Satya, Part 2: The Path from Truthfulness to Acceptance

by Nina

Reflections Rocks and Water by John Singer Sargent

11.3. The five afflictions (klesas) which disturb the equilibrium of consciousness are: ignorance or lack of wisdom, ego, pride of the ego or the sense of ‘I,’ attachment to pleasure, aversion to pain, fear of death and clinging to life. —Yoga Sutras, translation by Edwin Bryant

It’s in the zeitgeist this week: mortality, and the relationship between truthfulness (satya) and a good death. First of all, I’ve been hearing interviews with Atul Gawande about his book Being Mortal: Medicine and What Matters in the End, which is about how modern medicine can “not only improve life but also the process of its ending.” Gawande is on a mission to get doctors to talk more honestly with patients about end of life concerns, allowing them to make conscious choices about their care, rather than just fighting death with every procedure available, even at the expense of quality of life.

And then there was this article in The New York Times Seeking a “Beautiful Death” that took the patient's point of view, describing how important it is to have honest communication with your doctor about your goals for end of life care and also to insist that your doctor fully inform you about your prognosis and how life-prolonging treatments might actually affect your quality of life. 

“The doctor or nurse practitioner should talk with the patient and family about the goals of care and the patient’s wishes and preferences, then put a plan of care in place to insure that those preferences will be honored.”

Of course, I wrote about this a while back in my post Meeting Death at the Front Door, when I concluded that truthfulness (satya) was the only way to achieve a “good” death:

"And it seems that truthfulness—being willing to hear the truth as well as to tell it—will help you face your death and die the way you want to, and to be able to help your loved ones as they die."

But this need for truthfulness has come up again for me because a friend of mine wrote me this week about how her quite elderly parents were experiencing very serious, life-threatening health problems, and were “suffering” and feeling “helpless,” and how she found it hard to accept “this way of aging,” as she had always imagined something more comfortable and peaceful. 

I must say I was surprised that my friend was surprised that old age involved difficult physical and emotional challenges. But as sutra II.3 says, we all experience “fear of death and clinging to life.” And, of course, we not only fear our own deaths but those of the people we love. So this aversion must interfere with our ability to see difficult truths. And, unfortunately, denial of the truths of old age and death has been a cultural phenomenon in western society for some time now. (Don’t even get me started about how death is usually portrayed on television and in movies.) But if we’re not willing to face these truths, we can’t be of help to the very ones who need us. 

So I just wanted to say I’m glad that truthfulness about the end of life is now becoming part of the our national zeitgeist, with mainstream books, documentaries, and newspaper articles on the topic. And we can all contribute to the discussion by sharing these resources to as well as talking honestly with our friends and relatives about these issues, as difficult as that may be at times.

My friend also said this situation was making her feel “very, very angry.” At first I didn’t understand this at all. Who or what was she angry at? Her parent’s health problems and impending deaths are no one’s fault, right? But then I remembered the five stages of loss and grief: denial, anger, bargaining, depression, and acceptance.

I wrote last week in Truthfulness (Satya) as a First Step that facing the truth of our aging bodies is the first step in our yogic journey toward acceptance, and eventually contentment. In the same way, facing the truth about our aging loved ones—their difficulties and their mortality—is the first step on a similar journey. And if my friend has moved from denial to anger, that means she’s starting to walk the path. It’s a hard journey, of course. But we don’t have to take it alone.

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Truthfulness (Satya) as a First Step

by Nina

Landscape in the Rain by Vincent van Gogh

"When one is established in truthfulness, one ensures the fruition of actions." Sutra II.36, translated by Edwin Bryant 

A couple of weeks ago I wrote a post Another Word for Stubborn? Tapas, Maybe? , in which I sort of promised I would soon be writing about truth (satya) as a aspect of acceptance. No, I didn’t forget about it. It’s just that while I’ve been turning it over and over in my mind since then, didn’t feel ready to write about it because I needed a personal story or two to illustrate my point. (I feel that understanding abstract concepts, such as tapas and santosha, is much easier if there are vivid examples to illustrate them.)

