in what their bodies can tolerate, and it may take them awhile to adjust to new expectations.

McCall goes on to add that “a number of yogic practices may be helpful for people with cancer in reducing stress and managing side effects, both during chemotherapy and medical procedures and after. Although people being treated for cancer usually do not have enough strength to do vigorous asana practice, the poses can be adapted to meet almost anyone’s needs. Restorative postures and simple pranayama exercises can be both energizing and relaxing, and require almost no physical effort. Meditation and guided imagery…can be deeply relaxing and reduce anxiety.” (McCall 209)

The role of intention in the yoga practice at any phase of treatment

Regardless of the student’s treatment status, the actual cancer experience can be multi-layered, complex and overwhelming; the yoga studio is one place to practice focus on one thing at a time, for a period of time. The class becomes a meditative focus on whatever the teacher or students decide: on presence, on compassion, on grief, on letting go, on experiencing a sense of one’s wholeness or connectedness, on power, and so on. The instructor may either name an intention and weave that language into a class; or the instructor may invite the student to pick a focus and return to it with each asana, each breath.

The intentionality is part of what makes yoga a spiritual event, not just a physical one. Kelly Turner offers her perspective on why people are drawn to yoga as spiritual practice:

“I find that many people today are disillusioned

with weekly religious services that feel rote and outdated,

yet they attend them out of obligation;

meanwhile, experience-based activities

such as yoga or running are gaining in popularity.

Perhaps that is because having spiritual energy

actually course through our bodies and minds nourishes us

more than having spiritual beliefs that live only in our heads.”

(Turner 220)

Additionally, intentionality is not just about one’s head space, but also about the construction of the flow of asanas and their purpose. I would draw on principles Mark Stephens points out: if a student seems prone toward depression, avoid too many soothing asanas (he points out forward bends as one example), or anxiety (and therefore avoiding stimulating asanas, e.g., many back bends or stimulating, highly athletic yoga in the evening because of the effects this might have on ability to sleep). (Stephens 18) People, of course, can be a mixture of both, so a balance of techniques might be best in that case. It’s important to be sensitive to the student’s state of mind (which might change) and to encourage them to be aware of what they need. Hippocrates said, “Let food be thy medicine and medicine be thy food.” I would dare go out on a limb here and add, “Let exercise be thy medicine, too, and thy medicine be exercise.”

Pre-surgery/treatment

As instructors, we can support pre-surgical/pre-treatment students to focus on well-stretched, strong musculature, regardless of the reconstruction source (if they are going to reconstruct), which could be entirely local (implants placed under the pectoralis major) or it could be both local (to the breast area) and distal (from the abdomen, thigh, or upper back) in the case of “flap” reconstruction. Flap reconstruction can extend the recovery period by quite a bit, as muscle, nerve, fat and skin may all be relocated from one part of the body to the chest in order to create a breast.

Presurgery, it is easy psychologically, to experience a sense of fear and helplessness at this stage of things (pre-surgically, pre-treatment). I experienced it myself, and I have seen many cancer patients in the last year go through a very similar “dark night of the soul,” no matter where they were before the diagnosis. One can easily argue that the condition of the entire human race is that we’re dying (the only difference among us being the timing and precise cause), but we each have to face it at different times and in different settings. What happens to some of these cancer patients is something of a collapsing of the body out of helplessness and fear. For others, they may become superficially quite fierce and bristly. If the patient has any period of time before treatment, this can be a time (with doctor’s approval) when there is still no particular reason to reduce physical intensity of exercise, and the patient is most likely to benefit tremendously from the reminder of what is working in her body; to reconnect with the awareness that the body is not the enemy; that she can and should be in tune with her intuition, as well as her logical/strategic mind. The value of reducing stress through exercise cannot be overstated for this period of time.

One of the greatest challenges pre-surgically is the psychological aspect of uncertainty, as mentioned in our first section on “challenges.” During this time, it’s likely that most of a patient’s symptoms, particularly if the cancer was discovered early, is not physical but rather mental. There’s an entire section on meditation later in this paper, and that will be an important aspect of regaining mental grounding and reducing stress.

Sometimes women are encouraged to gain weight prior to surgical reconstruction in order to have enough fat for liposuction and actual relocation of fat tissue en masse. Yoga is one possible way to remain healthy while putting on additional fat, maintaining muscle tone and flexibility, in the process. For women who find the weight gain to be a challenge to their body image or self-esteem, yoga is something that can help them maintain their sense of wellbeing through that, as well.

