The Practice of Cultivating Bodhichitta and Maranasati more

Buddhism and Conscious Dying: The Practice of Cultivating Bodhichitta and Maranasati Jennifer R. Stevens Instructor: Ann Masai, PhD Saybrook Graduate School and Research Center San Francisco, California Independent Research Project July 20, 2007 Cultivating Bodhichitta & Maranasati 2 In the past 30-35 years, there have been a number of books, articles, and workshops dealing with conscious dying that have come out of pioneering work by people well known in the western world, such as Stephen and Ondrea Levine, Rodney Smith, Joan Halifax Roshi, Ram Dass, and others in the field of end-of-life care and thanatology. The two guiding principles behind much of the work represented by these people include Buddhist concepts and practices related to conscious dying, which are cultivating bodhichitta or “awakened mind/heart” and Maranasati or “being with dying” (Horrigan, B. 1997). As a Buddhist practitioner and a grief counselor for a hospice, I wanted to inquire more deeply into these concepts for a number of reasons. I hoped to gain information for my own personal practice, for my work with dying and grieving people. I also hope to gain insight into the ways various Buddhist traditions’ rich practices and beliefs can supplement end of life care today, continuing to expand our understanding beyond the dualistic medical model that continues to be prevalent despite decades of hospice work in this country. It should be noted that the information used throughout this inquiry comes from various Buddhist religious traditions such as the Theravada, Mahāyana, and Vajrayāna schools, as well from the Tibetan Bön tradition that predates Buddhism’s presence in Tibet. Information that is used also comes from Western meditation teachers who have integrated Buddhist teachings into their practice and their work. My purpose in researching this subject was multi-faceted. I wanted to explore the Tibetan Buddhist perspective regarding the process of actual dying and the transfer of consciousness (Phowa), that is believed to occur following the death and I planned to investigate the rituals and meditations associated with their understanding of death. I, also, hoped to discover how Buddhist thought can help supplement Western practices of end-of-life care, Cultivating Bodhichitta & Maranasati 3 including the methods of training, the use of rituals, and the ways of offering support to those who companion the dying. I hope to understand ways to implement Buddhist wisdom to deepen and enrich our lives and our dying in the West, especially if a patient is open to supplementing their own spiritual path with conscious dying. Finally, I intended to suggest some areas where further inquiry might be of benefit to the field of psychology and to the practice of working with death and dying. Reasons for this Inquiry There are six particular reasons why inquiring into the nature of conscious living and dying is important at this time in Western thought, medicine, and psycho-spiritual care. The first is that Eastern practices, religions, and philosophies are now open to the world and there are many ways that Buddhist thought is applicable to our contemporary post modern world, despite the fact that its teachings come from ancient times of Eastern cultures. Since the occupation of Tibetan by China and the exile of His Holiness the 14th Dalai Lama, Tenzin Gyatso, the world has more access than ever before to dedicated masters and teachers in addition to teachings and practices that are thousands of years old. Gyatso & Hopkins (2002) point out that life and death are not separate and dualistic in Eastern thinking, as they are in the West. These authors support their understanding of Eastern thought by quoting the Buddha, who said, A place to stay untouched by death Does not exist. It does not exist in space, It does not exist in the ocean, Nor if you stay in the middle of a mountain. If you accept that death is a part of life, Then when it actually does come, Cultivating Bodhichitta & Maranasati 4 You may face it more easily. (p. 40) Horrigan (1997) pointed out that Halifax, a Zen teacher, explains that life has small births and deaths in every moment and understanding this is vital to the end of unnecessary suffering. She, also, believes that this vision of no separation between life and death is a vastly different worldview than the one that has been historically in the Western culture. The second reason that I began this inquiry was that I wanted to understand the role of Eastern principles that are already at use in end-of-life care. In a taped dharma talk, meditation teacher Rodney Smith (1998) reminded listeners, “Death is what spiritual growth is all about. Unless we some way align ourselves to that fact, real spiritual understanding remains distant …” Within the medical model that has been embraced in the West, most are not trained to see death as a part of our spiritual path, but we see it as a failure, something to be avoided; a patient who can no longer be cured becomes a diagnosis about which no one can do anything. In hospice care, workers have witnessed that the dying are not always cured of the diseases that ravage their bodies, but the patient and family do or can find healing in the psychological, spiritual, transpersonal, and interpersonal aspects of life, which enables one to be at more peace in death. Eastern principles have also begun to impact how nurses, social workers, and spiritual care counselors interact with the dying to help foster an environment where healing is allowed and encouraged. For example, in an interview with Mishlove, (1988) Levine remarks on this noncurative healing: …maybe the sign of real healing is, what are the people at the bedside left with when someone dies? Are they left with their hearts full and a sense of connectedness to that person, or are they left frightened of death, scared of that person, with much rumination in the mind about how things didn’t work out, how could I have helped more? Did they leave a legacy of mental suffering behind? So I see people heal into death (¶ 14,). Cultivating Bodhichitta & Maranasati 5 The third important reason for understanding conscious dying and Eastern practices at this point in our culture is that many of the people in the United States are part of the baby boomer generation, born after World War II, who were coming of age during the counter culture revolution of the 1960s and 1970s. It was during this time period that Eastern thought began to become part of our collective unconscious. Many of the people in this generation are now questioning current medical treatment, research about their illnesses, and are open to looking at alternative or complementary care. They appear to have strong desires for wanting to live and die their way rather than by what conventional wisdom of the West suggests. According to Flower (2002), Ostaseki, founder of Zen Hospice Project and the Metta Institute, believes that medical care today, with its emphasis on curative measures, fails people who are facing life altering diseases and decisions. Ostaseki states, “their pain is uncontrolled, their symptoms are not well managed, the psychosocial issues and the needs of the family are not well addressed” (p. 19). In the United States today, people can educate themselves to see that they have more options on how to live with their dying than what is often offered through the medical model and even hospice care. Spiritual practices such as those of Buddhism are just some of the choices open to people today. In a taped Dharma talk by Smith (1988), social worker and Vipassana meditation teacher, helps to illuminate the teachings for the listener on death being the ultimate teacher in each of our lives. From the Bön Tibetan tradition, Hansard (2001) states that, “studying the nature of death helps us to know that we can be the authors of our deaths as well as our lives”, (p. 241), which emphasizes the nondualistic nature of living and dying that can appear to be foreign to traditional thought in the United States and other Western countries. Cultivating Bodhichitta & Maranasati 6 The fourth reason for this inquiry is complementary to the third; there is a growing number of people pursuing less heroic or extensive treatments when diagnosed with a life altering disease, such as chemotherapy, radiation, surgery, feeding tubes, and ventilators. Holton (1993) believes that the teachings within the Tibetan Book of Dying or the Bardo Thödol can open the field of thanatology, with particular interest in our caring for the dying, our methods of coping with grieving, and our choices of how to die (p. 165). This, ultimately, can give patients more options in the types of practices, treatments, and ways of being that they embrace as they are dying or after being bereft of someone close to them. Grof (1994) also supports that Bardo Thödol gives us direction on dying. Although more people are pursuing less aggressive treatment today, when some patients are told that there is nothing more that traditional medicine can offer them, there seems to be an initial sense of doom, resignation, or disappointment on the parts of the patient and the family or medical community. Often traditional allopathic treatment practitioners do not refer to alternative sources for healing because of their focus on curative measures. Not only are some doctors hesitant to suggest complementary treatment, they can also have difficulty or refuse to offer referrals to hospice and palliative treatment. Grof states that there is an alternative to this pessimistic postmodern view if we look back into history: …dying people in pre-industrial cultures typically die in the context of an extended family, clan, or tribe. They thus can receive meaningful emotional support from people whom they intimately know. It is also important to mention powerful rituals conducted at the time of death designed to assist individuals facing the ultimate transition, or even the guidance of dying, such as the approach described in the Bardo