This all started because Baxter made this comment about my yoga practice, “But the thing about you is that even while you’re being stubborn, you also know when to stop practicing poses that aren’t working for you.” And I felt that this combination of being stubborn (which I renamed “dedicated practice”) and knowing which poses or practices aren’t working for you expressed what Baxter and I are now calling the Yoga for Healthy Aging approach: acceptance and active engagement.

The new thing that I realized was that acceptance wasn’t just about contentment (santosha), or the ability to be comfortable with what you have and what you don’t have. Because in order to practice the yoga that serves you, you first need to look honestly at the aging process and how it is affecting you. Rather than practicing for the body you wish you had—or used to have—when you step on your mat, you need to meet yourself as you are. So that means truthfulness (satya) is the first step toward contentment. 

Then a friend of mine who is a long-time yoga practitioner came back from a meditation retreat and told me how difficult the first couple of days of the retreat were because she was so attached to the image she had of herself as someone who could and should sit on the floor, that even though she was having some physical problems, she spent the first couple of days of the retreat on the floor in pain. It was only when she admitted the truth to herself, that it was time for her to meditate in a chair, that she was able to get what she was looking for from her practice. That’s a perfect example of what I’m talking about. It’s possible that some of her physical problems will get resolved in the future, and she’ll be able to return to sitting on the floor or maybe that won’t happen—there’s no way of knowing for sure. But, she learned, for sure, that for this particular retreat, meditating in a chair was the right practice for her.

A couple of days after that talk, I read Ram’s moving personal story  Coming Out: My Personal Experience with Ehlers-Danlos Syndrome (EDS) and I realized that this story was also a perfect example of the Yoga for Healthy Aging approach. Because even when Ram first started practicing yoga, the extreme flexibility caused by his EDS seemed to his teachers like a sign that he should be doing “advanced” poses. It was only when he faced the truth about how the practice he was doing was causing severe pain in his joints and limbs, and even blood clots, that he realized the truth:

I soon realized I was responsible for my own safety and learned to become my own teacher. I used extreme caution to go very gradually into poses that required exceptional flexibility. I developed the qualities of dharana (focus) and dhayna (total awareness to the pose), watching every step and alignment, and taught myself to go to the edge without hurting or experiencing pain.

Again, this is the essence of what Baxter and I mean when we talk about practicing Yoga for Healthy Aging. Facing the truth about his condition led Ram to a practice that served him, rather a practice for a body that he wished he had:

Suffice it to say that over the years my asana practice has now metamorphosed into a stage where the focus is not on seeking a “macho” body balancing between two rocks perched over a deep gorge. I have not only gained experience and inherently improved my skill level, but my practices have taken my skill sets to a higher state of positive experience, contentment, and a sense of accomplishment.

I have stopped questioning why I possessed this body as I have started experiencing a positive mental-emotional balance that has resulted in improved health and happiness.

Yes, for Ram, facing the truth (satya) about his physical limitations was what led to contentment (santosha) and even happiness. And, ultimately, for Baxter and me, that’s what Yoga for Healthy aging is all about. From the beginning we’ve talked about how we were not recommending practices to extend our life spans; we said that instead Yoga for Healthy Aging was about extending our “health spans" (see Yoga for Healthy Aging is Not Science Fiction). However, despite our best efforts, the truth is that even if we don’t already have a health problem the way that Ram does, any of us can develop age-related diseases or conditions—whether that means bad knees, Parkinson’s Disease, or cancer—and it is only by taking the initial step of facing the truth of our aging bodies that we can fully take advantage of yoga has to offer us: the end of suffering.

Practice.

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Meeting Death at the Front Door

by Nina 

by Melina Meza

"Research shows that most Americans do not die well, which is to say they do not die the way they say they want to — at home, surrounded by the people who love them. According to data from Medicare, only a third of patients die this way. More than 50 percent spend their final days in hospitals, often in intensive care units, tethered to machines and feeding tubes, or in nursing homes.” —Dan Gorenstein from “How Doctors Die”

Yesterday I heard a very moving piece  How Doctors Die on NPR that made me think again about an issue close to my heart: being able to face death with courage.

