The Mayo Clinic Guide to Stress-Free Living

Copyright

© 2013 Mayo Foundation for Medical Education and Research (MFMER)

Illustrations on pages 35, 38, 39, 42, 52, 91, 156, 169 and 244 © 2013 Mayo Foundation for Medical Education and Research (MFMER)

Additional credits appear on page 285.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. Printed in the United States of America. For information, address Da Capo Press, 44 Farnsworth Street, 3rd Floor, Boston, MA 02210.

Set in 10-point Palatino by Eclipse Publishing Services

Cataloging in Publication data for this book is available from the Library of Congress.

First Da Capo Press edition 2013

ISBN: 978-0-7382-1713-3 (e-book)

Published by Da Capo Press

A Member of the Perseus Books Group

www.dacapopress.com

Note: The information in this book is true and complete to the best of our knowledge. This book is intended only as an informative guide for those wishing to know more about health issues. In no way is this book intended to replace, countermand or conflict with the advice given to you by your own physician. The ultimate decision concerning care should be made between you and your doctor. We strongly recommend you follow his or her advice. Information in this book is general and is offered with no guarantees on the part of the author or Da Capo Press. The author and publisher disclaim all liability in connection with the use of this book. The names and identifying details of people associated with events described in this book have been changed. Any similarity to actual persons is coincidental.

Da Capo Press books are available at special discounts for bulk purchases in the U.S. by corpo­rations, institutions and other organizations. For more information, please contact the Special Markets Department at the Perseus Books Group, 2300 Chestnut Street, Suite 200, Philadelphia, PA, 19103, or call (800) 810-4145, ext. 5000, or e-mail special.markets@perseusbooks.com.

10 9 8 7 6 5 4 3 2 1

Mayo Clinic

Managing Editor:   Lee J. Engfer

Editorial Director:   Paula M. Limbeck

Product Manager:   Christopher C. Frye

Art Director:   Richard A. Resnick

Proofreading:

  Miranda M. Attlesey

  Donna L. Hanson

  Julie M. Maas

Indexing:   Steve Rath

Research Librarians:   

Anthony J. Cook

  Amanda K. Golden

  Deirdre A. Herman

  Erika A. Riggin

Administrative Assistant:   Beverly J. Steele

This book is dedicated to all my patients,
past, present and future.

Table of Contents

Copyright

Preface

Introduction: The Workshop

PART 1 The Brain and the Mind

CHAPTER 1 The Brain: Why Your Mind Wanders

CHAPTER 2 The Mind: Focus and Imperfections

CHAPTER 3 The Anatomyof  an Experience

CHAPTER 4 The Stress-Free Living Program

PART 2 Attention Training

CHAPTER 5 Joyful Attention

CHAPTER 6 Integrating Joyful Attention

CHAPTER 7 Kind Attention

PART 3 Refining Interpretations

CHAPTER 8 Integrating Interpretation Skills

PART 4 Gratitude

CHAPTER 9 What Is Gratitude?

CHAPTER 10 Why Practice Gratitude?

CHAPTER 11 How to Practice Gratitude

PART 5 Compassion

CHAPTER 12 What Is Compassion?

CHAPTER 13 Why Practice Compassion?

CHAPTER 14 How to Practice Compassion

PART 6 Acceptance

CHAPTER 15 What Is Acceptance?

CHAPTER 16 Why Practice Acceptance?

CHAPTER 17 How to Practice Acceptance

PART 7 Higher Meaning

CHAPTER 18 What Is Life’s Higher Meaning?

CHAPTER 19 Why Search for Life’s Higher Meaning?

CHAPTER 20 How to Find Life’s Higher Meaning

PART 8 Forgiveness

CHAPTER 21 What Is Forgiveness?

CHAPTER 22 Why Forgive?

CHAPTER 23 How to Forgive

PART 9 Tribe

CHAPTER 24 Your Tribe: Seed and Feed

CHAPTER 25 Your Tribe: Weed

PART 10 Relaxation and Reflection

CHAPTER 26 Relaxation, Meditation and Prayer

Conclusion: Self-Actualization

Acknowledgments

Credits

Index

About the Author

Preface

Cathy sat across the table in my office as she recited the lines, loosely based on a verse in the biblical book of Philippians, that had guided her for the past 40 years: “Fix your thoughts on what is true and honorable and right, and pure, lovely and admirable. Think about things that are excellent and worthy of praise.”

Cathy had a serious diagnosis; each jab of pain reminded her of the transience of life. She was also going through a difficult divorce. She peered into space, scanning the unresolved hurts in her memory bank.