Thödol (¶6). The fifth purpose for this investigation of Buddhism and conscious dying is what I see as the need of end-of-life care in the United States to move beyond and expand existing paradigms that are based on religious practices such as those from the Jewish and Christian tradition. People are seeking new ways of looking at the world, the way they live life, and the way they Cultivating Bodhichitta & Maranasati 7 will live their spirituality and dying. Many of the concepts held by the majority of our population and hospice or medical personnel are grounded in these two traditions with beliefs such as in heaven and hell, in a creator of all things, and in suffering for the atonement of one’s sins; therefore, a person who is dying could be suffering in their living from what others have judged as an unholy life or that when the person dies they will go to a hellish realm. In an article in the International Journal of Palliative Nursing, Barham (2003) shares the story of a young woman named Sarah who was dying. At the time of Sarah’s dying, her Buddhist teacher guided her through the turbulent emotions of her transition in the present moment rather than being concerned about deathbed confessions, conversions, or increased doses of pain medication which would affect her consciousness. He reminded her that she even in her dying, she could calm the chaotic thoughts and emotions that she might be experiencing as her body shuts down and her physical life ends (p. 250). The sixth and final reason for researching this subject on dying and writing this essay was that I wanted to understand what potential Buddhist teachings and practices could contribute to the ever-growing field of transpersonal psychology. Gyatso & Hopkins (2002) offer that “dying is a time when the deeper levels of mind manifest themselves; daily reflections also open the doors to those states” (p. 58). Transpersonal psychology pioneer, Grof (1994) puts forth that, “the study of transpersonal experiences has an indirect relevance for thanatology” (¶1). He suggests that the study of exceptional experiences (EEs) where a person feels the presence of a deceased person, as well as experiences like life reviews, encounters with divine beings, and visions that facilitate transition, can all expand our understanding of the nature of and levels of consciousness. Cultivating Bodhichitta with Meditations throughout Life and into Death Cultivating Bodhichitta & Maranasati 8 Meditation for Daily Living Meditation is a cornerstone of all of the Buddhist traditions and is practiced for cultivating bodhichitta, or the awakened heart, as well as for understanding the nature of impermanence. The most well-known form of Buddhist meditation to most Westerns is mindfulness awareness meditation, during which the first instruction regarding attention to the breath is given. This form of meditation has become so well known and accepted that it is being used in psychotherapeutic treatment, in stress and pain reduction clinics, and in business settings (Epstein 1998, Kabat-Zinn 1990, & Richmond 1999). Meditation “can generate very calm states of mind and relieve anxiety” in daily life, while caregiving for the dying, or while we are grieving (Hawter, 1995, ¶3). Buddhists believe that our practice of meditation is not just for our own benefit and wellbeing, but, also for the benefit of all beings from the merit that comes from meditation practice. Venerable Pende Hawter (1995) believes that even ordinary meditators will die happily and that our practice of meditation deepens “our potential in the here and now” (¶2 & ¶14). Several forms of meditation will be discussed in the following sections that are important practices for our daily lives. It should be noted that some of the daily meditation practices are essential to the practices that occur while a person is dying or for the caregivers after death. Since there is no dualistic thinking of life and death as being separate phenomenon, the practices of everyday life prepare us for the ultimate practice upon our dying. Gyatso & Hopkins (2002) wrote, If you have not practiced and on your dying day you are surrounded by sobbing friends and others involved in your affairs, instead of having someone who reminds you of virtuous practice, this will only bring trouble, and you will have brought it on yourself. Where does the fault lie? In not being mindful of impermance. [sic] (p. 162). Cultivating Bodhichitta & Maranasati 9 The Dalai Lama’s words above clarify the understanding that daily meditation for a lifetime is imperative to the Buddhist teachings. The types of daily meditation that will be discussed below are: mindful awareness, gathas, or verses used in mindfulness meditation, tonglen, lovingkindness metta meditation. Two other types of daily meditation will be discussed below, the daily meditations on the five powers and the meditations on the nine contemplations, both of which are related to the meditations at the time of dying. Mindful awareness meditation is the foundation of all other mediation practices and is one element of the eight-fold noble path that the Buddha taught his followers as a way to free themselves from suffering. “Right Mindfulness accepts everything without judgment or reacting. It is inclusive and loving. The practice is to find ways to sustain appropriate attention throughout the day,” (Nhât Hanh, 1998, p. 59). With mindfulness practice, one is able to stay present to the here and now of experiences as they arise without becoming attached to them. This practice allows openness to our current experiences and teaches acceptance of the experiences as they are without a story line or drama that the mind wants to add to our thoughts. By practicing mindful awareness meditation, the practitioner can learn to calm and settle the ongoing dialogue of the restless mind. Gathas, or mindfulness verses, are intended to help the practitioner stay mindful throughout our daily activities. Nhât Hanh, (1990) Vietnamese Zen Master, explained to his followers the value of using the gathas by saying when the gathas are used, “we return to ourselves and become more aware of each action. When the gatha ends, we continue our activity with heightened awareness,” (p. viii). Gathas can bring awareness to our mundane everyday activities where we can find ourselves lost in thought and not aware of what we are doing. The verses are simple, sometimes only a few key words that keeps our awareness in the Cultivating Bodhichitta & Maranasati 10 present while we are performing tasks such as washing dishes, cooking, gardening, and walking. In this practice, one word is often recited during the inhalation and another on exhalation. This is a simple way to cultivate mindfulness outside of formal meditation practice. Examples of gathas follow: “Breathing in, I know I am breathing in. Breathing out, I know I am breathing out” (Nhât Hanh, 1993, p. 23), “Smiling to my body, I breathe in. Releasing the tensions in my body, I breathe out” (p. 17), “Looking at the roots of pain in my body, I breathe in. Smiling to the roots of the pain in my body, I breathe out (p. 74),” and “Knowing I am not limited by this body, I breathe in. Knowing this body is not limited by my lifespan, I breathe out (p. 94). Each part of the statement is coordinated with the breathing and the gathas are repeated. The gathas can also be used during walking meditation where the inhale and stepping down of one foot is synchronized and the end of the phrase and the out breath are synchronized with the other foot touching the floor, grass, sand, etc. Tonglen is another form of meditation that is practiced daily. Tonglen literally means “sending and taking” (Chodron, 2001, p. 55) and is a practice of cultivating bodhichitta for practitioners, as well as others. Unlike Western thought regarding mediation as a way to rid the self of painful, conflictual, stress-producing thoughts and emotions by releasing them from our mind, with the practice of tonglen Chodron, a teacher in the Shambhala tradition of Tibetan Buddhism that was founded by Chogyam Trungpa Rinpoche, states that we “breathe in what is painful and unwanted with the sincere wish that we and others could be free of suffering” (p. 55). Tonglen is a practice which can be done in each moment, throughout the day rather than just on the meditation cushions and through this immediate and ongoing practice, it is possible to learn how to stay with the discomfort of pain and suffering within the self and with others without running from it. This is an important meditation in training for the time of our death or of the Cultivating Bodhichitta & Maranasati 11 deaths of those that are loved because the practitioner learns to sit with what is with the intent of being fully present and compassionate to suffering. In the practice of tonglen, a grieving mother, for example, would upon the inhalation, breathe in the pain, confusion, suffering, or fear associated with loss and upon the exhalation, would breathe out qualities such as compassion, mercy, love, ease, or comfort. The grieving mother would do this practice repeatedly, starting with herself, the expanding her practice of tonglen to other grieving parents she might know. The object is to cultivate bodhichitta and expand the practice of tonglen so that the practitioner, while inhaling, visualizes breathing in the uncomfortable, painful feelings and qualities of all parents, everywhere, that have ever lost a child. During the exhalation, the practitioner would visualize breathing out qualities of comfort, kindness, and consolation to all parents, regardless of time or space, whom have experienced the loss of a child. Loving-kindness meditation is also called metta meditation. Salzberg (1995), Vipassana meditation teacher, states that: …When we do metta practice, we begin by directing metta toward ourselves. This is the essential foundation for being able to offer genuine love to others. When we truly love ourselves, we want to take care of others, because that is what is most enriching, or nourishing, for