In her interview with a magazine for psychotherapists, Maneesha explains what she means by conscious dying and how she combines meditation with counselling skills in her work.
This article originally appeared in The CAPA Quarterly (the magazine of the Counsellors and Psychotherapists Association of NSW, Australia).
Chris Walker interviews fellow psychotherapist Maneesha James about ‘conscious dying.’
Tell me a little about your background, Maneesha.
Many moons ago, I trained in general nursing, midwifery and psychiatric nursing. In 1974, aged 27, I became a ‘sannyasin’ – a meditator with the mystic, Osho – and had the great good fortune to live in Osho’s meditation commune in India for the last 15 years of his life. In my 40’s I became intrigued with the subject of death and dying, perhaps because there are so many similarities with the experience of meditation.
That initial interest became a passion after I supported Anna Freud, the child psychoanalyst and youngest daughter of Sigmund Freud, as she was dying – see The Last Taboo. Shortly after she died I experienced a profound silence and stillness. It was not the usual silence and stillness I know of when I meditate; it seemed to descend on me and to surround me like a feather-light blanket. Afterwards, I thought that if a non-meditator could leave such peacefulness in her wake, how much more potential could a conscious death, a meditative death be?
Sometime after that, I started travelling extensively, facilitating meditation workshops and conducting individual sessions, all on the subject of meditation for both living and dying consciously.
A ‘conscious death’: What is that exactly?
Just as a mother consciously prepares to give birth – through ante-natal classes, learning what changes her body will go through, how she can do what is best both for herself and her baby – we can prepare for a conscious death. After all, we may not all give birth to another’s life but we all give birth to our own death! Death is, as the existential philosophers emphasize, ‘the inescapable, immovable boundary at the end of our lives’ (Ref. 2, p 17). Given that, plus the fact that most of us fear dying, it makes sense to me to look at any issues we might have about dying while we are still able.
The focus of my private practice and group work is on providing support for clients through a health crisis – that is, supporting them back to health and, if/when that’s not on the cards, helping them prepare for dying.
In my experience, when we are seriously ill the spectre of death is bound to hovering about in the background. So, my suggestion is: rather than trying to pretend it’s not there, why not use the opportunity to face the fear of dying? Ignoring or repressing fear – any emotion, for that matter – takes energy… energy that could be better channelled into healing.
If you look your fears in the eye and work through them, and then it happens that you recover, great! – you’ve used your sickness wisely in doing some preliminary preparation for when it is your time to die. And, as Yalom (Ref. 6) writes in Staring at the Sun, ‘Death awareness may serve as an awakening experience, a profoundly useful catalyst for major life changes’ (Ref 6, p 30). And that’s what I see, too, that the process of dying provides potential for inner growth.
It has certainly been my experience that many individuals confronted with terminal illness experience their disease as an opportunity to do something different; to change their mind-set, their habitual behaviours; to develop a spiritual practice; to tap into their creativity and so on.
That’s right. And if it becomes clear that return to health is not going to happen and that you are moving towards death, you’ve made a start in getting ready for that, and from there we can continue our work together.
With all your meditative expertise, what made you become a counsellor?
I’d gathered some counselling skills along the way but realised that, especially if I wanted to work with the mainstream public, I needed more. I’m really glad I did a degree in psychotherapy and counselling because I have learnt so much.
I think being a meditative therapist is a great mix. For example, training in psychotherapy has taught me how important it is that the therapist constantly works on herself and the value of the therapeutic alliance. Meditation is the most profound way I know to become more conscious. It also allows one to develop a calm, meditative presence, and to tune into the other without any of the judgements we therapists can privately harbour, even as we work to develop that ‘therapeutic alliance’ with another.
I’m wondering: Where does your work as a meditative counsellor and psychotherapist differ from that of a regular therapist?
Though I’m drawn to the Existential Therapy approach, I do find it intellectual, so, limited.
Yalom (Ref. 6) writes of how ideas can ‘help us quell roiling thoughts about death’ (p 77), and to ‘reflect usefully on our own death anxiety’ (ibid, p 92). As an editor and author I love and respect words; as a therapist I respect the value of reflection. Yet as a meditator I know there’s a whole dimension beyond thinking that can address far more profoundly the big issues in life – such as love and dying. For example, rather than trying to ‘quell’ those very natural thoughts about death, why not explore experientially what those thoughts are about?
Let’s say one of those ‘roiling thoughts’ is fear of not being, of dissolving. Rather than having you just talk about that, I’d encourage you to enter the space of meditation. There, as you relax you come to know yourself – not just intellectually but as a felt experience – as separate from the bodymind. You can experience yourself as far vaster than your body and mind – an inner ocean of consciousness.
There’s a book about cancer counselling from the existential modality standpoint called, When Death enters the Therapeutic Space (Ref. 1). In one essay, the author (Lockett) writes of the counsellor ‘helping the client to reconstruct a new sense of self, to help her regain a sense of control, of being useful’ (Ref. 1, p 50). Is that an approach you’d take too?
This is a good example of how a meditative approach differs from that of any therapy modality I know of.