Wiping tears from her eyes, she said, “I have read and memorized the right verses and books. … I know I should be in the ‘now.’ Yet I don’t know how to live in the now. I don’t know how to keep the noble thoughts when the stresses of life challenge me. I know I should forgive, but I am not able to. … Can you help me with this, doctor?”

Never had I received a request so direct, so moving, so precisely articulated, and coming from such an inspiring person — someone who was struggling with the vicissitudes of life, many not of her creation.

This book is written for Cathy and for each of you who believes that the brilliant sun is somewhere in the sky, but currently the clouds seem too dense. You have an inkling where you wish to go, but the obstinate fog won’t clear this morning.

I see this every day — the finest people, salt of the earth, suffering through no fault of their own. Based on my experience of practicing medicine for more than two decades and across two continents, and of observing the world and learning from numerous scientists, philosophers and spiritual luminaries, I’m convinced of this: Human suffering is seldom a human fault. Most of our suffering originates in traits we acquired in our collective struggle for survival.

This book brings together the ideas, inspiration and instruction of the Mayo Clinic Stress-Free Living program,{1} a course I’ve taught to tens of thousands of patients and learners at Mayo Clinic and elsewhere. The program grew from my quest to understand and alleviate the suffering and stress I observed, not only in my hometown of Bhopal, India, where I experienced the tragedy of the 1984 chemical spill, but also in the United States, where I have been practicing medicine since 1995. After several years of research, I came to two important realizations:

• Most of us have little information about how the brain and mind work.

• Most of us do not use our brains and minds as well as we can or should.

In the past two decades, neuroscientists have made phenomenal advances in mapping the brain’s function. Using this base of medical evidence, scientists now have a much better instruction manual for the brain and mind than they did even a decade ago. But the bulk of this information remains in the confines of research papers. As a result, just as we don’t read instruction manuals — and thus use our electronic gadgets as if they’re 20-year-old technology — we continue to use our brains and minds in much the same way our ancestors did a few thousand years ago. We haven’t translated scientific breakthroughs into practical strategies for taking care of ourselves and others.

In this book, you’ll learn important information that will help you use your brain and mind to live your life to its fullest potential. My colleagues and I have conducted several research studies of this approach among healthy volunteers, professionals experiencing stress, patients confronting serious illness and others. The results show remarkable improvements in stress, anxiety, resilience, happiness, well-being and quality of life.

In Part 1 of the book, I’ll take you on a behind-the-scenes tour of your brain and mind. In the process, I hope you arrive at the same startling conclusion that I did a few years ago: Your brain and mind work very hard to keep you stressed. Your brain is wired to escape the present moment into a default mode of mind wandering. Your mind is gifted at recognizing threats and flaws, an essential survival instinct in the perilous past. Today, this instinct serves you well when confronting true physical danger. But if thoughtlessly applied to people around you, this instinct causes tremendous anguish. Further, the mind is a brilliant but restless and shortsighted tool that gets hijacked by impulses, infatuation and fear. As a result, we carry oversized emotional baggage in our heads. We crowd our memory banks with unresolved fears and unfulfilled wants. Fears and wants, in toxic overdose, generate stress. 

Stress is the struggle with what is. A mind that doesn’t have what it wants or doesn’t want what it has experiences stress. The plethora of choices we have to sift through each day at life’s ever-increasing speed worsens stress. Saddled with hundreds of “open files” in the mind, we spend half our day physically here but mentally elsewhere. We get so caught up weeding the yard that we completely miss the tulips that nature gives us for a few precious weeks. We postpone joy. 

Joy deficiency, a pervasive phenomenon, presents with many symptoms — restlessness, anxiety, emptiness, malaise, inability to focus, insomnia, fatigue, irritability and apathy. Excessive stress decreases efficiency, productivity and creativity. Stress also weakens attention, worsens most medical conditions and hastens your escape from the present moment. Stressed brains make reactive decisions, causing countless conflicts. Understanding and working with the brain’s and the mind’s imperfections isn’t a luxury; it is an absolute necessity if we hope to survive and thrive as a species.

A good understanding of these imperfections will help you overcome them, the topic of parts 2 through 10. In these sections, we’ll accomplish two goals: train your attention and refine your interpretations. Attention training will soften the voice in your head so you are free to appreciate the present moment. Refining interpretations will clear your inner dialogue of its prejudices and plant in your mind the saplings of timeless, constructive principles.

In Part 2, we’ll discuss the single most important skill for your success and happiness: the ability to pay deep and sustained attention. With modest effort, you can reclaim a strong attention, just as you can strengthen your heart or bulk up your biceps. Trained attention will help you discover that the present moment has more novelty and meaning than you could have ever imagined. You will log on to your life.

