Taking a Zen Approach to Diabetes

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Stop. Breathe in. Breathe out. Be aware. Do.

This process may be a key ingredient to help you manage stress and even help you successfully manage your diabetes. At least that might be what one would say from a Zen perspective.

All right, we should back up. First, what is Zen? One way to understand it is as an approach for experiencing the present moment with the help of meditation. Zen, and more generally Buddhist practice, is not a prescribed religion, but more a method to help ease suffering. One of the central paths to relieving pain is to become mindful of the present and let go of the impermanent things that we cling to.

The discomfort, pain, frustration, and anger that can occur with being diagnosed and then managing diabetes are perfectly understandable. How could you not feel these things? But hanging on to that pain, being distracted by it, or even using it as a reason for not effectively managing your diabetes causes even more suffering. Zen practice may be a useful strategy that could help you live a full, rich, and present life.

We probably need to back up one more step again. There are several unique forms of Zen. These strategies, or even ways of being, probably are as varied as the people who practice them. Said differently, there is not a right or wrong understanding of these ideas; there is really only what works for you.

I have studied and practiced Zen for the past several years, but I am an academic professor of psychology by trade, not a Zen scholar. I get paid to teach and instruct, but I would not tell you what to do with your struggles with diabetes. In fact, most Zen practitioners do not tell others what to do. The approach many take, and that I take here, is to invite you to consider another way of engaging whatever challenges you may have with managing your diabetes. Still, I cannot tell you what to do – you need to come to this from where you are. Consider this the briefest of invitations.

East meets West

For many of us, Zen is a very foreign idea. It can be difficult to grasp and is often shrouded in New Age mysticism. Still, this Eastern tradition dating to nearly 1500 years ago has been finding its way into Western teaching and psychology more and more in the past few decades.

I have tried in my psychology and psychotherapy to find similarities between Western and Zen practices and places where these traditions can come together. One approach to combining these two frameworks is a psychotherapy called Acceptance and Commitment Therapy (ACT). Many people find ACT to be a very useful bridge for understanding some of these Eastern concepts from a more Western or American perspective. My wife, Jennifer A. Gregg, and I, together with the founder of ACT, Steven Hayes, wrote a book called The Diabetes Lifestyle Book: Facing Your Fears & Making Changes for a Long & Healthy Life that uses some of the concepts in this article together with some innovative strategies to manage diabetes more effectively.

With Zen practice, one of the challenges of understanding these ideas lies in our own Western framework, one dominated by its focus on consumption. This emphasis has benefits, but sometimes it creates difficulties in our lives. For example, we sometimes confuse wanting something with needing something. We become attached to our things and even can confuse the value of an experience with the object we purchase to remind ourselves of that experience. The snow globe we purchased at the amusement park becomes the fun day at the park, instead of the experience of that day.

This same attachment can carry over into our attachment or need for things to be a certain way, to reject our current experience of the world and grasp for what we wish it could be. In fact, we may cling to our own pain and suffering in a way that makes it very hard for that pain to leave us. This attachment, what we do, may actually be the cause of our own suffering.

In the case of diabetes, it could be that a person’s desire to not think about how hard it is to manage this disease – to wish it away, to be frustrated when his blood glucose is not well controlled, to be angry at his family, at his doctors, at himself – all may be part of why he struggles even more. It may be that his desperate need for this to be different, for the moment he is in right now to be a different or better moment, is actually part of the problem that he is having. These feelings are all perfectly understandable. They are all perfectly natural. How else could a person feel but how he feels? However, as a person clings to those feelings, those wishes for a different moment, he may actually be making his problems bigger.

Instead of checking his blood glucose, he remains frustrated. Instead of exercising, he remains too sad to move. Instead of making more healthy choices in his diet, he remains angry at his body. These feelings, which are all part of who a person is, become things that are held onto so strongly that he cannot move in the direction of health and happiness.

A brief invitation

In no way would I argue that a person should become radically different from who he is. If he is Western in his tradition, so be it. There is nothing inherently wrong with that. It may be the case, though, that some of what a person does as a result of these cultural practices does not always work as well as a different approach might.

In the case of diabetes, it is essential to take care of yourself on a daily basis. This can get annoying, time-consuming, and frustrating. Still, as long as you manage your diabetes, you can live a healthy, happy, and long life. Zen practice may offer some unique strategies to help you in this process. The greatest appeal to these practices is that they can be incorporated by anyone at any time. They are also free. That’s right. I said it. You don’t need to buy expensive equipment. You don’t need to join a pricey or exclusive club. You can do these incredibly helpful things for your own benefit without cost or compromise to your values, spiritual beliefs, or your wallet. More than that, they are actually ridiculously simple.