us. When we have a genuine inner life, we are intimate with ourselves and intimate with others. (35). As mentioned above, when we are practitioners, metta is practiced for ourselves before all others. This is not out of selfishness but our need to experience unconditional acceptance before we can continue on with the practice. The practice continues into three other stages: sending Cultivating Bodhichitta & Maranasati 12 loving-kindness to those you love, to those you are indifferent to, and finally toward those to whom you have ill feelings. Metta practice helps us in two ways beyond experiencing love and acceptance for ourselves. Metta allows us to practice for the benefit of all beings with the wish that they find happiness and alleviate suffering. This practice also helps us to re-open our hearts to those whom we have previously closed them and in doing this practice we achieve the understanding of the inter-connectedness of all beings and gain deeper understanding that we are not different from those that we may have perceived as our enemies. Meditations for Preparing for Dying Death is not an event that many people in our society are prepared for despite the fact that we all know on some level that dying is inevitable. We have made strides in the past decades increasing death awareness beyond the impact of the hospice movement. People are preplanning their funeral arrangements, are more open to making decisions like living wills, are preparing durable power of attorney and ethical wills. As a society we are having more conversations with someone close to them about how they want to be treated if they cannot speak for themselves. While we are seeing more of these plans put into action, it is still seemingly easier to make plans about dying in the future rather to embrace that death is only an exhale away from us. Conscious dying is about bringing our awareness and concentration to the fact that we are mortal and that our death will surely come. Tibetan doctor Dhonden (2002) assures the reader that: … in the cases in which one dies gradually, there are techniques with which one can meditate on the specific phases of the dying process. One is taught to anticipate these different phases so that one can be fully cognizant of each one, and enter with full consciousness into the transitional process following death. In Cultivating Bodhichitta & Maranasati 13 this way, it is possible to transmute the entire dying process into a meditation, which has great benefit after this life (p. 40). The techniques that Dhonden describes above are the meditative techniques that Buddhists spend a life time practicing so that they have reconciled with their fears of death and so that in knowing what to expect can remain calm and peaceful as their death occurs. As was referenced earlier, one aspect of the teachings and practices on conscious dying is the cultivation of bodhichitta. The meditation on the five powers is practiced daily and also at the time of death. Rinpoche (2003), a Tibetan Lama, states, “practice daily and you won’t need to do phowa if you do the practice phowa, the five powers will have been integrated into your practice before death” (p. 24). He points out that bodhichitta practices that cultivate awakening the heart, meditating on the five powers, helps us to let go of what we are attached to now and to alleviate suffering to benefit others (p. 24). While doing the meditations on the five powers daily, one meditates on the same five powers in daily meditation as they do while they are dying, however, with slightly different meanings. For the practice of meditation, whether in living or dying, there are the five powers that are practiced: the power of the white seed, the power of familiarity, the power of determination, the power of repudiation, and the power of prayer (Rinpoche, 2003, p. 24). The first three of the five powers meditation are directly related to increasing and fostering the increase of bodhichitta in all daily activities and to actualizing bodhichitta to overcome attachment to ego. The last two powers are focused on denouncing the ego and accumulating merit for the benefit of all sentient beings. The meaning of the daily practice of the five powers will be first introduced. The power of the white seed, according to Tibetan teachings is focused on the means to increasing one’s Cultivating Bodhichitta & Maranasati 14 bodhichitta by means of cultivating wisdom and method for awakening the heart (Rinpoche, 2003). The power of familiarity is practicing bodhichitta while doing daily life activities such as doing the dishes, walking, gardening, etc. The power of determination is the most vital of the five powers, as indicated by Tibetan master Pabongkha Rinpoche. It means that the practitioner is dedicated toward finding meaning in life “by actualizing bodhichitta and overcoming the selfcherishing thought” (p. 24). The power of repudiation is to thoroughly devote oneself to breaking free of ego-centric thought and the power of prayer is the practice of offering the benefits of these practices to all beings in the world each day we practice the five powers. Previously stated, the practice of the five powers takes on a different meaning while being practiced at the time of death. They will be discussed in the same order as above. The power of the white seed at the time of death means letting go of all delusions and attachments to increase bodhichitta as we begin to die (Rinpoche, 2003). The power of familiarity refers to dying while meditating and taking the three Mahāyana refuges of seeking shelter in the Dharma or teachings of the Buddha Shakyamuni, in the Buddha or enlightened one, and in the Sangha or spiritual community. The power of determination, at the time of death, is the practitioner’s steadfastness to bodhichitta even as the person goes through the bardos of dying, of karmic becoming and rebirth, and again into life, to be discussed later in the essay. The power of repudiation upon dying is to renew one’s spiritual vows and the power of prayer means not to pray for our own rebirth into a better spiritual place but rather to reinforce the dying person’s practice of taking on the suffering of others so that all beings may be free from suffering and its roots. As a practitioner of Buddhist meditation, I have learned that when the practice of the five powers is done upon dying, the aspiration is to continue increasing and purifying our awakened mind, however, they take on a slightly different focus. The same five powers are still focused Cultivating Bodhichitta & Maranasati 15 upon and they are all directed toward increasing and purifying bodhichitta for the benefit of others and self in addition to resolving not to be estranged from the practices during the dying process. Rinpoche (2003) states, that “the five powers are sources of immediate protection” (p.24) during the dying process. Like the practices of meditating on the five powers, the meditation on the nine contemplations is, also, a practice that is lifelong and particularly important while one is dying (Gyatso & Hopkins, 2002, Halifax, Dossey, & Rushton, 2007, and Hansard, 2001, Hawter, 1995). The nine contemplations, which are described by the above mentioned authors, are important teachings in the Tibetan, Zen, and Bön traditions respectively. They focus on the impermance of our lives, the uncertainty of death, and that death is inevitable. These contemplations are listed below: • Death is inevitable; no one is exempt. Holding this thought in mind, I abide in the breath. • Our life span is ever-decreasing; each breath brings us closer to death. Holding this thought in mind, I delve deeply into its truth. • Death will indeed come, whether or not we are prepared. Holding this thought in mind, I enter fully into the body of life. • Human life expectancy is uncertain; death can come at any time. Holding this thought in mind, I am attentive to each moment. • There are many causes of death – even habits, desires, and accidents are precipitants. Holding this thought in mind, I consider the endless possibilities. • The human body is fragile and vulnerable; our life hangs by a breath. Holding this in mind, I attend to my inhale and exhale. • At the time of death, material resources are of no use to us. Holding this thought in mind, I invest wholeheartedly in practice. • Our loved ones cannot keep us from death; there is no delaying its advent. Holding this thought in mind, I exercise non-grasping. • Our body cannot help us at the time of death; it too will be lost at that moment. Holding this thought in mind, I learn to let go (Halifax et al. 2007, pp. 40-41). As one can see, there appears to be a dual process that takes place through the nine contemplations; that of emphasizing the impermance of human life and that of vowing to use our Cultivating Bodhichitta & Maranasati 16 daily practice and life as a way to prepare for our dying, as well as to enhance our living. By keeping one’s death as a focus each day, the nine contemplations give guidelines and ethics that keep our practice centered, helping us to practice other interrelated teachings such as the noble eight-fold path. Halifax et al. (2007) ask the following questions in regard to the nine contemplations: “What are we doing to deepen our practice? How are we now working with our own fear and suffering and the fear and suffering of others? Which further deepens our everyday practice of the Dharma?” (p. 41) Buddhist Understanding of the Dying Process: The Dissolution of the Body and the Tibetan Practice of Phowa In many of the Buddhist traditions, it is encouraged as a mainstay of practice to do contemplative practices upon death and dying as a way of understanding that our true nature is that of impermance and emptiness or shunyata. Gyatso & Hopkins (2002), write, “The cornerstone of my own [The Dalai Lama’s] practice is reflection on the four basic teachings of impermance, suffering, emptiness, and selflessness. In addition, as part of eight different daily ritual practices, I meditate on the stages of dying.” (p. 