Parts 3 through 8 will guide you to exchange your biases, if any, for time-honored principles. Using a structured approach, you’ll enhance your focus on gratitude, cultivate compassion, creatively accept what is, dis­cover life’s meaning and strengthen your forgiveness muscles.

With sustained practice of present-moment awareness, gratitude, compassion, acceptance, meaning and forgiveness, your mind will become free of fear and distracting desires. The whole day will become a flow experience, a state of low-intensity meditation. Peace will no longer be a distant goal; it will light the entire path.

Your authentic presence, gratitude, kindness and acceptance will nurture your relationships, the topic of Part 9. This section will guide you to create and sustain a stronger “tribe.” The book concludes with a discussion of contemplative practices in Part 10, including practical tips for starting a personal mind-body practice.

My goal is to offer simple solutions for complex problems and share principles-based skills that are applicable to most life situations. A personal growth program for the 21st century should tap the wisdom of philosophers and sages as well as advances in science, particularly neuroscience and psychology. The program should deepen your engagement with life, strengthen your focus, creativity and emotional intelligence, and yet feel light and fun. Further, it should steer clear of dogmas and rituals. My humble hope is that you’ll find this combination in the Mayo Clinic Stress-Free Living program.

While sharing information in this book, I frequently hear comments such as, “Why don’t we teach this to all our kids in the schools?” or “I wish I had known this when I was going to college.” I couldn’t agree more. Improved stress, diminished anxiety, increased joy and resilience, better health, closer relationships, enhanced creativity, greater professional success — I have observed these and other beneficial effects among the tens of thousands of participants who have walked with me on this journey. The goal is to help you perceive and pursue your life’s meaning with greater clarity and vigor. It was the pursuit of this meaning that allowed my patient Cathy to discover an oasis of peace.

I and my colleagues at Mayo Clinic feel privileged to share our Stress-Free Living program with you. I believe that you have within you everything you need to overcome your obstacles and live a fulfilled life. Together, we’ll discover and awaken your strengths. Please consider me your friend and co-traveler on this journey, the goal of which is to collectively cultivate greater peace, joy and contentment for every citizen of our beautiful planet.

I wish you well.

— Amit

Introduction: The Workshop

Fall

Rochester, Minn.

We gather in the sunroom of Assisi Heights, a three-story Italian Romanesque building set in open, rolling hills about two miles north of Mayo Clinic in Rochester. The October morning sun looks deceptively warm as it filters through the hand-blown stained-glass windows. In a month or two, Minnesota will be adorned, like a bride, in gorgeous white — Minne-snow-ta!

I scan the room while playing with the dancing steam coming off my hot lemon tea. The 25 participants in the two-day Stress-Free Living course are seated in groups of five facing a white screen. Social workers, homemakers, corporate executives, wellness coaches, a chaplain, students, physicians, nurses, philanthropists — the group is pretty diverse today. One common theme that bonds them is a passion to make a difference. They want to create a better world for themselves and for their children and grandchildren. What a treat to spend a couple of days with such splendid people.

I begin my remarks. “I’m grateful to the countless scientists, sages, philosophers and ordinary citizens whose wisdom we will share today … and to the tens of thousands of patients who have taught me all I know about stress-free living. My gratitude also to you all for your trust and commitment.”

I pull up the first slide, a poster of the 1966 Italian epic The Good, the Bad and the Ugly. The three lead actors (Clint Eastwood, Lee Van Cleef and Eli Wallach) stare at us, not exactly sporting faces of lovingkindness.

 “Stress comes in three flavors,” I say. “Let’s introduce them one by one. Anyone find vacations stressful?” I ask.

Many participants smile. Claire,{2} a financial consultant, quips, “I do, when I’m with six people wanting six different things.”

Daphne, our course coordinator, adds, “Or when I’m changing a baby’s diaper in a four-square-foot bathroom at 36,000 feet.”

“Stress can be good, bad or ugly,” I say, flashing the laser pointer at the slide. “Vacations are a good stress. So is a new job. Good stress motivates you, preps you for a challenge and gives you extra pep. A life without stress is as bland as a no-salt diet. Any other examples of good stress?”

“Home remodeling.”

“Winning a big contract.”

“A new baby in the house.”

Someone adds from the back, “Coming to this course today!” The group breaks into laughter.

“The stress of coming today will decrease your stress tomorrow. Otherwise you get a full refund!” I add.