Treatment and beyond

The precise medical picture of each patient is complex, and there are entire books written on the topic of how to adapt specific asanas to accommodate breast cancer patient needs. It’s outside the scope of this paper to go into that level of detail, but here are some of the highlights we as instructors need to keep in mind.

• It’s important that the client has received doctor’s permission to return to exercise. A breast cancer patient could cause herself harm if she returns to a practice that is too intense for her stage of recovery. One cannot assume that a doctor actually knows what’s involved with a yoga practice, unfortunately, but knowing that a patient is reasonably healed in order to resume exercise is important. In spite of the need for doctor’s permission and a need to be aware of limitations, it’s also important for the instructor to hold the yoga student with the awareness of the student’s essential wholeness and power. The patient may either be tired of being treated as being damaged or may have bought into that belief, and finding a place where her wholeness is acknowledged is something essential to her wellbeing.
• Bones: Metastases to bones, chemotherapy and induced menopause can cause early osteopaenia or osteoporosis, so caution should be observed in these cases for the amount of torque and torsion put on the pelvis and large bones of the body. Osteoporosis can occur in the arms, as well as the legs, particularly in instances of long disuse. (Kollak 41) Tumors in bones or radiation to bones may also weaken the bones and prohibit application of torque/twisting to the bones in a way that would put pressure on them. (Fein Web) Therefore, it’s important when instructing cancer patients/students to make sure they do not push their twists to the end point but rather explore a range of motion that is moderate and gentle. The student should build up exercise intensity more gradually than they might have done prior to treatments.
• Central lines and ports may require limitations of movement. These are usually in place for people who are either in active chemotherapy or who have completed chemotherapy but not yet had their lines removed. This can happen a number of weeks after the completion of chemo, so a cancer patient coming for yoga may say they have completed chemotherapy but still have this in place, so it cannot be assumed that there isn’t one. (Fein Web)
• Other yogic tools can help with pain, a frequent cancer symptom, particularly in its later stages, including relaxation, meditation, and breathing practices. The slower, deeper, more regular breathing that yoga facilitates can help you feel calmer and more energetic during the stressful period of being diagnosed with cancer and enduring treatment for it. Learning to cope with that stress can help you get through the ordeal, and may even improve the odds of survival. (McCall 209)
• After treatment is complete, the patient is faced with the challenges that happen post-surgically (e.g., scar tissue and adhesions, restricted range of motion in the shoulders from restricted use and guarding, other muscular tightness and/or weakness from immobility, fatigue, lymphedema, remote areas of healing from reconstruction, limitations to weight-bearing from sub-pectoral implants), post-chemotherapy (e.g., weakness, fatigue, bone loss, and post-radiation (e.g., lack of elasticity to the skin, weakened bones, heart, lung damage). Yoga asanas can influence the rate of healing and the ability to strength and regain flexibility with attention and gentleness.
• Of course, at any phase, the cancer patient/yoga student is faced with uncertainty and challenges to their self-image and choices in life. The yoga mat can be an excellent place to intentionally work with both the fears and the rebuilding, with the grief of losses and the return of joy and sense of personal power as she emerges into the daylight again.
• Special attention to adaptions of asanas locally (breast, chest, arms, shoulders) but also distally, depending on type of reconstruction, if any (“flap” reconstruction can involve moving tissue from the thigh, abdomen, or latissimus region of the back over to the reconstructed breast). Thus, adaptations may not just involve the pectoralis, deltoid and various arm muscles; they may need to be made for scar tissue and guarding that affect the abdominals, hip flexors, abductors and adductors, and all the muscles of the back. The teacher, in other words, needs to not have an expectation of where guarding or scarring may be an issue but should be sensitive that it could be very widespread. Additionally, it’s not always possible to gather such detailed and personal information from each student prior to a class, but the instructor can give general direction with this in mind.
• Some studies indicate that yoga may be useful in reducing needs for pain medication (McCall 6) The yoga student can be encouraged to gauge her pain prior to and after practice so she can become more conscious of using this tool for her pain management.
• Lymphedema can be an issue post-surgically and post-radiation, and yoga can help, with caution that one adapt one’s approach to holding static asanas. “As for using upright yogasanas to improve lymph circulations, repetitive motions are better than static holdings,” (e.g., it’s better not to hold downward dog for long periods of time), says Mel Robbins, who has studied and written extensively about the physiology of yoga. He adds, “However, the yoga practitioner must use caution in prescribing lymph-activating yogasanas for relief of edema in certain situations, for the lymphatic system can also be the pathway for the spread of cancer cells. As similar caution is in order for students having sinus infections, for inversions can help spread the infection to other sites.” As a former massage therapist and reasonably well-read yogi, I don’t find any evidence that exercise of any kind contributes to the metastases of cancer. This statement by Robins seems to be a simplistic/mechanistic view of how cancer spreads (and outdated). However, it makes sense, of course, to err toward the side of caution in the case of lymph-pumping movements when there is known or suspected cancer in the lymphatic system, but not to restrict exercise in general. Exercise has too much evidence for its benefits for insulin, inflammation, mood, function, strength and the immune system, all of which are critical in the case of the cancer patient. (And I will add that this is an area in which I will study more in the future.) Personally, based on my own research and interest in preventing lymphedema from occurring in my own case, I will be adding lymphatic-pumping movements and intention to my own practice, while realizing there is not yet any firm data regarding yoga’s ability to prevent lymphedema from sentinel lymph node/mastectomy surgery.
• Timothy McCall had an interesting perspective on intentionality as it relates to karma yoga, and he gave me food for thought on how to harness that for cancer patient yoga students. “Some cancer survivors, once they are in recovery and have regained their strength, find volunteer work or other forms of service (karma yoga) to be useful in providing a sense of purpose and meaning.: (McCall 209)

