Sometimes it comes by way of a family member, sometimes a news story, sometimes, perhaps, a call from the police, or on the wind with a violent storm…and sometimes it comes from a doctor.

It came to me in June 2016. The PSA was 4.9. The biopsy said it was cancer.

Human beings are caught in an unavoidable set of irreconcilable conflicts. Eventually there will be tragedy.

  • We like pleasure and seek to acquire it; we don’t like pain and seek to get away from it.
  • We like praise and love to receive it; we don’t like criticism and blame and can’t avoid it.
  • We like fame and appreciation; we can’t avoid embarrassment and sometimes disgrace.
  • We like to get what we want; and if we do get it we can’t keep it forever.

We can’t always get the pleasure, praise/love, appreciation, possessions/relationships we want and we can’t avoid losing them. How then do we find lasting happiness if it is tied only to the positive side of those polarities?

A classic understanding of depression is that it is about loss. Early losses in life such as the death or divorce of parents seem to predispose people to developing depression throughout life. Granted healthy attachment is essential for children to develop emotional and interpersonal stability or they will have to struggle to develop it some other way. However, that stability is in reality a “fool’s errand”. We cannot depend on it to provide everything we need. Regardless of how secure our attachments are no relationship is either perfect or lasts forever. Every single one of them ends. So, like it or not, we are insecurely attached to everyone and everything.

So in the depressed mind there are most often ruminations about “losses” of all kinds and not just the “big” ones such as death, chronic illness, disability, divorce or betrayal. We can mourn the loss of anything from childish desires for material possessions or not being picked first in a pick up basketball game (or at least not last) to the loss of innocence due to molestation. We can get lost in wishes that our circumstances in life had been better, that we didn’t have to change schools, that our girlfriend didn’t dump us, that we didn’t fumble the football in the big game, that we didn’t get fired from a job or that the promotion had been offered to us, that we are more successful than we are, that our sexual orientation isn’t what it is. And make no mistake; we can upset ourselves terribly about things like this. The depressed mind can make anything into a life altering disaster at any time and any place.

We simply do not want the unwanted. We do not want the unpleasant to occur.

Furthermore, there is no way to avoid losses in the future. Live long enough and we will lose our minds. There is illness, aging, and death awaiting all of us who escape accidents and early death. These existential losses are part of the fabric of reality. Few would deny this is so and yet most of us live as if we will go on forever and the very thought that this might not be so can devastate and debilitate us in the present. We also can worry ourselves excessively about simply having anxious feelings like folks with panic disorder most often do. We worry because we worry because we worry. As we can grieve just about anything we can also worry about just about anything. The anxious mind may be characterized by worrying about losses in the future.

The PSA level in September 2016 was 6.2.

People who grow up with secure attachments to parents and in relatively stable home environments do not generally tend to upset themselves as much as those less fortunate. Depression and anxiety are less likely with them. However, the same universal conflicts are true of all and all are likely to suffer from an unrealistic belief that only the pleasant sides of the conflict equations are acceptable. All of us could benefit from a realistic perspective on these existential realities.

I remember a Zen aphorism often when considering this dilemma.

“Pain is inevitable. Suffering is optional.”

“Pain” is considered what cannot be avoided by any of us–illness, aging, and death. But is also means the discomfort, the restlessness we feel because life in intrinsically and inescapably unsatisfying. No matter what we do we cannot keep feeling good. Research even suggests that the greatest joy we feel is BEFORE we acquire what we want. After we get it the joy quickly fades leaving us wanting something more; an endless game to play. We will be endlessly unhappy if we seek for happiness in the next wonderful thing.

“Suffering” is often described as separate from “pain”. In this definition suffering is based on what we make of what is happening. It is produced by psychological process. It is based in a mindset. It is a mindset expecting from reality what it cannot give, of upsetting ourselves about what, at that moment, cannot be any different.

The mindset of acceptance of what is, of what is reality, is not “natural” to us however. It must be developed and because we have a lifetime of being caught in the misunderstanding how to deal with the four polarities, of expecting only the positives and avoiding or fighting the negatives. If we want this mindset we will have to develop it. We will have to let go of what we have thought we knew. So let’s get started.

There are several principles one must adopt.

1) We must accept that there is nothing wrong with reality the way it is including the inevitability of pain.

Life contains pleasure and displeasure, satisfaction and dissatisfaction period. One may actually say that the one cannot exist without the other. Just as darkness and light are part of the same continuum in reality so are the polarities of life and death, Summer and Winter, beautiful fall leaves and dry, brown, withered ones. There is no escape from the fact that life is generally unsatisfying in between the experiences of pleasure and dissatisfaction. We will experience restlessness, feelings of emptiness, and boredom when nothing particular is happening. And then there are the times when the more uncomfortable and seemingly unbearable unpleasant things occur. With this in mind we can also enjoy the pleasant experiences when they occur. We can become naturally more grateful for them because we do not insist we always feel pleasant and insist we never feel uncomfortable. We can even experience peacefulness about dissatisfaction. We can relax into it as strange as that sounds.

If you are religious there are several quotes from eminent religious teachers reflecting this truth.

“In this world you will have suffering.” — Jesus of Nazareth

“Life is suffering but that’s not all there is.” — Thich Nhat Hanh

2) Everything is transient; nothing last forever.