The next slide shows a formally dressed, busy-looking executive who is text­ing. “Let’s talk about bad stress,” I continue. “Peter is a senior vice president in a finance company. He’s married, with two young kids. He works late hours, and every night he brings home a two-page to-do list that never gets done. A few years ago, he loved hopping in and out of planes. Not anymore. He’s tired of adapting to three different time zones every other week. He has no time to exercise or eat healthy food; he often wakes up at 4 a.m. with a committee meeting inside his head. Lately he sweats and fumbles during presentations, struggling to find the right words. He dreads that someday his brain might freeze during a crucial conversation. Business meetings aren’t fun anymore.

“Almost every week now, Peter explodes at his kids over trivial issues that never used to bother him. At his wife’s prodding, he had a full physical exam. He heard the usual spiel — eat more vegetables; shed some pounds; exercise; sleep eight hours a night. The doctor also prescribed a baby aspirin and a cholesterol pill. Peter hates taking pills.”

I sip my tea and gauge the pulse of the group. They look engaged.

“Which is the nastier imp in Peter’s life — high cholesterol or too much stress?”

“Too much stress,” a few people whisper.

 “How many of you know a Peter?” Half the hands go up.

“Anyone here face similar challenges?” Almost all the hands go up.

I continue, “Peter isn’t facing disasters. He doesn’t have incurable cancer. His company hasn’t filed bankruptcy. But all the little nuances add up — piles of unread mail, living room clutter, missed deadlines, unpaid bills, forgotten birthdays, a colleague’s eye roll. Those daily annoyances, pooled together, sting us like an army of furious fire ants.” I see several smiles and nods.

“How you lift the load and for how long are as important as the load itself,” I say. “Holding a glass of water above your shoulder for a few minutes doesn’t hurt, but hold it for an hour and you might need a steroid shot and physical therapy. Your reactions turn good stress into bad stress.”

“Can you explain how that happens?” Lorna, a psychologist, asks.

I write on the board:

Excessive workload, lack of control, lack of meaning

“Work stops being fun when you’re triple-booked throughout the day with meetings or household chores. Lack of control also fuels stress. Imagine if on a Monday morning, you discover that your office has been relocated … to a windowless basement. How would you feel?”

“Pretty mad,” says Lorna.

“What if the same move is explained and planned with your input?”

“I still won’t like it, but it’ll be easier to swallow. Why is that?”

“You feel insulted when someone calls the shots for you, neglecting your needs or preferences. Lack of control also creates fear. When is the next shoe going to drop? And how heavy will it be?

“The third aspect, meaning, changes everything. How would you feel if you heard that your friend lost a unit of blood?”

“Pretty alarmed,” says Lorna.

“What if you’re later told he donated it?”

Lorna smiles.

“Pain that hasn’t found its meaning becomes suffering. An 80-hour workweek becomes worthwhile when your supervisor sends a special letter of appreciation, copying your company’s senior managers. An able leader inspires and empowers by matching demand with resources, sharing control with the people who are affected by a decision and crafting a positive collective meaning.”

The Rev. John, a chaplain, comments, “I suspect meaning might be the most important. People feel stronger when they find spiritual meaning in life’s downturns.”

“That’s right,” I say. “The next slide addresses precisely that challenge. Mary is in her early 30s, a substitute teacher. She’s married and has two kids, a 4- and a 6-year-old. Life was treating her well until one weekend about three months ago, when she developed worsening back and lower belly pain. An emergency CT scan showed shadows in her liver and pelvis. Two days later she learned she had advanced ovarian cancer. Doctors have given her three to six months to live. Each day brings pain, fatigue, nausea and financial concerns. But these are only the tip of the iceberg. What is the biggest fear that wakes her up at 3 a.m.?”

“Her young kids?” someone says from the back.

“Yes, she’s worried about what will happen to them. Like a satellite, their lives revolve around her. After she passes away, who’ll love and care for them as much as she does? Who’ll kiss their scrapes, comfort them with hugs and protect them from bullies? Who else could trick them into eating enough fruits and veggies? She knows her husband will be a good provider. The children will survive, go to college, and start jobs and families, but she won’t be there. She’ll be a mute picture on a shelf or a fleeting thought.”

I pause to clear my throat and take another sip of now-lukewarm tea. Mary’s face flashes in front of my eyes. These are real problems of real people.

I continue, “Mary also fears becoming a burden. She isn’t comfortable having someone else make her bed or give her a shower.”

“Has she told her kids?” Miguel, an IT consultant, asks.

“She hasn’t. She isn’t sure what words to use that won’t leave them feeling afraid or guilty. In her bedtime stories, she talks about guardian angels and beautiful worlds hidden far away in the stars. She is trying to connect them with faith, but her own faith has been shaken.” We all become somber.