In personal observation and experience, I’ve seen many cancer patients go on to serve in volunteer roles in an effort to fight cancer and as cheerleaders for up-and-coming patients. It could be a useful tool for the yoga instructor to use in helping students to take on these “karma yoga” roles intentionally. This is particularly a useful and interesting exploration for breast cancer patients. Many women I’ve known, myself included, use their cancer experience as a “wake-up call” and find that they have imbalances in caretaking and ego. Some authors have even postulated (with a caution that we not be too rigid in categorizing people’s emotional contributors to disease) that there is a “Type C” personality correlation to breast cancer, just as there is often a “Type A” personality correlation to heart attacks. (Hirschberg 146-147) Inviting the cancer patient yoga student to participate in service mindfully, with the power to say “no,” when she needs to, to be supported in the process, and to contribute meaningfully to other cancer patients could be a powerfully healing process. (I have not read of anyone other than McCall mention this as an intentional tool to implement with cancer patients; it seemed a natural direction one might take his point of karma yoga.)

• As an instructor, I’m intrigued with the potential benefits of partner yoga for the cancer survivor. I have not seen any references on this topic, but after a brief experience of partner yoga in a general admission class, it seemed that partner yoga (either with one’s life partner, a good friend/caregiver, or just with another cancer survivor) could be a powerful way to restore a sense of connection with community. Feeling isolated by one’s diagnosis and the unique challenges of the psychological and physical hurdles of cancer treatment, a cancer patient could potentially find a powerful healing force here, and this is something I would explore in my classes.
• Complex emotions can continue for quite a while after physical interventions have ceased. Many people misunderstand the survivor’s experience and expect them to be relieved that the doctor’s “got it all,” for example However, what the patient may have a hard time communicating is that the oncologist’s offers of hope may very well be tinged with cautions, whether realistic or not, about the chances of recurrence. Every cancer is different, including the many subcategories of breast cancer. It’s important for the cancer patient/yoga student to find their own way through life post-cancer in a way that feels meaningful and in integrity with them. If someone is capable of a healthy dose of denial or compartmentalization, then as an instructor, I’m not going to be the one to attempt pierce that, and I will make a space in which a student may explore more difficult emotions as she is ready. However, if someone is actively dealing with anxiety, then calming poses, breathwork and meditation can be profoundly stabilizing therapies. The key for the instructor is to set a stage where whatever arises is okay; and to work with the yoga student’s agenda, not the instructor’s.