162). He further shares insight into his own practices which help him to visualize his own death so that when the time comes, he will be familiar with the process. For those who have made a practice out of meditating daily on their death, it can have the effect of relaxing the body and relieve general anxiety. He reminds the practitioner that, “for the one who cannot now face even the word ‘death,’ never mind the reality of it, the actual arrival of death is likely to bring with it great discomfort and fear” (p. 97). Rosenberg, (2000) Vipassana meditation teacher, asserts that death awareness practice is the definitive practice and emphasizing the point with a quote from the Buddha, “Of all the Cultivating Bodhichitta & Maranasati 17 footprints…that of the elephant is supreme. Similarly, of all the mindfulness meditations, that on death is supreme” [sic] (pp. 14-15). Although the meditations discussed earlier in this essay focused on concentration, stillness, compassion, the meditations on death help us to contemplate some of the most fundamental of Buddhist teachings on the our true and basic nature, for instance, impermance, co- existing and emptiness. In his Dharma talk as a Vipassana meditation teacher, Smith (1988) gently challenges us by asking, “Your practice is wonderful in quietude but how is it in turbulence?” Our practice on the dissolution of the body upon dying allows us a rehearsal before the turbulent and chaotic thoughts and emotions that may arise during our death are actually unfolding before us. Before active dying takes place, Gyatso & Hopkins (2002) counsel that many changes will occur, sometimes years prior to the actual death occurs. Some of these changes are simple, possibly unnoticeable signs including dreams, change in personality, lack of enthusiasm for life, a change in the luminosity that radiates from the body, and other physical signs (p. 118-119). In my years of working at hospice, patients have shared long before their body begins to shut down and be ravaged by disease, they have experienced signs of approaching death like visions in their room that no one else can see, life reviews, and decreases in desire to be connected to the world around them. So if the Western and Buddhist understandings of the death process are different, what is at the heart of the Buddhist understanding? Holton (1993) reports that the Buddhists see dying as “a lengthier process that we had imagined” (p. 164) because they focus on the dissolution of the elements of earth, water, fire, air, and wind in the body. Another difference is their deep understanding of the levels of subtle consciousness that also disperse during dying. Cultivating Bodhichitta & Maranasati 18 Halifax et al. (2007) gives a vivid and thorough description of the sequential dissolution of the elements of the body. These are similar to those that are described by Rinpoche (2003) and Gyatso & Hopkins (2002). Rinpoche (2003) writes that: The physiology of death revolves around the changes in the winds, channels, and drops. Psychologically, due to the fact that consciousness of varying grossness and subtlety depend on the winds… their dissolving or loss of ability to serve as the bases of consciousness induces radical changes in our conscious experience (p. 10). The dissolution of the elements in the body brings forth changes that are both internal and external phenomena which arise in an orderly progression. The internal signs are the inner experience of the person who is dying and the external experiences are visible to those who are tending or companioning the dying. Together, there are five cycles that occur as the elements that comprise the body dissolve, also bringing about the dispersing of consciousness, and a sixth cycle of the dissolution of inner phenomena. It is on these five cycles that one meditates on during the daily meditations so that upon actual experience the individual is aware of what is happening and to stay focused on the practices. The first of the five cycles is the “dissolution of earth into water and the unbinding of the body” (Halifax et al, 2007, p. 174). During this time, the internal experiences of the dying person are the appearance of mirages (Rinpoche, 2003) and the sense of heaviness of the body accompanied by sensations of sinking, tiredness, and sensory perception decreasing (Halifax et al, 2007). The external signs are as follows: the body becomes thinner, the limbs become smaller, the sight becomes unclear and dark, and the strength of the body diminishes (Rinpoche, 2003). Gyatso & Hopkins (2002) report, “Now the capacity of the water element to act as a base of consciousness becomes more manifest” (p. 121). Cultivating Bodhichitta & Maranasati 19 The second cycle is the “dissolution of the water element into fire and the unbinding of feelings” (Halifax et al, 2007, p. 176). It is now that the fire element becomes the basis of consciousness (Gyatso & Hopkins, 2002, p. 122). At this time, several external signs occur such as bodily fluids beginning to dry up, feelings such as pleasure, pain, and neutrality diminish; a sense of numbness increases, internal and external hearing no longer exists, and the ability to differentiate between physical and mental awareness ceases to exist (pp. 176-177). The internal experience is visions of smoke which makes differences in thoughts, feelings, and sensations undifferentiated (p. 176). The third cycle is the “dissolution of the fire element into air and the unbinding of perceptions” (Halifax et al., 2007, p. 177). The external appearances are the dying person no longer has the sense of smell, hunger or thirst and no longer remembers or recognizes those who are around them. In addition, the dying person’s inhalation becomes weak and the exhalation becomes lengthier, and mentally the person vacillates between states of confusion and states of clarity (Rinpoche, 2003, p. 12). “The throat emits rattling or gasping sounds” (Gyatso & Hopkins, 2002, p. 123) usually called chain stoking by hospice staff who explain this phenomenon to family and friends of the dying person as a sign of impending death. The internal process for the dying person is that sparks or fireflies begin to appear within the smoke that came into vision during the second cycle and all other senses of perception cease (Halifax et al., 2007, p. 177). The fourth cycle is the “dissolution of the wind element into space and the unbinding of mental formations” (Halifax et al., 2007, pp. 177-178). Mental formations are synonymous with consciousness. During this phase of the dissolution of the body, Gyatso & Hopkins (2002) describe the external experiences as: Cultivating Bodhichitta & Maranasati 20 The tongue becomes thick and short, its roots turning bluish. Experiencing physical touch is impossible, as is physical action. The breath through the nostrils ceases, but there are subtler levels of breath, or wind, so the cessation of breath through the nose does not indicate the completion of the death process (p. 123). The internal experience of the dying person is that they have let go of any need to be active. At this time in the process, that brain function has stopped, breathing has ceased, and one’s consciousness “dissolves into space” (Halifax et al., 2007, p. 178). It is also reported that, “at the moment of physical death, one sees the small, flickering flame like a candle. Now it is suddenly extinguished, and you are without any awareness” (p. 179). In addition to the five cycles of dissolution of the elements and consciousness, Halifax et al. (2007) also describe the inner dissolutions, which occur after what Western medicine would deem the physical death of a person. The authors describe the process in the following manner: From the crown a white drop Is propelled downward through the central channel toward the heart. This is the male essence, and anger transforms into profound clarity. You experience an immaculate autumn sky filled with brilliant sunlight. A red drop from the base of the spine is propelled upward through the central channel toward the heart. This is the female essence, and desire transforms into profound bliss. You experience a vast and clear copper-red autumn sky of dusk. The white and red drops meet in the heart in the heart and surround your consciousness. You are now freed from the conceptual mind. Thick, darkness like a deep autumn night sky appears. You dissolve into unconsciousness. Out of this nothingness, luminescence arises. You are one with a clear dawn sky free of sunlight, moonlight, and darkness. You are bliss and clarity. Now the Clear Light of Presence is liberated, the Mother Light of your awareness. This is your ultimate Great Perfection. This is the actual moment of death (p. 179). Cultivating Bodhichitta & Maranasati 21 What is important to realize is that the inner dissolutions can be seen as the spiritual death after the physical death has occurred, or as Smith-Stoner (2005) describes it, “this is death, beyond resuscitation” (p. 230). The teachings make it clear that as this process is taking place, the dying person should be in a calm, peaceful environment and that the person should not be physically touched as this can cause attachment to this life and cause difficulties in the process of rebirth (Hawter, 1995). The exception to not touching the deceased is that someone can lightly tap the crown of the head, approximately eight inches backwards from the original hairline, encouraging one’s consciousness to leave through the top of the body. The teachings also suggest that if the deceased person is touched at the hands or below the heart area, this can cause rebirth into a lower realm (Smith-Stoner, 2005). This will be discussed more in the following section on the phowa or transfer of consciousness. The Transfer of Consciousness (phowa) and the Bardos To reassert, there is no dualistic view of life and death in Buddhist thinking, practice, and teachings and Mahāyana/Tibetan practice of phowa, although primarily practiced for the transfer of conscious at the time of death, it is still a lifelong