My mother died of breast cancer at age 85, and she was able to die with hospice care at home without any invasive procedures, any time in a nursing home or being “tethered” to any machines. Because I was talking to her doctors for her and coordinating her care, I can testify that this was only possible because my mother was clear-eyed about her condition and was willing to admit she had a terminal condition. In fact, one of the requirements for beginning hospice care is for the patient to agree to no more potentially “curative” treatments (hospice provides comfort care only). So this means being willing to face the fact that you are dying.

The piece on NPR and the companion piece in the New York Times article How Doctors Die: Showing Others the Way made the same point. The doctors in the article were able to choose the way they died—and lived while they were in the process of dying—because their medical knowledge helped them face the truth of their situations. Realizing that her condition had become terminal, Dr. McKinley decided to turn down more treatment and to begin hospice care.

"What Dr. McKinley wanted was time with her husband, a radiologist, and their two college-age children, and another summer to soak her feet in the Atlantic Ocean. But most of all, she wanted “a little more time being me and not being somebody else.” So, she turned down more treatment and began hospice care, the point at which the medical fight to extend life gives way to creating the best quality of life for the time that is left."—Dan Gorenstein

While some people do very much want to die in a hospital, I believe that most of us do not. And to make that happen, either for ourselves or for our loved ones, we must be as clear-eyed and honest with ourselves as my mother and the doctors portrayed by NPR and the New York Times were. That takes a lot of courage.

"BRAVE. You hear that word a lot when people are sick. It’s all about the fight, the survival instinct, the courage. But when Dr. Elizabeth D. McKinley’s family and friends talk about bravery, it is not so much about the way Dr. McKinley, a 53-year-old internist from Cleveland, battled breast cancer for 17 years. It is about the courage she has shown in doing something so few of us are able to do: stop fighting." —Dan Gorenstein

How can yoga help you be brave? Of course I can’t write about my own death, but I did help both my parents die at home (and have all the clear-eyed conversations that entailed), so I know it is a very stressful process. So I expect that stress management, of whatever kind works for you, would be valuable. I tried to stay as calm as possible when I was helping my mother and found myself every day doing very long sessions of Legs Up the Wall pose combined with breath work (extended exhalation). And sometimes when I’m doing my breath work these days, I consider that this is a practice I will probably have access to until the very end. For information on various options for stress management, see The Relaxation Response and Yoga. Anxiety—which is fear of things to come—can also be a problem, and yoga can help soothe you when you’re anxious. Baxter and I have done a whole series of posts on anxiety, so see Yoga Solutions for Anxiety and check the index on the right side of the blog under the label "anxiety."

I also hope that yoga philosophy will come to my aid. The Yoga Sutras actually describes abhinivesha or “clinging to life” as one of the impediments to samadhi, describing it as inherent tendency.

Yoga Sutra 11.9 [The tendency] of clinging affects even the wise; it is an inherent tendency.  —trans. by Edwin Bryant

But the Yoga Sutras also tells us that truthfulness (the yama satya) is a crucial part of yoga practice. This is one aspect of the universal “great vow” that is the second branch of yoga.

Yoga Sutra 2. 36 When one is established in truthfulness, one ensures the fruitions of actions. —trans. by Edwin Bryant

And it seems that truthfulness—being willing to hear the truth as well as to tell it—will help you face your death and die the way you want to, and to be able to help your loved ones as they die. Just the other day a friend told me how she was trying to help a friend of hers who was dying. “But he won’t admit it to himself,” she told me. “And that makes it impossible for his friends to help him."

So it's my feeling that you have face the truth yourself. That you have to tell your family the truth. That you have to insist your doctors—and your loved ones—tell you the truth. And if you are helping someone else who is dying, facing the truth about their condition will allow you to provide them with the help they need.

In the audio version I heard, Dr. McKinley called her approach to her impending death as “Meeting Death at the Front Door.” Besides being able to do the things you love as you age (see Being Able to Do What You Love), isn’t an essential part of healthy aging being able to die the way you want?

"The front door at Dr. McKinley‘s big house was wide open recently. Friends and caregivers came and went. Her hospice bed sat in the living room. Since she stopped treatment, she was spending her time writing, being with her family, gazing at her plants. Dr. McKinley knew she was going to die, and she knew how she wanted it to go.