Pranayama for All Cancer Patient Yoga Students

In response to the challenges of trauma, anxiety and grief, Jayan Landry is one of the therapists whose work I draw upon personally, and I would suggest incorporating one of her favaorite tools – ujjayi (“ocean-sounding”) breathing – as part of pranayama for all cancer patients. Not only may it be used in the yoga classroom but also strategically throughout the day, any time anxiety or trauma arise. Landry describes ujjayi breathing in the following way:

“Inhale through your nose, filling up your lower abdomen, chest, and back, and then exhale through the back of your throat with your mouth open, making the sound ‘heeeeer.’ This stimulates the top of the tenth cranial nerve, which lowers heart and respiratory rate eliciting the parasympathetic branch two calms you down side. Use this anytime you need to feel calm.” She adds the caveat, “Some people describe feeling lighter or even lightheaded initially. If this is true for you, do not do this exercise while driving or operating machinery…” (Landry 61)

Tari Prinster has a great point about the power of simple breath movements, so simple that before cancer we might have scoffed at how powerful and important they could possibly be: “The thoracic duct is the main detention center of the lymphatic system. It runs parallel to and is nestled close to the spinal column from the top of the lumbar spine…to the base of the neck…,” she begins. “Why do we care? Because the location and function of this duct along its narrow, long, vertical path is in constant contact with the movement of the horizontal diaphragm muscle, which is massaged by the action of breathing. This knowledge reveals a little secret and creates magic to aid recovery and maintain lifelong health for everyone, not only for the cancer patient and survivor. “ (Prinsler 39). I think that’s one of the things I love most about yoga (and arts like it, including meditation): there is magic in the smallest things we can do for ourselves. This is great to know and practice in day-to-day life. It’s akin to a superpower when we’re in the pit of cancer diagnosis and treatment to know that our pranayama or meditation can be potent self-healing tools. They serve as timely focii for any stage of diagnosis, treatment or maintenance.

Meditation for the Cancer Patient Yoga Student

We’ve already looked at symptoms and the effects of yoga, meditation and pranayama on them. However, I would also like to address meditation (and yoga as moving meditation) as one way not only to combat dis-ease but also as a way to cultivate wellbeing.

Betty Edwards is one of the writers who helps her art students (primarily those who begin with little-to-no art background) make the shift from left brain to right brain activity. It’s essential to shift to right brain in order to “see” for the purpose of art. Edwards has a very clear way of describing the difference: “The left hemisphere analyzes, abstracts, counts, marks time, plans step-by-step procedures, verbalizes, makes rational statements based on logic…the analytical, verbal, figuring-out-sequential, symbolic, linear, objective mode.” (Edwards 35) Of course, we need these abilities to function well in life, for everything as simple as creating a grocery list, to being on time to pick up our children from the bus stop, to building skyscrapers. We need the linear part of our brains.

However, this part of the brain can go into overdrive during the cancer diagnosis, treatment and survivorship times of a cancer patient’s experience. What does the cancer patient do when dozens of options lie before them? What does the cancer patient do when she has to wait? What does the cancer patient do when the “right” path is ambiguous?

As a meditation instructor, I draw quite a bit on right brain/left brain as ways to help students demystify the shift that happens in consciousness during meditation (including moving meditation, such as in yoga practice). First, let’s define right brain with Edwards’ words: “[W]e have a second way of knowing: the right-hemisphere mode. We ‘see’ things in this mode that may be imaginary – existing only in the mind’s eye – or recall things that may be real (can you image your front door, for example?). We see how things exist in space and how the parts go together to make up the whole. Using the right hemisphere, we understand metaphors, we dream, we create new combinations of ideas. When something is too complex to describe, we can make gestures to communicate.” (Edwards 35). I would add that right-hemisphere is also aware of body sensation, connection to the fabric of existence, and loses track of time. (Salleh Web)

I offer my meditation students some indicators they can use to know if their left brains are “over functioning” at any particular moment, rather than being useful:

• Is the thought original or repetitive? If a thought is repetitive, and there is no new information to add to the cognitive process, it may be a good time to drop into right-hemisphere awareness.
• Is the thought anxiety-producing, with no clear action that can be taken? A little anxiety can be a good thing if there’s direct action we should be taking and are avoiding (e.g., the patient should go for a follow-up exam because she found a new lump, but she’s afraid to go; the anxiety is actually giving the patient the signal to take constructive action here, and to suppress the anxiety is a misguided effort, until the appointment is made or the patient has a clear plan to make the appointment). However, once all concrete action has been taken or at least planned and avoidance of important action has been eliminated, the anxiety is not useful. It’s a good indicator to drop into right-hemisphere awareness.
• Is it boring? This one can apply to cancer patients who get “stuck” in chemotherapy appointments, diagnostic procedures that require long periods of stillness, waiting in doctor’s offices, or simply being too fatigued to do much that is usually interesting and stimulating. Meditation is an underrated “thing” to do that has a great deal of constructive benefit and literally has almost no limits to when and how one can use it. (I point out to my meditation students that left brain quickly becomes bored by the things that right brain can use – like following the breath or noticing sensation or repetitive movements. To the left brain, one breath or action is the same as the next. To right brain, each one is new and different and interesting. So boredom can be a sign that left brain is ready to “check out” and let the right brain have some fun!)