practice that, “…helps to purify our regrets, harm, and negativity, and it can be used to assist in emotional or physical healing” (Longaker, 1997-2006, ¶2). Phowa may also be practiced at the time of someone’s dying by a person, particularly a Sangha, spiritual community member, or teacher. Smith-Stoner (2005) affirms the importance of this practice as helping us to let “…go of attachments, especially to one’s body” and that phowa “is key to successful transference of consciousness at the time of death (p. 361). Tibetan doctor Dhonden (2002) describes phowa more extensively as he clarifies the process, “…for people who are well-trained, when entering the dying process it is possible for them to direct, or transfer, one’s consciousness from this life Cultivating Bodhichitta & Maranasati 22 to a destination of one’s choice” (p. 42) and that for Tibetans this destination is to “the buddhafield, where they dwell in the presence of a Buddha, receive spiritual teachings, and progress towards enlightenment (p. 42). Buddhism also offers hope in that if one does not realize the true nature of mind through this lifetime, it is still possible to recognize it during the death practices upon the actual physical death (Ponlop, 2007). The success of the transfer of consciousness “relies on the invoking the presence of a Buddha (a fully enlightened being), combined with our receptivity and devotion, and the familiarity which comes from having done the practice throughout our lifetime” (Longaker, 1997, p. 123). The Tibetan practice of phowa is a practice of visualization for uniting with one’s chosen deity, acknowledging one’s need for mercy, purification, and blessing. Longaker describes the beginning of the process: With all your heart, invoke in the sky before you the presence of a Buddha or a Divine Being for whom you feel a devotion. See the form of this Presence, not as flesh and blood, but as radiant light. Recognize that this being’s qualities of perfect wisdom, boundless compassion, and limitless power to benefit beings are no different from the qualities of your own wisdom nature. Consider the Divine Presence you have invoked is actually present [author’s italics] – alive, breathing, and gazing toward you with kindness and love (p. 124). During this process of visualization, dying persons let go of all of their flaws, weaknesses, illnesses, and negative karma and opens to the healing presence of the buddha or the deity in which they invoked to create healing, compassion, and bliss. The dying persons becomes open to lived experience of having those aspects rain down from their chosen deity to purify and dissolve any ego to which they may still be attempting to grasp. It is in this process that Levine’s statement, “there’s a healing we took birth for…it’s because this is the place we come to heal…” (Mishlove, 1988, ¶5). If one takes Levine’s words literally and figuratively, then our living and Cultivating Bodhichitta & Maranasati 23 our dying come about from our need to heal our negative karma and ignorance, or our need to heal by creating compassion and understanding for self and others. After the dissolution of the body and consciousness and the ejection of consciousness into the pure realm of the buddha or our deity, the Mahāyana Buddhist tradition affirms that one’s consciousness goes through the bardos, or in-between states where further healing and “spiritual rejuvenation” (Hansard, 2001, p. 235) can be accessed. Kramer & Blumhorst (1993) describe the bardos as “transitions, in between, suspended” (¶10) between the dispersion of our consciousness at the end of one life and the beginning of rebirth. The bardos, themselves, are also non-dualistic in nature. Although they can be a time of healing before rebirth, “…in the bardo states of death and after-death, we are very susceptible to intense emotional stress” (Ponlap, 2007, p.18) which can cause “…overwhelming moments of panic and fear” (p.18). Because the bardo states, of which there are a total of six, can bring forth healing or chaos, it is important that practitioners is prepared for the intense emotion and have the ability to transcend our habitual tendencies of reacting to our mind states. The six bardo states include: the natural bardo of this life, the bardo of meditation, the bardo of dreaming, the painful bardo of dying, and the karmic bardo of becoming (Ponlop, 2007). Yet Kramer & Blumhorst (1993) view the bardos as an opening for liberation and positively state that “there’s always hope – in life, in death, and in the bardos” (¶29) for the individual meditator to attain enlightenment. Death-Related Practices for Family and Professional Caregivers Given that after death, we enter into the in-between bardo before the bardo of rebirth, it is important to realize that a person’s consciousness may not be totally detached from its surroundings. Every seven days, for a total of forty-nine days, it is possible that a consciousness Cultivating Bodhichitta & Maranasati 24 may find a new place of rebirth. Longaker (1992-2006) reminds those left behind that “since the mind is no longer associated with the body, the person’s consciousness is more malleable” and that “whatever spiritual practice we do after someone has died has a powerful influence, because the person’s consciousness is now more receptive and clear” (¶1). As the person’s consciousness becomes more impressionable, the Buddhist teachings suggest that those left behind to grieve should not show strong displays of emotion that would allow for the deceased’s consciousness to stay attached to its previous life. Upon arriving on a Saturday evening to a Laotian patient’s home after his death, I knelt beside him on the floor and repeated “Given to the Dying” which is found in the Anguttara Nikaya and translated by Nhât Hanh (2002). I recited the prayer several times, seated near the head of my patient and when his nurse could be near, in unison we chanted: This body is not me; I am not caught in this body, I am life without boundaries, I have never been born and I have never died. Over there the wide ocean and the sky With many galaxies all manifests from The basis of consciousness. Since beginningless time I have always been free. Birth and death are only a door through Which we go in and out. Birth and death are only a game of hide-and-seek. So smile to me and take my hand and wave good-bye. Tomorrow we shall meet again or even before. We shall always be meeting again at the true source, Always meeting again on the myriad paths of life (p. 186). The nurse and I found comfort in our chant for this body that had belonged to our patient who, with his family, had become quite close to us. It was a closing and a new beginning for both our patient and my colleague and me. If one’s consciousness is nearby, then it is important that the bereft understand that death is only an illusion to a life ending and that there is no need for Cultivating Bodhichitta & Maranasati 25 sorrow or clinging to something that has transformed. Hansard (2001) warns that “the dead will be curious about how others see them…loud noises at funerals can shock people who have recently died and cause them to panic because they have not fully come to terms with being dead” (p. 251). These words are important not only at the funeral but also wherever the patient may be dying whether that is in the hospital, the home, or the nursing home or inpatient hospice setting. All of the meditation practices that have been mentioned thus far are for practice during life and during dying these meditations are important for those who are bereft to practice as well. It is important that family and friends have clear concentration on the importance of impermance, suffering, and the ways to free one’s self from suffering. At this time, practicing tonglen for others who are bereft or for those who have died is an important practice that reminds us of our interconnectedness with all those in the world that are experiencing the same thoughts, feelings, and emotions. Hospice and nursing home staff can be helpful in guiding family to honor the spiritual practices and wishes of the person who is dying or who has died. Any individual near the dying person can be “a reminder to caregivers that helping to ease the pain and suffering of others can also enable them to achieve growth and healing in their own lives (Sentient Times, 1998, ¶4). This is an important practice for professional caregivers, family, and friends to remember as part of their own experience, regardless of their spiritual practices. While a patient is in the process of dying, Smith-Stoner (2005) has several practical suggestions for care giving and care planning for the interdisciplinary team. The following three ideas can be important protocols that team members can model for others around the dying person. They are: Cultivating Bodhichitta & Maranasati 26 • Maintaining a visitation schedule that allows for uninterrupted periods of religious practice. The patient may want to have team members visit at the same time. • Maintaining an altar with religious photos and relics. This alter may include candles and incense. • Specifying who the patient would like to be present at the time of death. The preference may be for no one to be present, especially if family and friends are very emotional or unsupportive of the religious practices (p. 231). In addition, simple advice may help the team members be able to be supportive of the patient’s spiritual practices, such as entering the patient’s room after calming their own mind, suggesting to the facility that the patient would be helped by being in a room that is farthest away from noisy, congested areas, spending some time in silent contemplation or meditation of their own spiritual path at which time staff may tend to the patient’s altar, play soothing music, or practice slow, mindful breathing with the patient. It is also helpful to be supportive of the patient’s family, especially in situations where they might not understand or agree with the patient’s spiritual practices. Caregivers