“It’s not a decision I would change,” Dr. McKinley said. “If you asked me 700 times I wouldn’t change it, because it is the right one for me.”

Dr. McKinley died Nov. 9, at home, where she wanted to be." —Dan Gorenstein

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Satya: The Truth About Lies and Healthy Aging

by Ram

Sun Through the Clouds by Brad Gibson

In the Sadhana Pada of the Yoga Sutras by Patanjali we are introduced to the yamas that serve as moral, ethical and societal guidelines for a harmonious living. The five positive guidelines help us to behave and relate to our surroundings and environment and to achieve oneness with it. Patanjali considered the yamas as universal vows and preached that they be practiced on all levels: by way of thoughts, actions, and words. Thus, the yamas serve as prized guides to lead a conscious, honest and ethical life. Satya, meaning truth, is one of the five yamas in the yoga sutras. Verse 2.36 defines satya as:

satya pratisthayam kriya phala ashrayatvam

Being well grounded/established (pratisthayam) in truthfulness (satya), the fruits (phala) of actions (kriya) naturally result (ashrayatvam) according to the will of the Yogi. —translation by Swami Jnaneshvara

Satya is also defined in Sanskrit as “sate hitam satyam,” which translates to “The path to truth is ultimate truth itself.” Thus, one who is always truthful in actions, speech, and thoughts, his or her will is naturally fulfilled since such behavior allows a natural flow of goodness or positive feelings. Truth is considered divine and should be spoken to maintain righteousness (dharma in Sanskrit). Truth connotes purity and is superior to silence. If we start living in truth, we may not have to tell lies at all at any point of time. Truth keeps us free from all kinds of emotional turmoil.

Telling the truth significantly improves a person’s mental and physical health, and has a positive impact on health and longevity, according to a “Science of Honesty” study presented at the American Psychological Association’s 120th Annual Convention. Anita Kelly and LiJuan Wang of Notre Dame recruited a group of 110 people from 18 to 71 years old, and told them that once a week for ten weeks they’d have to come in and, in a lie detector machine, report how many times in the previous week they had lied. Approximately half the participants were instructed to stop telling both major and minor lies for the duration of the 10-week study. The other half served as a control group that received no special instructions about lying. Both groups came to the laboratory weekly to complete health and relationship measures and to take a polygraph test assessing the number of major and white lies they had told during that week.

The results were astounding. Participants across both groups who lied less in a given week reported their physical health and mental health to be significantly better that week. Participants in the no-lie group reported improvements in their relationships, less trouble sleeping, less tension, fewer headaches, and fewer sore throats. Telling three fewer minor lies a week translated to four fewer mental health complaints, and three fewer physical complaints. According to the authors of the study when you are honest, you feel good about it and life gets better. Associated with this, there is less stress and fewer physical and mental problems.

Research on how lying affects health is scant, but lying is thought to trigger the release of stress hormones, increasing heart rate and blood pressure. Stress reduces the number of your body’s infection-fighting white blood cells, and over the years, could contribute to lower-back pain, tension headaches, a rapid heartbeat, menstrual problems, and even infertility. Moreover, research has linked telling lies to an increased risk of cancer, increased risk of obesity, anxiety, depression, addiction, gambling, poor work satisfaction, and poor relationships (see The Prevalence of Lying in America: Three Studies of Self-Reported Lies. According to these studies, lying and its negative effects are a two-sided problem: liars create physical and emotional problems for themselves and people with these underlying problems are more likely to lie. Lies not only imprison an individual, but the more we lie, the harder we have to work to protect those lies from being discovered. As a result, all the physical, mental and emotional energies are diverted into protecting those lies, and we live in constant fear that can lead to chronic stress, health problems and unhealthy aging

One method that has been suggested for cutting back on lies and telling the truth is to surround yourself with like-minded, honest folks who will encourage you to be a truthful person. There’s an adage “Truth hurts for a little while, but lies hurt forever.” So tell the truth and protect yourself from the insidious damage of chronic stress, as it will help you live healthier and even longer lives.

Satyameva Jayate
(Truth Alone Triumphs)

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