For all of these reasons, the cancer patient yoga student may find the meditative aspects of either specific seated (or lying) meditation practice and more generally applied moving meditation of yoga asana to be particularly healing for the mind. Left brain activities, if not productive, can contribute to anxiety and distress. Right brain activities help the student to access a sense of wholeness, connection, peace, creativity and intuition, regardless of the circumstances she faces in her life. She may access meditation and its benefits through an attempt to deal with a particularly odious symptom; she will find, however, that many aspects of life begin to feel better when using meditative, right-hemisphere perception.

A book I found particularly helpful for doing some of this work post-treatment was Martha Becks’ Finding Your Way in a Wild New World, and it’s one I would highly recommend to my yoga students who are looking to find ways to apply meditative awareness to their daily lives and decision-making processes.

A large number of meditations is available for step-by-step relaxation on the Internet, in books, on CDs. Our own Aura Wellness meditation CD has an example; James Hewitt’s book Complete Yoga Book goes into a detailed description of this type of meditation. For the cancer patient yoga student, learning these meditations and self-application at bedtime (and other quiet moments) can be an extremely helpful way to ease a particularly distressing symptom (i.e., insomnia).

Additionally, for the cancer patient who may wish to dive deeply into meditation practice but either does not have the money or easy access to it, there is a free MBSR (Mindfulness-Based Stress Reduction) course online. MBSR has excellent research to show benefits to cancer patients (Brown Web); while MBSR typically costs several hundred dollars and requires significant time commitment over 12 weeks, there is one course of which I’m aware online available at no cost by a certified MBSR instructor. I have reviewed it myself and found it to be an excellent resource: http://palousemindfulness.com/.

For the cancer patient who is particularly expressing fear of death and is willing to explore this, there is a meditation practice that may be helpful. I daresay that a focus on or even discussion of death itself is not particularly socially acceptable in our culture, so some sensitivity is needed here. However, there can be tremendous power in making peace with the thing that frightens us.

The fear of death is a form of meditation practices by many Buddhists. (https://en.wikipedia.org/wiki/Tantra_techniques_(Vajrayana) – aka, “Death Yoga”). My own cancer diagnosis in the spring of 2015 became a 9-month meditation on my own death that led me back to yoga and to a deeply healing meditation practice.

There’s one other reading resource I would recommend for those with a fear of death: Anita Moorjhani’s Dying to be Me. She had very advanced cancer and was actively dying of multiple organ failure, and her “end of life” story offers a mystical perspective that can give the cancer patient/yogini a different and inspiring perspective on life and death.

For the yoga student who is looking for more she can do outside the yoga studio, she may be encouraged to keep a journal of her goals, what works for her, results, and an action plan for the future. (Kollak 20-21)

Yoga Instructor Boundaries and Self-Care

Cancer is an emotionally charged subject. According to the American Cancer Society, 1 in 8 (12%) of U.S. women will get breast cancer, so it’s the rare person who doesn’t know someone who has cancer, know someone who has died from cancer, or had cancer themselves. As an instructor, there are some specific cautions I need to keep in mind as I work with cancer patients.