It is hard to believe that this truth can even be in question. And really it probably isn’t on the level of the rational mind. Our emotional brains, however, feel about things sometimes quite differently. The problem is we often find ourselves reacting to losses in reality as if it is not inevitable and should not happen. This we may see in excessive emotional reactions to events. It is reasonable to suggest that these reactions arose from unrealistic expectations that such events shouldn’t have happened despite the person’s logical belief about transience. These expectations may not be conscious until the event occurs.

But think about it. There are examples of this in everyday life. The flowers in the vase will wither and die. The chocolate cake will cease to exist. My favorite jeans will be thrown out (prematurely) or fall off me in tatters. My son will move out. My team will lose a big game. Everywhere we look something occurs and then ceases.

3) We must learn to accept that we will experience both approval and disapproval try as we might.

The possibility for one presupposes the possibility of the other and since humans are imperfect, foolish, sometimes ignorant, and sometimes self-defeating if not downright provocative we will experience both. I am old enough to have experienced all four.

4) Unpleasant things will happen; Big ones and little ones.

When I was 10 years old I was in the YMCA Boys Chorus led by the indomitable Miss Wattles. Since I was a twin and both of us could sing we were often tagged to do duets. One year, during the Christmas concert my brother and I were on stage standing in front of the choir doing a bang-up version of “O Holy Night” when suddenly from behind us came this horrible retching sound. And then, it hit me. Literally. One of the boys on the third row became ill and threw up all over the back of my head. The faces in the audience were ghostly pale and their mouths were open in horror! I continued and since there was only one more song in the concert I backed up into the horrified choir and sang the last song before dutifully and in regimented fashion exiting the auditorium.

I was lauded for my still upper lip and “show must go on” mentality when really I had been blindsided and was in shock.

Does it get any worse than this? Of course it does. But when the inevitable happens as we experience the unpleasant there may be no one and nothing to blame for it. Learning to skillfully navigate the small ones will help when it is time for the “big” ones.

The ability to experience discomfort in the yourself and choose to do nothing about it (unless it is a medical problem or a matter of immanent injustice)is a key to developing this mindset and has been shown in recent studies to be a primary key in the effective treatment of addictions. This cannot be developed unless one practices it but what do we normally do?

When we feel restless we go to the kitchen for a snack, or pull out our smart phones to mindlessly scroll through social media, we grab a drink or other drug, or smoke a cigarette (of some kind). We do anything we can to take the edge off instead of being present with the sensations of restlessness, boredom, or emptiness. We avoid. We fight. We lose. These feelings are part of the fabric of existence; it is intrinsically unsatisfying and a mix of pleasant and unpleasant. It is inescapable. The only way to navigate it skillfully is to accept things as they are, do what we can to change things, learn to be with the things that cannot be any different than it is (or just was—whew they can pass quickly!), stabilize our minds, watch the discomfort come and go, and do the next right thing.

As always I recommend developing the art of mindfulness and meditation, a direct path to these therapeutic ends. Learning to stabilize the mind does not prevent the experience of the inevitable pain of existence but it can help to lessen the experience of optional suffering. Thinking that the mindset described about above is a good and true one is not enough. The practice of the mindset is in mindfulness and mindful living…in my opinion.

After the biopsy last June PSA levels increased over the months from 4.9 to a frightening 9.2 in December 2016 (normal is below 3.0) leading my physician to recommend we do not wait any longer.

I thought I was prepared for this possibility. I was quite sure I would be able to feel at peace about it right away but this was not so. The upcoming surgery and aftermath triggered a plethora of existential issues and a heretofore unknown level of angst–Sleepless nights, emotional turmoil through the day, and under the surface anxiety reaction upon anxiety reaction, high blood pressure.

Time to practice what I preach.

I increased my time of meditation to 3-5 times a day, for 15 -20 minutes at a time, and this did not include sitting up in the middle of the night; that was additional. The middle of the night sessions could go for an hour of more. I listened to talks by people far more skilled at this than I am. Sitting with the pain and psychological suffering, working with my tendencies to either avoid or fight what couldn’t be any different, and offering kindness and compassion to my hurting self was the task. Not an easy task. I decided that if I wanted a skillful approach to this novel life experience I would have to develop it by inputting new data and acting on that data with increased meditation practices. If I wanted new insights I could not continue to do only what I had been doing. I needed to give my brain new things to process. And process it does. Insights come as the brain processes the new “information” and this on the unconscious level. New experiences occur. The one most helpful to me was the experience of being ok with whatever happened. You can experience this too.

I would be overly “romantic” to say that since then everything has been smooth as silk.

Surgery was successful. Cancer involved only 1% of the prostate. No additional treatment is necessary and I am on the mend. It’s nice to be a poster child for early detection and treatment. I recommend keeping an eye on things.

We typically do not deal with the unavoidable and tragic pain of life until we are faced with it. But we can we prepare for it. Firstly by learning to approach life’s smaller disappointments, the relatively minor unpleasant side of reality, with gentle, kind, compassionate acceptance. By doing this we will develop the process of approaching pain of all degrees more skillfully. Secondly, by learning to approach the awful pains of others without flinching and with openness, kindness, and compassion. Third, by holding onto all things, including the pleasant, lightly rather than clinging to them. Fourth, keep practicing. As skill increases the results appear to be cumulative just as the brains of one with 10,000 hours of meditation is vastly more skillful in these ways than one with only 10 hours.

By practicing these ideas and behaviors we may even come to understand that, underneath, there are really no polarities at all.