may help family to seek spiritual solace through inspirational readings or community as ways of taking care of their own spiritual needs while respecting those of the patient (Smith-Stoner, 2005). Maranasati: Being with Dying Being Present at the Sickbed Today there are several training programs that incorporate the teachings, the wisdom, and the practice of Buddhism into the training of professionals and volunteers that care for the dying. Some of the most well-known of the programs include; the Upaya Zen Center in New Mexico, Zen Hospice Project in California, Metta Institute also in California, and the Rigpa’s Spiritual Care Program which is now working in conjunction with Naropa University Center for Contemplative End of Life Care in Colorado, all of which bring the contemplative and meditative practices and teachings of Buddhism to the practice and care of the ill and dying. The Cultivating Bodhichitta & Maranasati 27 term maranasati literally means “being with dying” and this word was chosen purposefully for discussing the findings of my inquiry into conscious dying and caring for the ill and dying. There appears to be a subtle shift from care for the dying to being with dying; the emphasis on presence and connection rather than technique and technology. Founder of Zen Hospice Project and The Metta Institute, Ostaseki shared his views about dying in an interview for Health Forum Journal (Flower, 2002). Ostaseki told his interviewer, “The first [step] is to recognize that dying is not primarily a medical event. It’s much more an issue of relationships” and “…accompanying the dying is a matter of facilitating these relationships” (Flower, p. 18). Ostaseki goes on to state that, “it’s a willingness to be there, not to turn away from the mysterious and the unanswerable” (p. 18). Levine (1982) asks us to contemplate the following: How do you relate to someone who’s ill? With openness. [sic] With an honoring of the truth we all share. Work to dissolve the separateness that keeps one lost in duality. Become one with the other. No help, just being… Come to the common ground of being (p. 157). Further into the reading, Levine takes his ideas of relating to someone to an deeper level and encourages us to understand that, “You are simply there, listening with a heart that is willing to hold the joy or pain of another with equal capacity and compassion” (p. 163). This is the heart of the teaching of being with dying and what is needed for someone to be a caregiver. At the heart of Ostaseki’s and Levine’s teachings is being in relationship to the person who is dying and to one’s self as we relate to the person who is dying. It is implicit in their teachings that their belief of what end-of-life care could be is deeply rooted in contemplative, meditative practices resembling mindfulness and loving kindness which are the very practices that this inquiry set out to first understand and describe as practices throughout our lifetime and during our dying. Cultivating Bodhichitta & Maranasati 28 Tibetan Bön practitioner Hansard (2001) describes in detail how to practice maranasati. Hansard stresses the following, “honesty, understanding, the desire for freedom, respect, love, and acceptance are key in creating a beneficial relationship between the person who is dying and those who are caring” (p. 247). Caregivers should be forthright and perceptive while caring for the dying due to their sensitivity to the environment in which they find themselves. He also is cautious to instruct for the caregiver to stay compassionately detached from the dying so that their caring and their relationship do not become spiritually connected and, therefore, have difficulties in their dying. An aspect of Hansard’s beliefs about working with the dying that is important when the dying person wants to continue their meditative and contemplative practices is two-fold. Caregivers should respect the mental competency of the dying. If the person who is dying is suffering from mental anguish, high levels of sedative medication do not help to facilitate a peaceful death because they enter into the dying process mentally confused and agitated. It is more helpful if caregivers can remind the patient of their lifelong practices of compassion, equanimity, and meditative awareness (p. 249). Levine (1982) addresses the caregivers’ respect for the dying person. He asks the reader to contemplate their intentions. He writes: It is important before using such subtle techniques to examine your motivation. Are you trying to change someone’s consciousness to what you imagine is “best for them”? Or are you just there with another sending love and a sense of okayness of things? One does not take from another, nor do you steal their states of mind. To attempt to steal “denial” from another is an act of righteousness and separatism (p. 163). Five Precepts of Zen Hospice Project Hanging on the walls of a nursing facility in San Francisco, California is where I first came into contact with the concept of Zen Hospice’s Five Precepts. At the time, I was astonished at the simplicity and pithiness of these teachings. I remember the eagerness I felt as I Cultivating Bodhichitta & Maranasati 29 asked a staff member for a pen so that I could write the five precepts on the back of a newsletter that I was holding. The thought that being with dying could be so simple, profound, and beautiful made me question the chaos and toxicity that my own hospice team created. The first precept is “Welcome everything…push away nothing” (Flower, 2002, p.19). With the first precept, one is instructed at the beginning of their training to accept everything with equanimity. The instruction is similar to that of mindfulness when one is taught to acknowledge thoughts, feelings, and sensations and allow them to dissolve. Everything that we experience while working with people living with illness, mental or physical, brings its own lessons for both the person who is ill and the person who is the caregiver. Whether the caregiver and patient have similar beliefs, lifestyles, or practices, by pushing nothing away, we allow ourselves to be open to whatever spontaneously arises. This allows both parties a rich bounty for their contemplative practices as well as developing compassion and loving kindness. The second of Zen Hospice’s precepts is “Cultivate ‘don’t know’ mind” (Flower, 2002, p. 19). The basic teaching poignantly reminds us that we are not always in control and not always the expert. It also gives us the space to allow the patients to let us into their worlds. After being of service to others, it can be easy to stereotype the person in front of us as, “that cancer patient, this drug addict, or the moody old man down the hall”. If we have the belief that we know everything about the person who we are with, there is no room for relationship to be built and no opening that allows us to just be with the person. “Bring your whole self to the bedside” (Flower, 2002, p. 19) is the third teaching at Zen Hospice. When we can leave our cell phone, our busy schedule, or our next patient outside the door, we can genuinely be present to the person we are with and the exchanges that take place in that encounter. Bringing your whole self reminds us to cultivate one-pointed awareness to Cultivating Bodhichitta & Maranasati 30 whatever we experience. It also gives us permission to bring the totality of who we are into the caregiving relationship rather than keeping up the separation between expert and patient. It allows for unconditional acceptance and warmth. “Don’t wait” (Flower, 2002, p. 19) is the fourth precept. It has been my experience with dying people that they understand on some level that their time appears to be more limited than those around them. This precept has taught me to listen deeply to my intuition and feelings. If someone crosses through my mind, I try to call them or send them a note within 24 hours. I often hear from clients, friends, and colleagues that the timing of my outreach was when they needed some extra kindness or comfort. “Don’t wait” is also a wise teaching for the people who are ill and do not know if they will have time to work with feelings, relationships, and situations that may need attention. For the caregiver, “don’t wait” also holds many connotations. It can mean not to procrastinate in telling the dying that they love them or not waiting to come to the bedside because they believe they have more time with their loved one than they do. This precept calls for definitive action, gentle communication, and no hesitation. The last of the precepts is “Find a place of rest in the middle of things” (Flower, 2002, p. 19). My introduction to these precepts at the nursing facility came eleven years after being a caregiver to my dying brother. To have truly heard from someone that we need to find a place of shelter, a place of refuge, a place within ourselves that does not get attached to outcomes would have made a difference in the world in which I found myself. As crises arose and fell, life felt like it was a rollercoaster ride, with nothing solid as a foundation. The precept itself is a foundation that brings us back to our own center, to our practice, to our teachings, and to those things that bring comfort to us. Now, when counseling grieving clients, I hold the intention to stay near the middle of the path, to create the space in our time together where they can find a Cultivating Bodhichitta & Maranasati 31 safe place to rest in the middle of the chaotic feelings or life situations in which they find themselves. In their totality, the five precepts provide guidance to dying patients, to their family, and to those who support them as professionals or volunteers. The teachings act as short slogans to remind us of what our practice is, like the gathas that are used in mindfulness meditation. They also act as reminders that allow us to come back to ourselves so that we can be fully present to our lives and our patients. Training and Supporting Companions in Conscious Dying While compassionately caring for the