• As the instructor, it’s my job, not my student’s, to hold my emotional reaction to their cancer. This means that whatever fears, anxieties, propensities toward collapsing/helplessness, depression, grief (etc.), anger, denial, empowerment, optimism or pessimism may come up for me around cancer, meaning-making, looking for metaphors or mind-body cause and effect, I’m in a professional role with the student, and their experience is the focus of our class time together. This doesn’t mean I can’t share with them from my own experience, but this is not the time or place for sharing raw, unprocessed emotion, for leaning on them for a listening ear, or for pushing them in the direction I feel most comfortable with them going. My own meditation practice, journaling and yoga practice are places where I can (and I would say must) do my own spiritual and psychological work so that when I come to the mat to teach, I’m teaching from my lived reality. When I’m teaching, that background work needs to be done before I go to try to teach, and my focus, during class, is on a non-judging, non pre-judging of what the student’s experience is. They may have emotions that are quite contrary to what I think they will be, and I need to be cautious about how I project my own feelings onto them.
• Keep my unsolicited advice to myself; deliver solicited advice cautiously. It’s a deeply ingrained part of the American culture that we need to do something in response to a perceived threat. In this case, that threat is cancer. We want to tell someone what they should do, not only because we care but because we, too, are afraid of what might happen if they don’t. It may or may not be based on our advanced research and professional study as doctors, nurses, physical therapists, nutritionists, psychotherapists and so on. We have to be cautious in terms of stepping outside our scope of practice. For example, unless I’m a nutritionist, I ought not to be giving nutritional advice. I may, however, have a good nutritionist I trust in my contacts to share with students; I may also recommend books I’ve found helpful. Unless one has either been a cancer patient or worked closely with one, one may not realize that the cancer patient in inundated with information on a daily basis. “You have to take turmeric!” one friend will say on FaceBook. “You need to eat vegan/ketogenic/vegetarian!” others will say. From personal experience, I will say that many people who loved me had no filters on speaking from their deep fear that I would die if I did not do what they were recommending. That’s a heavy burden for the cancer patient to bear. As yoga instructors, we need to be particularly aware of our “professional” tendency to speak out of our own fears, even if the intention is to be loving. We need to raise the bar on what “loving” means and truly offer our clients an open, non-judging environment in which to explore their bodies and minds. Our clients are particularly vulnerable and possibly even desperate. It’s important to be aware of our professional responsibility to 1) only speak from our professional training in terms of medical advice; 2) share from personal experience sparingly; 3) ask the student in-depth questions about what she has tried; what her values are; what her resources are (does she have the money for the expensive supplements I’m recommending? Does she have the time/energy for the type of exercise or treatment options I’m telling her about? Am I adding to her burden or relieving it by suggesting things she is not able or interested in doing?) Even if one does have other training/licensure, it’s important to note what context the cancer patient approached the instructor. For example, if one is a doctor who also happens to be a yoga instructor, whether the student came to the instructor first as their doctor or as their yoga instructor should give some bearing to what advice is proffered. I hate to add the “L” word here, but if something goes wrong, I am then open to litigation in addition to simply being out-of-line.
• Trust in the power of simple practices. We are not lacking for information in our age; we are lacking for practice. We are used to the model of learning that says if you didn’t walk away from a weekend seminar with a 500-page manual to memorize and implement, you didn’t get your money’s worth. However, in the realm of mind-body health and wellbeing, we’re going deep with a simple principle, something as simple as following the breath, as breathing into our pain, or as one intention to our hour on the mat. The more we as yoga instructors can experience and trust that power, the less we’ll need to talk to convince our students that what they’re doing is useful or to inundate them with our advice or opinions. We will know experientially from our own practices that their practice will lead them where they need to go. Aminah Raheem is a psychotherapist who also works with bodyworkers and energy workers of many disciplines and teaches them about their own state of energy and how that affects the client. She talks about entrainment, where the provider’s energy helps to shift the energy of the recipient/student. “The therapist’s energy system directly affects the state of the client…If the therapist’s energy systems are reasonably balanced and strong they will have a health-supporting effect on the client. But if they are seriously imbalanced or weak, the session can be diminished.” (Raheem 186) The more experienced yoga instructor will have gained some trust for a “less-is-more” approach to their own contributions to the student’s experience; will know that their own cultivated Presence is more important than advice or too many interventions; that one simple, targeted practice for the student may be far more powerful than a laundry list of lifestyle changes; that one small adjustment in class or one word may be ample to meet the student’s needs.

Conclusion

Yoga is a proven way to improve the cancer patient’s outcomes; it is also a proven way to improve quality of life. There is still plenty of room for research, however, and the yoga community and cancer patients can only benefit from more work on that front. On a deep level, yoga can serve as the laboratory for exploring the causes of one’s discomforts, identifying the healing means one will employ for addressing them, and for finding meaning and one’s place in the universe. Yoga is potent medicine. Instructors have the ability to be a powerful force for healing in their students’ lives, and should take caution in how they apply this medicine. The student can, if they wish, open up their hearts, minds and bodies in profound ways on the mat; it is the teacher’s responsibility to act with restraint, with loving intention, and with wisdom to that openness. With that respectful care, the yoga student with a cancer diagnosis can blossom.

 

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