Being sick can throw one into a gap. That gap can provide a valuable opportunity to be with, and to explore, this state where the old sense of self, the old labels and old identities have dissolved and the new has not yet come.
I would support the client who is ready and willing in asking herself: Who is looking for ‘a new sense of self’? Who am I when I let go of my need to be in control or to feel useful? Or: What if I were to hang in there, in this space of not-knowing, and see what happens…see what or who emerges from it?
Again, such an exploration is bound to take one to the experiential understanding of oneself as just pure awareness, as the conscious observer separate from the body and mind. That position of the watcher is constant and, as such, provides an internal secure base. To have that is far more helpful than stressing out trying to stay in control. Resting in that secure base or ‘centre,’ one no longer needs to ‘get a grip.’ In one’s dropping the effort to control and, instead, relaxing into the stance of a watchful consciousness, all the tension involved in trying to manage things drops too. That freed-up energy becomes available for healing.
I’m struck by your term, an ‘internal secure base.’
That’s the term that psychotherapist and author David Wallin (in his book Attachment in Psychotherapy) uses. As a meditator I generally use the term ‘centre’ or ‘the seat of consciousness’: whatever the term one prefers, that sense of having an unmoving, constant space inside is a really significant resource.
And this is especially important for a dying client?
Well, think about it: You are dying, and with that is the relinquishing of all your memories, of life as you have known it till now, of all roles you have played till now, of relationships, of your identity as you have understood it till now. All is in flux, and that can be really scary. To know that there is an unchanging aspect to you – that is, consciousness – that is not part of your bodymind that is clearly disappearing, has to be enormously significant.
This is another difference, then, in my way of working: supporting my client in connecting with the secure base, and in seeking to know herself as consciousness, as the observer – of her thoughts, feelings, and all the various physical sensations and changes.
In her book, Everyday Mysteries, van Deursen (Ref. 4) says that in the existential therapy approach ‘the object is never simply to … dilute the tensions implied in living, but rather to maximize one’s ability to stand them’ (p 230). Is that something you would agree with?
Certainly building up one’s resources, having resilience is important, and that’s why meditation has so much value. Being able to ‘unhook’ oneself from tension, for example, being able to notice or ‘witness’ that one is feeling stressed is the master key.
It’s important to get that witnessing is not about avoiding or repressing any experience; on the contrary. As Wallin (Ref. 5) expresses it: ‘Exercising voluntary, sustained, and non-judgmental attention to our here-and-now experience changes any experience – at once deepening and lightening it: Deepening because we can be more fully present, accepting and aware; lightening because present-centered awareness is less burdened by the weight of the past and future, less encumbered by shame and fear.’
He adds, ‘Such awareness can be beneficial in many ways. It contributes to the regulation of difficult emotions. It also tends to de-automatise habitual patterns of response, enabling us to wake up and experience the world afresh – as if with a beginner’s mind’ (p 68). I often say that if meditation were a pill we’d be downing such pills by the mouthful!
Can you offer some examples of your work with individuals who are/were also meditators?
A woman whom I met in a palliative care unit in Sydney always used our time together to meditate. One day, she talked about her fear of dying. At some point I suggested a method in which to simply watch, from inside, the rise and fall of the chest or belly as the breath came in and went out.
As she closed her eyes and began this, I commented that with each inhalation, life was entering her, and with each exhalation, she was letting go of that life… that perhaps she could notice how these two, seemingly contradictory actions, were not fighting each other but were working harmoniously together… and how this movement – of taking in and letting go – has been part of every moment of our life, in fact sustaining our very life, and so on.…
In this way she could understand experientially that living and dying are not enemies but just parts of – partners in – the same dance. Observing this inner dance, having a felt experience of that dance, she was able to relax. She became deeply still and was in quite a different space when she opened her eyes. Where before there had been anxiety – I had sensed her beseeching me for some kind of help – now I saw calmness in her eyes: she had returned to herself.
I recall a client, a young woman, dying of ovarian cancer, who was generally accepting that her time had come. However, sometimes she did feel really angry, too. Then she’d take herself off to the nearby forest (we were in the Danish countryside), and shout and rant and rave, till she’d vented all her rage. Because she was doing that consciously – as opposed to being blindly taken over by her anger – that release was a form of meditation, too. By unburdening herself of her anger, she could contact a new spaciousness inside. I recall her coming back home and, within minutes, we would be laughing about something, or she’d want to put on some music and dance, or she’d noticed a new flower in the garden and was delighted: she had moved on.
Another client used a certain meditation technique I suggested as a kind of rehearsal for dying. Osho (Ref. 3) points out: ‘The experience of entering death voluntarily is meditation. The inevitable and automatic phenomenon of dropping the body that will take place at the time of death: [in meditation] we can willingly experience that through creating a distance, inside, between the self and the body. And through leaving the body from inside, we can experience the event of death; we can experience death occurring’ (p 12).
My client did this regularly for the last months of her life. I was fortunate enough to be with her when she died, and as far as I could see, she entered that experience meditating. I cannot imagine a more graceful exit than the one she made.
See also How to Die Consciously