dying, caregivers also benefit from cultivating bodhichitta and maranasati. The practices of mindful awareness, loving kindness meditation, as well as the practices focused on death – the five powers, the nine contemplations, and the meditations on the dissolution of the body upon dying. These practices allow caregivers to have an intimate relationship with the nature of their own life and dying. It is the practice of what Horrigan (1997) calls “being present where there is suffering [that] brings one a sense of deep gratitude in one’s own life” (¶55). It is about following instructions like the five precepts of Zen Hospice and about finding support for your own practices and your own well-being. It is important to support those who have chosen to be caregivers to the dying and to remember that dying is more than a medical crisis or failure but a time of deep reflection, of reconciliation, and of equanimity. Levine (1982) addresses the issues of caregivers in hospice. Hospice workers, like any of us, are a product of their conditioning, and there can often be transmitted the fears of life and the grasping at the body which makes death so difficult. Many who work in hospice don’t recognize the trap of being “a helper”; the separatism which sometimes comes when you use another to Cultivating Bodhichitta & Maranasati 32 reinforce your self-image, to make yourself feel that you are living up to who you are supposed to be (p. 168). He also reinforces that even in hospice care, with its philosophy of interdisciplinary care for the whole person and the family, hospice can neglect the spiritual needs of the dying and that can also be a “means of spiritual awakening” (p. 169). A further discussion of the neglect of the psycho-spiritual needs caregivers, particularly professional caregivers will be addressed in the section on training individuals in contemplative end-of-life practices and care. The hospice philosophy was created out of awareness that dying people were greater than their illnesses. In the same manner, contemplative end-of-life care training that focuses on cultivating bodhichitta and maranasati for those who are dying and to their caregivers to nurture an awareness of the psycho-spiritual needs of patients and themselves. These practices also bring the experience of impermance and the subject of dying into our everyday awareness giving us the opportunity to explore our mortality before we are on our deathbeds. Contemplative end-of-life care training programs such as the ones mentioned in this essay combine a sense of community for caregivers, contemplative and mindfulness practices for patients, family and caregivers. These programs also include teachings on indigenous practices, rituals and holding council, and restorative practices for the caregiver. The aforementioned subjects will be discussed in further depth in the following section. Creating Community through Ritual In our world of increasing technology and unending supplies of information it can be easy for people to not be in the moment; a lack of mindfulness can be natural even when we are in our most intimate relationships and are not being present to the other. With the drive for increasing productivity, gaining more material goods, and furthering ourselves from the past, we have lost a vital part of what once was – the use of rituals to mark important events in our lives Cultivating Bodhichitta & Maranasati 33 such as birth and dying. Many have forgotten simple rituals such as the Sunday meal with the whole family together because each member is busy with their own individual interests and because of a belief in the scarcity of time that is indicative of our post modern world. Elaborate rituals of beside vigils, wakes, and other death-related rituals from the past have been exchanged for a one-day viewing of the body, holding the funeral, and spending time with family. In an audio tape on rituals and dying, Feinstein (1992) describes three needs for ritual in our lives, “for entering sacred time, for bringing structure and meaning to chaotic emotional conditions, and for confronting one’s mortality”. In a world focused on tomorrow, there is little time to be in the present and stop for ritual. The use of ritual creates a time, a purpose, and an outlet for community, whether family or interdisciplinary team, to come together to seek meaning and purpose from their experience. Although as a society we have moved away from collective rituals or allowed them to be transformed into hollow remnants of what they may have been, there are individuals who are seeking ways of bringing meaningful ritual back into everyday life. During a time of illness, uncertainty, transition, and dying, rituals can bring a community together. Feinstein (1992) remarks: It is entirely possible to learn how to innovate contemporary rituals that can help you approach such questions [as meaning and purpose of life] more astutely and more creatively. You will come to understand ritual as a relevant, inspiring, above all practical way to participate with very subtle, but very important dimensions of your life. (audio cassette) Halifax et al (2007) suggest four main characteristics of rituals for healing in caregiver training program at the Upaya Zen Center. The first is intention to what is present or the need to acknowledge a special need such as healing, transformation, or dying. The second characteristic is time. In ritual, one sets the intention for setting aside time that is sacred and different from Cultivating Bodhichitta & Maranasati 34 one’s average every day existence. Place or physical environment, the third characteristic, is important to ensure a place of safety and a place for soul work to occur. Lastly, the fourth characteristic is a key factor, people. Halifax et al describe ritual as a “healing force because they contain steps for healing and recovery, and reduce feelings of anxiety, fear, and helplessness” (46). When preparing for ritual, it is important that people understand the richness and sacredness of the time together. The use of ritual is not only important for the dying and their family and friends, but also for caregivers who are being trained to be with the dying. Ritual can be a key to self-care when added to meditative and contemplative practices. Whether ritual is performed in groups or in private, they provide a time for reflection, for mindfulness, and for restoration of the caregivers’ psycho-spiritual needs. When groups use ritual to honor the experiences of the individual and the collective group, healing can occur within the safe container that ritual provides from our daily life. Halifax et al (2007) provide an example of a simple and yet powerful ritual that is used in training their volunteers. In their volunteer manual at Upaya Zen center, Halifax et al. share a ritual that they use to end the first day of their training. They state: The basket of pebbles services as a symbol of all that each person brings with them: joys, burdens, fears, and sorrows. Each participant is invited to take a pebble from the basket, she/he is asked to sit in silence for one minute and reflect on her/his pebble and what it represents. Next, everyone is invited to put her/his pebble into a large bowl of water. This symbolizes emptying one’s self and thereby readying one’ self to be filled with new understanding related to compassionate care of the dying (8). After a ritual like this, group members could take a pebble with them as a symbol of emptying ones’ self before entering the room of a dying person and letting go of what might keep them from being present and open to the experience. Cultivating Bodhichitta & Maranasati 35 Exploring the Three Tenets of Upaya Zen Center This year, Upaya Zen Center founded by Joan Halifax Roshi, made their compassionate end-of-life care training manual (Halifax et al, 2007) available to the public. She started using variations of the material starting in the 1970s. Although the curriculum is similar to those of Zen Hospice Project, Naropa University, and Metta Institute, obtaining the manual gives one an in-depth understanding of the training process that caregivers go through while learning about being with dying. There are three tenets that caregivers learn while going through the training at Upaya Zen Center that are based on the work of Zen Teacher Bernie Glassman’s work on peacemaking from his book, Bearing Witness (1998). As stated above these tenets are similarly used in other programs and have at the core basic Buddhist teachings as understood in many traditions of Buddhist rich and varied lineages. Not-knowing is the first tenet and its focus is on the wisdom of insight and intuition (Halifax et al., 2007) and refers to “…the mind that is not attached to fixed ideas about the self or other or the world” (p. 43). As a professional caregiver practicing not-knowing with grieving people is important so that I can be open to and not attached to outcomes of where I think a client should be during the grief process. If I believe that I am the professional with all of the answers, I am not able to truly hear and see the person who has sought the safety of counseling. Not-knowing keeps caregivers open to their intuition and expanding insights. The second tenet is bearing witness and “…reminds us to be fully present for what is – our lives and the world” (Halifax et al., 2007, p. 43). When one practices bearing witness, one has developed one-pointed concentration and presence to what is arising in the moment. By Cultivating Bodhichitta & Maranasati 36 bearing witness, the caregiver creates a container for deep listening and compassionate speech and action to take place. Compassionate Action is the last of the three tenets of the Upaya training program in compassionate end-of-life care. Compassionate action is two-fold in that it is being “…of service to others” and including “everything that arises in our experience” (Halifax et al., 2007, p. 43). While being with a dying person, it is important for caregivers to not only cultivate onepointed concentration and