The art of simplicity

Stop. Breathe in. Breathe out. Be aware. Do.

This, for some of us who practice Zen meditation, is what much of it boils down to. Simple, isn’t it? In some ways, the principles of Zen practice lie in opposition to the way we live our lives. The main idea basically is to calm our minds. We get so harried and so bogged down with our daily struggles that life feels complicated, even chaotic.

One of the principles of Zen practice may be understood as simplifying our experience. This can take many forms. Some people find it helpful to reduce their consumption of material possessions; others find it helpful to focus on arranging their life in a way such that they are pulled in fewer directions at the same time. By no means does one have to give up everything he owns, dress in robes, and wander the earth to achieve this. It is actually more about changing the way we approach our lives and calming the mind.

A strategy that some people find useful here is to determine what is important in their lives, what they deeply value, and try to just focus on those things. For example, if you value a life with less stress, you may look for those activities you are doing, those commitments you take on, and determine which need to be done and which you choose because you want to or feel obliged to do but which actually can be left not done, at least not done by you. By reducing your activities to those that you need to do (like work) and those you choose to do for yourself (such as spend time with loved ones, read a book, or take a walk), you may find that life feels less chaotic.

Another practice you can try is to focus on doing one task at a time. We are incredible multitaskers in this culture, and that has some major advantages for getting things done. However, it can also pull a person in multiple directions at the same time. If, when it is possible, you focus on one task at a time, that can make things feel a bit calmer, a bit more manageable. Thinking of all of the things you have to do to manage diabetes can get overwhelming. It may even make you want to just give up. The goal here is to try to slow yourself down and focus on what you need to do right now.

Of all of the millions of things we try to get done, it may be useful to simply take on one of those tasks at a time, and then move to the next one. This may even help us decide which things are most important and which we may not need to do, even though they seem tremendously important at the time.

Like all of the strategies suggested here, these are going to be easier said than done. It is one thing to say “I should cut back on how much time I spend at work,” and another thing to actually do that. There are many factors that influence our choices such as rewards and punishments that keep us running at a breakneck pace in this culture. Still, there are some things that, when we stop and examine them, we can really let go. This can help us to feel calmer and allow us to engage in life in a much more purposeful way.

This idea of simplifying and sticking to our values, what we honestly care about, goes for managing diabetes as well. If you care about your health, and you truly want to live a full and healthy life, then you need to make time to do the things that allow that to happen. This includes committing to monitoring blood glucose, taking medicines, eating healthier foods, being as physically active as your body allows, and continuing to talk to your health-care provider.

I will be the first to admit that there are many, many other things that feel more important in the moment than going to a doctor or making healthy food choices. My mind can give me so many good reasons not to do those things or others that I honestly need to do: “I am too busy,” or “I will do that tomorrow, when I have more time.” The problem is that we are often choosing something that we really don’t need to do simply to avoid those activities that will help us live a longer, healthier life. We may create or continue in our busy lives to avoid those choices. More plainly said, we remain in chaos to avoid the choices we have in the present moment.

This is what we mean by “Stop.”

Slowing ourselves down

Now that we have “stopped,” what then? The answer is to be here, right now, and to try to go a little bit slower.

Being in the present moment is a phenomenally basic concept. “Be here now” is an expression many of us hear but rarely engage. The present moment in fact is terribly fleeting. Let me give you an example. Are you ready? OK, this is the present moment. Now that moment is gone. Good news, though, here is another one coming up. Oh, there it went. Now, that is just a playful way of saying that the moment is always here. The challenge we have is that our minds, our self-chatter that is always going on “upstairs” in our head, can sometimes pull us out of the present and send us flying into a past or future that actually does not exist in the way that this moment, where we are right now, actually does. But it really feels like the past and future we create do exist. If we let our minds wander, we can end up so far into a past event, something that happened hours, days, even years ago, that it feels like we are actually there. We can lose entire days to this process. The same can be said of the future. We are often so engaged in thinking about how things will be that we have lost track of what is.

There is absolutely nothing wrong with remembering the past or planning ahead. These are incredibly useful things our mind can do for us. However, sometimes our mind pulls us all over the place and keeps us from being here, in this moment, a place where we can make choices about our lives. This of course relates directly to making effective choices in managing diabetes and other aspects of our self-care.

