It simplified the more complex traditional Indian meditation practice. Shame at how the nurse and doctor look at you. Shame because you are not normal, not like others; But the clinic nurses and doctors seem so insensitive to how you feel. Sometimes they keep talking while I'm standing naked in front of them. I don't feel comfortable with a woman looking at my skin. Once they even called in a group of medical students. That was the worst! I felt like a curiosity, you know, a--something like the Elephant Man. I wanted to hide my face. There were two or three young women, just a few years older than me, in that group. Family members, as well as patients, benefit from the physician's willingness to hear (and thereby authorize) their account. They may require help with practical problem-solving tasks associated with the disorder; Sometimes it is the spouse even more than the patient who needs someone to sanction anger and to encourage periodic withdrawal to replenish supplies, so to speak. Grieving for losses owing to illness is also a ubiquitous family experience to which clinicians can make a contribution. For the family as for the patient there is nothing like the realization that the practitioner is sensitive to their needs and competent to offer help. I am convinced that ultimately what the practitioner does best is to organize care around the phenomenological appreciation of the illness experience and its psychological and social consequences for the patient. This necessitates education in attitudes, knowledge, and skills that are rather different from those currently given priority in the training of the physician and in the health care system. I turn now to consider the major implications this perspective holds for modern medicine. But I feel an unease I wish to share with the reader.

Is it possible to teach a professional, as Philip Larkin wrote, It's a very natural, simple technique and is typically done for twenty minutes twice daily. This practice has you sitting in a comfortable position with your eyes closed while repeating a mantra. Your mantra is a word or phrase chosen specifically for you by your teacher, designed to bring you to a relaxed yet attentive state of mind. TM is popular because of its effortlessness - there's no conscious attempt to control your thought process, and it can be done practically anywhere. Most of the scientific meditation studies have utilized the Transcendental form. Known as Zazen, and part of the Zen Buddhist practice. The goal of zazen is to experience profound and meaningful insights about existence, and to eventually attain enlightenment. When Sitting, you suspend judgmental thoughts and allow ideas and images to emerge and then pass, without really focusing on any of them. Traditionally, this is done in a seated, cross-legged position and a comfortably erect spine (remember Lotus? It can also be done in a chair or on a bench, with your feet on the floor. Oh, it was terrible. Most of the time I avoid taking a shower in the dorm when others are around. I don't want anyone to see how bad my skin is. How different I am, how ugly. I had to stand before those medical students like, like a thing to gawk at. Damn that doctor for putting me through that. He never considered how I might feel. All I am is an interesting case. The Elderly Leper

I remember the first time I visited a leprosarium. To find words at once true and kind, Or not untrue and not unkind. Perhaps this is an aspect of physicianhood that is so deeply indwelling that it cannot be taught didactically, that it must be learned through the difficult experiences of the student's own pain and the pressing need to do good for others. Perhaps it is also dependent on the practitioner's current stage of adult development. Can one effectively empathize and assist another person's grief, if one has not personally experienced bereavement? Perhaps nothing short of the personal reality of illness or of doctoring can fashion this wisdom. Of course, I am not recommending that the healer educate his clients to be pessimistic. There is some evidence from the cross-cultural study of schizophrenia that overly negative Western expectations about its chronic course actually contribute to the chronicity (Waxier 1977). Although there is no convincing evidence this is true of chronic medical disorder, it is plausible to suspect that the effect does occur. But in chronic medical disorder, a much more common event is that the biomedical ideal of a magic bullet and the popular expectation that all disease can be cured create great frustration for patient, family, and caregiver. AKA Vipassana, mindfulness has a history of at least 2,500 years in India. It requires a detached and impartial awareness and acceptance of everything that's happening right now. The goal is to remove the causes of suffering. The long-term practice of Mindfulness Meditation is said to eliminate the cause of physical and mental pain and bring a state of happiness that isn't affected by outside circumstances. ACTIVE MEDITATION If you don't like the idea of sitting still, you may want to try an active meditation of some sort, such as walking, swimming laps, free-form dancing, even washing the dishes or weeding your garden. In this form of meditation, you'll make a conscious effort to focus on the present moment while doing your physical activity. You can notice thoughts that enter your mind, and allow them to pass through and away. You might also notice specific tiny movements your body is making, or what's happening in your immediate vicinity.

How your arm cuts through the surface of the water, pushing water out of its way, and allowing your head to turn so you can take in some of that wonderful air. It was a large one, in a run-down condition, most symbolically sited on Taiwan. It was separated from the road by a large hill: cut off, hidden, isolated. I went to one of the clinics, and even with my medical training I felt threatened by what I saw: such severe wounds and disfiguring mutilations. I wanted to visit patients in their small shacks. I remember how an elderly woman with a severely deformed face and no fingers turned away from me. I thought she was angry at my intrusion. It was not anger but shame. She didn't want an honored foreign guest to see such horrible deformity. Her family had rejected her, even though she was no longer infectious and, in principle, was free to return home. She had resisted discharge, because she had no place to go. Hence the myth of cure is a large problem indeed, with expectably negative economic, personal, and clinical outcomes. Here I emphasize the intimate context. But the practitioner must also be sensitive to the broader, changing political, economic, and institutional context, which as we have seen are primary constraints on experience: both his patients' and his own. His tasks of witnessing and providing practical help must be seen in that wider social world. The tension between his appreciation of that world and its intimate effects and his inability to alter such large-scale forces is a crucial source of his commitment and compassion. Cassell (1985) lists adjectives that practitioners should command to describe the patient's pattern of speech, tone of voice, logic, and presentation of self. Similar listings have been developed to describe quality of pain and other symptoms. Personality inventories and coping scales can enrich the description of the sick person. Physicians vary so widely in descriptive skills in part because few have been trained in the techniques of systematic description.

Examples are the excessive claims played up in the media for the practical use of recent research developments in understanding the biochemistry of cancer, few of which will ever be practicable and most of which are red herrings; Then doing it all again. Qigong (say chee-gong) and Tai Chi (tie-chee) are two types of active meditation with ancient Chinese origins. They are related to one another, similar in many ways, but different. Both are designed to move your body's energy in desired ways to improve overall wellness. Tai Chi involves the performance of gentle, slow movements and also incorporates deep breathing. Qigong uses a series of exercises and postures that include circular, slow movements, self-massage, focus and regulated breathing. Yoga can also be considered a form of active meditation, even though poses are normally held for several minutes each. Many yoga classes seem to end with traditional meditation as a wind-down. Yoga, Tai Chi and Qigong are best learned from a qualified teacher, rather than from video. But if you like, videos are great as a support for your practice after you've been taught proper stance and movements by an expert. She was unacceptable to the outside world, she told me. Her family did not want others to know about her and laugh at them. She had learned to make a life for herself in the hospital. The other patients looked as deformed as she did. She, like them, was a leper. This is where she belonged. It was impossible, the hospital director told me, for such patients to reenter society. The fear of leprosy was too great; Patients knew this.