presence but also to be mindful of their own thoughts, feelings, and sensations as they arise. Compassionate action along with bearing witness and not-knowing are nurtured and promoted through contemplative and meditative practices. Creating a Safe Container through the Practice of Council Central teachings of contemplative end-of-life care are compassionate action and speech and deep listening and holding council is a way of engaging in both of these practices. Although the council practice is being explained in the section on caregiver training, the council process can also be used in groups of people who are ill, such as in a residential hospice setting and used in family home settings by professional caregivers. It can also be a powerful practice for interdisciplinary team members and for training of caregivers/volunteers. There are four basic guidelines for council participants to follow. Halifax et al (2007) describe the guidelines as simple: 1) to speak truthfully and constructively, 2) to listen openly, 3) to be concise and go to the essence [of what needs to be addressed] and 4) to be spontaneous (p. 4). When using the practice of council it is important that there is an innate “experience of trust including trusting the wisdom of the [council] process” (Halifax et al, 2007, p. 5). Holding council helps to establish boundaries and a container or space where deep process and healing can take place because the group acknowledges the council’s confidentiality. Honest respect and Cultivating Bodhichitta & Maranasati 37 engagement can take place when individuals can be spontaneous rather than rehearsing how they will respond to the person who is talking. The use of I-statements helps the individual to be mindful of their own internal processes and external experiences. Council practice values both insight of the individual and the group. Each individual in the council is allowed time to share and this varies depending upon the variation of the council process. Often the facilitator of the council session will offer a talking piece, an object that can be passed from member to member, that is meant to keep the intention focused on the one person who is speaking. If one does not have the talking piece in the group, their participation in the council is to practice deep listening. Once a person has the talking piece it is suggested that the council participant speak precisely and with compassionate speech. Rather than sharing rehearsed statements, the person who is about to speak is encouraged to engage in self-reflective questions such as the following that are used in the Upaya training: What is the truth of what is happening at this moment? Can I articulate what I see? Am I able to bring this forward at this time? Can I trust and let go of my fears as I go deeper than I what I know? (Halifax et al, 2007, p. 6). Holding the safe container in council also allows for healing and self-care to be practiced. One way in which healing occurs is by the council’s acknowledgement of the shadow, that which might not be said or that which may be undercurrents that accompany group work such as triangulation. Acknowledging the shadow in the process and in one’s self allows for clear understanding and contemplation. Council also provides several ways in which the individuals can learn self-care such as establishing limits and boundaries, developing compassion and tolerance of differences, practicing patience and authenticity, and learning to let go of attachments to outcomes. Cultivating Bodhichitta & Maranasati 38 Training for compassionate caregiving holds many important gifts and opportunities for those involved which impact their lives and the lives of the people they companion through conscious dying. Caregivers learn to create community and sacred space through the use of rituals. They are encouraged to practice the three tenets of not-knowing, bearing witness, and compassionate action. They experience the tools of self-care and compassionate speech by learning to create safe space during the process of council. In addition to the abovementioned opportunities to be cultivated, training encourages the caregiver to practice contemplative and mindfulness practices as well as death-related meditations so that both bodhichitta and maranasati are blended together in their experiences. Moving Beyond: Areas of Further Inquiry As this inquiry unfolded, a number of questions revealed themselves to me that were beyond the scope of this particular essay that could be further studied. An important question to explore is the adaptability of the principles of conscious living and cultivating bodhichitta and being with dying through our practices to people of different spiritual or faith paths? Can contemplative end-of-life care be of use to people in the way that is as successful as KabatZinn’s work with mindfulness practices in coping with pain and stress? If the essence of these practices were distilled of their Buddhist roots, what would the care consist of and how would professionals and volunteers be trained? A second question that was the impetus for this initial inquiry was to look at opening the field of thanatology to include training of therapists, psychologists, counselors, chaplains, and other professionals as being companions to those who choose to practice contemplative means for living with illness at the time of diagnosis. Could these same professionals continue to companion their patients through the conscious dying practice in at least an auxiliary role rather Cultivating Bodhichitta & Maranasati 39 than to take the place of a spiritual teacher or Sangha member? What kind of on-going training and support would be necessary in order for these professionals to companion individuals through the later stages of their lives? A third question that arose from my inquiry came from an article by Smith-Stoner where she discussed the support of families who do not have the same spiritual beliefs or practices as the person who is dying. This topic was of personal interest to me since I have become a Buddhist practitioner and my family who were raised Roman Catholic know little about Buddhist teachings such as impermance, interbeing, conscious dying, and phowa. I began to question how I would like my own family to be supported so that they would respect my practices even if they seemed foreign or contrary to their own beliefs. This question also has further personal relevance for me because of my brother’s death where he had no spiritual practiced and had not reconciled issues he held with the church and my parents’ need for some sort of Catholic church service. How could a family in this situation be supported so that each individual’s spiritual needs would be met? Conclusion Since the 1960s introduction of Buddhism to mainstream America, vast and subtle changes have occurred; one of the most profound is the Buddhist teachings on being with dying, on impermance, and on mindful awareness practices and the subsequent use of the teachings in end-of-life care. Propelled by the counter cultural revolution and the United States hospice movement being adopted from the work of Dame Cicely Saunders in the UK during the 1950s and 1960s, contemplative practices in general have moved beyond their infancy and beyond their grassroots beginnings and are becoming more accepted standards of care at the end of life. Cultivating Bodhichitta & Maranasati 40 A second phenomenon that furthered Buddhist practices of end-of-life care was the AIDS epidemic in the 1980s. When people did not have primary social support or caregivers and were often denied access to traditional medical services and programs such as Zen Hospice Project and Maitri Compassionate Care, both located in San Francisco, California, were founded in response to meet the needs of the dying. Both organizations used Buddhist principles, such as those discussed in this essay including contemplative practices, cultivating mindfulness, and being with dying as their foundations for bringing compassionate care. Buddhist teachings on living and dying have opened Westerns to a non-dualistic view that life and death are not separate but are a continuous chain of events that include the dissolution of the body, the transfer of consciousness, and the experiences of the bardos of living, meditating, dreaming, dying, and becoming. Various Buddhist traditions have each contributed different aspects of conscious living and dying such as; the Mahāyana teachings on cultivating bodhichitta or the awakened heart, the Vipassana teachings of loving kindness, and the Tibetan practices of tonglen, the meditations on the dissolution of the body as well as the practice of phowa. Buddhist teachings have complemented and expanded work that was started in the hospice movement and holds important practices that promote caregivers’ practices of self-care, deep listening, and compassionate action. It has also introduced them to contemplative ways of tending to the needs of the dying as well as their needs as caregivers. Buddhist medicine, psychology, and spirituality have deeply rooted teachings in the impermance of all things, in the nature of suffering, and in specific ways that suffering can be alleviated. Buddhist teachings have a great deal to offer to the study of transpersonal psychology, thanatology, and Western medicine. With the number of well trained and skillful Cultivating Bodhichitta & Maranasati 41 teachers creating programs to help foster Buddhist understanding of compassionate care, awareness of impermance, and contemplative practices, end-of-life care practices could be greatly enhanced by the practices of cultivating bodhichitta and maranasati. Buddhist teachings and practices still have much more that they can teach those who work and volunteer in end-of-life care and in understanding the subtle levels of consciousness. Buddhist teachings combined with other indigenous practices such as the use of rituals and the holding of council provide deep spiritual growth and experience. 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