Stop. Breathe in. Breathe out. This next part of our basic Zen practice is to slow ourselves down and become more present in this moment. Breathe. Become aware of your own breaths. Notice yourself breathe in and then exhale. Really focus on this. You can try doing it with your eyes closed, if that is helpful, or do it with your eyes open. It doesn’t actually matter. Do what works for you. You can do this reading a computer screen, sitting in your car (keep your eyes open for that one!), walking, eating, wherever. Notice the feeling of the air coming inside your lungs. Notice how the air feels as it leaves your body. Take nice, slow, regular breaths. In other words, slow down.

Remaining in the present moment

As you do this practice of noticing your breaths, notice that you are here, right now, in this present moment. This is you, right here, breathing. This is you becoming present to your life. In this moment, all things are possible. This moment allows choice; it allows you to be fully you.

As your mind begins to pull you back to the past, to things you should have done, as it pulls you to the future to what you need to do or become, focus on your breath. Allow yourself to fully notice those breaths in and out. If it helps to count them, you can do that. If it helps to say “in” and then “out” to yourself, try that.

Stop. Breathe in. Breathe out. Be here, now, and notice that the chaos begins to drift. At least for a short while. Notice that your mind can start to become calm.

As you do this, you may begin to notice thoughts come, and then they go. As a thought appears to you, you may want to try to see what happens if you let it just sort of exist there without jumping on board with the seeming reality of that thought. “I should go do laundry right now. It’s really piling up.” OK, there’s a thought. Let’s see what happens when you let that go and come back to it when you are done with this.

Try to notice your feelings. Notice the physical sensations in your feet, in your hands, in your shoulders. Notice how your clothes feel on your skin. Notice how you are sitting, standing, or lying. Try to notice the emotional experiences you are having. See if you can let those come to you, and then leave on their own, without acting as if they are real, as if they need to be gotten rid of, made larger, or otherwise made more real than they are in that moment.

Our thoughts and feelings are a gift. They are part of what makes us uniquely human. Many times when we listen to our thoughts and feelings, it can be very helpful. However, when we act as if our thoughts and feelings are real, things that can hurt us or things that we must have, this can sometimes cause us pain. When we can notice our thoughts and feelings, experience them as they come to us, let them go as they will, sometimes we are free to continue to be here and present in our lives. Feelings and thoughts, like all of our human experiences, are impermanent. They will come and go as long as we do not try to attach ourselves too strongly to them. This process is what some people call awareness: Stop. Breathe in. Breathe out. Be aware.

The practice I am discussing here can also be understood as meditation. It takes many, many forms, and it can be as basic as this. (For more information on meditation, check out the article “Meditation and the Art of Diabetes Management.”) No matter how you define this process or act of meditation, it can be very helpful in getting you “unstuck” when you feel you are in a jam with your thoughts and feelings.

You tell yourself, “I don’t want this diabetes.” That makes perfect sense. Of course you don’t. Now, as you have that thought, try to be aware of it and of all the feelings that come with it. Breathe in. Breathe out. Notice that thought and your feelings. Now, in this moment, can you let them be there and still be present to what you want your life to be about? Can you, in this moment, with all of this awareness, take action in your life that will serve you and help ease your pain? Can you be aware of how hard it is to have diabetes and with that be aware of what you need to do for yourself, your loved ones, your health?

Stop. Breathe in. Breathe out. Be aware. Now, do. Take action. If you decide you don’t want to check your blood glucose in this moment, then be fully aware that it is you deciding to do this. If, instead, you decide to check your blood glucose, make a healthy food choice, exercise, or something similar, be aware that that is also you making that choice. As you are fully present (or as much as you can be in that moment) you become central to your own life. You are taking committed action. You are living what some call an intentional life. You can choose things that are less helpful, even self-destructive. You can choose what will assist in having better health. In either case, it is you taking action, being mindful of your experiences, your surroundings. It is you that is doing.

Practice, practice, practice

As I mentioned earlier, this is all easier said than done. Sometimes this may feel helpful in your life; sometimes it may not. One way to understand the central tenets of Zen practice are as a method to ease human suffering. Our suffering comes and goes. It is not permanent, and neither is our skill at using strategies like mindfulness and meditation. This all takes practice.

The expression “practice makes perfect” may not be completely accurate in this context, at least not to me. However, continuing to practice (and practice, and practice!) can be very helpful. As life gets chaotic, you are invited to consider simplifying your life and focusing on one task at a time. To help calm your mind, you may try noticing your breathing and your thoughts and feelings. You may try to become present to the experiences you are having in this moment. And you may find these help you take action in a way that allows you to better manage your diabetes and live a full, healthy, intentional life.

I would invite you to do this: Stop. Breathe in. Breathe out. Be aware. Do.

Originally Published December 18, 2009

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