Dukkah -- Dis-ease and health

This is the third post in the series connecting aspects of Buddhism and public health. In the first two, I explored two of the dharma seals: impermanence and interconnectedness (although the second is frequently extrapolated to its most challenging application: non-self.) The third dharma seal is usually considered to be dukkah. Dukkah is frequently translated as suffering, but in a very broad sense. Another translation that may be more accurate is dis-ease, dis-comfort. The Dalai Lama posted on Facebook earlier this week this comment on dukkah:

"Every type of happiness and suffering can be divided into 2 main categories: mental and physical. Of the two, it is the mind that exerts the greatest influence on most of us. If we are not ill or deprived of basic necessities, if the body is content, we virtually ignore it. The mind, however, registers every event, no matter how small. Therefore we should focus our most serious efforts on bringing about mental peace."

If the body is not cared for, it will dominate our thoughts, of course. Too hungry and we can not concentrate; too tired and we can not make wise choices. No amount of mental peace will chance the body's needs.

However, as the Dalai Lama suggests, more often than not in our time and place, our dis-ease is caused by the mind. In this country (US) in this time (2000s), most people have more food than we need (although our access to healthy and whole food is much more limited), and need to engage in far less activity than our bodies need to get that food. Most (not all, but most) have adequate shelter and can clothe ourselves as is needed to protect our bodies from the elements. Most of the time, the stressors in our lives originate in our minds.

A mind-originating stress is not less valid than a body-based one. In fact, they are interconnected. Body-based dis-ease causes us to feel emotional and/or mental dis-ease, as I described already. Mind-based dis-ease causes physical symptoms and outcomes in the body. Chronic stress has been shown to have important outcomes: heart and blood pressure problems, less-healthy birth outcomes, blood sugar irregularity, etc. In fact, few if any body diseases lack a mental health component; almost all are impacted by stress. Also, when we are upset, we frequently crave the very things that are not good for us. For example, many people find stress directly impacts their appetite. We feel hungry, and crave foods that will make our bodies feel less good in the long run; or we feel disgusted by food and avoid eating when we need. The two are not readily separable. Since our bodies and minds are not separate beings, this should not be a surprise. However, we need to figure out if our hunger is for lack of food, for example, or from stress. The difference is not how important they are, but in how we address them.

When addressing dukkah, the Buddhist approach is most helpful in addressing the mental stresses. (Physical ones, of course, are more straight forward in terms of figuring out what to do. If food is needed, apply food. The challenge is in the circumstances that led to food not being available.) It is also a helpful approach in terms of figuring out if the source of the problem is the mind or the body.

In Buddhism, the belief is that mind-based dukkah is caused by a disconnect between what is real, and what we would like to be real. Therefore, the approach is to see, truly see, what is real. This is harder than it appears. The question is not what upsets you, but what is the situation -- from all angles. When we can see the situation this way, we will see the way to resolve our dis-ease as simply and clearly as solving a physical dis-ease.

To get to a place where we can see clearly enough to accomplish this feat, we need to quiet our minds: meditation. This is, essentially, the main reason that meditation has physical benefits -- because our minds and bodies are interconnected, and we need this clarity to resolve our mind-based dis-ease. Meditation can be done while sitting still with a quiet mind, or while walking or doing work with a quiet mind. Wash the dishes, just focusing on the dish in front of you. "I am washing this glass. Soap, water, warm, cool."

Dukkah is typically personal: what is out of sync between my expectations and my life? However, as public health messages are crafted by people, that disconnect can, and does, happen in our work. When our messages are not reaching people we have to ask ourselves the same kinds of questions. To see the context of the health behavior we want to impact clearly, we must start by listening and observing clearly, without expectations. Without that, we will not reach our audience. If we have not listened clearly, we can not expect to be heard.