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Buddhism: perspectives for the contemporary world 

Buddhism: perspectives for the contemporary world
Buddhism: perspectives for the contemporary world

Kathleen Gregory

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Buddhism approaches the human being from the perspective of impermanence and, as a consequence, the inevitability of illness, ageing, and death is stressed. In this way, rather than defining health in terms of the physical domain, Buddhism emphasizes mental health in terms of the kinds of attitudes we have to the most immediate and direct experience of impermanence—the decline and death of the human life process. To live within these conditions from which none of us can escape, Buddhism suggests, is not to be pessimistic, but to have a ‘healthy attitude’ of mind. As a result, the central role that mind plays in terms of our wellbeing is at the heart of Buddhism. Appreciating who the Buddha was and how the philosophies and practices he taught arose from his own experience becomes the basis in this chapter for understanding health from a Buddhist perspective. Further, within the contemporary context, Buddhism will be shown to be not only the religious domain of many Asian communities living in Western countries, but also the site of both religious and spiritual meaning for many Westerners to varying degrees of commitment, which itself brings challenges to healthcare workers and systems. Moreover, the evident interface of Buddhism with the fields of palliative care, psychotherapy, and general wellbeing further demonstrates the significant role Buddhism is already playing in relation to healthcare within the contemporary Western context.

Exemplifying this, recently, a friend was diagnosed with cancer and her prognosis was not good. She had learnt meditation in a secular context many years ago and asked for any Buddhist meditations that might be helpful. As a long-time Buddhist practitioner I gave her some instruction at this time. She had found a picture of a Buddhist shrine from somewhere and this was in her hospital room when she died. She had been raised in an atheist household and had little exposure to Buddhism, yet it came to mean something to her in the last few months of her life. It is well recognized that approaching death can bring a ‘spiritual crises’. With the focus on mental health this chapter explores what in particular Buddhism can offer, both for living and dying in the contemporary Western context.

The aim of this chapter is to assist Western health practitioners to appreciate that the central concern of Buddhism is how to live well within the conditions that circumscribe our lives as human beings. Health is a concept in Buddhism that can be understood first, in relationship to the unavoidable sufferings and inevitability of sickness, ageing, and death; and secondly, in terms of developing a healthy attitude of mind characterized by understanding, mental stability, and compassion. To this end, the Four Noble Truths will be elucidated in relation to these factors. Furthermore, the fear of death is understood as natural and, in Buddhism, the importance of the living in dying is stressed in relation to developing a peaceful and calm state of mind.


The notion of the West is defined not only in relation to geography but perhaps more importantly, by ideology. In the contemporary context the West is characterized by secularization and universality as dominant ideological forces.[1] This ideological context has played an important role in the rise of the concept of spirituality in the West, and in both the appeal and popularization of Buddhism within that.

Religion and spirituality are terms that, to a certain degree, have become oppositional. For example, formal versus informal, collective versus individual, public versus private, tradition versus modern, closed versus open.[2] However, it also remains that people continue to think very differently about what these terms mean. In relation to Buddhism, the question is often asked, ‘Is it a religion or spirituality;’ as if, as Traleg Kyabgon says, there is a distinction to be made. To consider Buddhism in relation to these terms, he suggests the religious refers to the external aspects, such as prayer, ritual, chanting, a belief system, and where the spiritual is the ‘internal aspect of the whole religious phenomenon’.[3] From this perspective, the religious aspect is the method to attain spiritual realization. It is beyond the scope of this chapter to explore this distinction; however, it does provide an example of the enduring difficulty of translation and the application of Western terminology to another tradition like Buddhism.

Buddhism is a system that can be distinguished in relation to geography, historical time, and/or doctrine. Identified within Buddhism are the traditions or schools of Theravada, Mahayana, Vajrayana, and Zen, and within these further distinctions can be made. However, this concept of Buddhism in terms of schools can result in an over-determination of differences at the expense of the essential or basic teachings that are the ‘unifying link between the various Buddhist traditions’.[4] In this chapter, Buddhism is presented from the essential perspective; inclining towards ‘a universal approach’, which characterizes the practice of Buddhism irrespective of time, place, or school. This perspective places emphasis on the mind in terms of wellbeing.

Buddhism and Buddhists in the contemporary Western spiritual context

Buddhism is now without doubt, on ‘Western ground’.[5] In the last 40 years or so an explosion of interest in Buddhism has been well-evidenced in Europe and America; Brazil, Canada, South Africa, New Zealand, and Australia have all earned chapters in a relatively recent publication concerned with the spread of Buddhism ‘beyond Asia’.[6] From the increase of Buddhist Centres in the West to the proliferation of books about Buddhism or with a Buddhist theme, from popular cultural images to the iconic status of His Holiness the Dalai Lama, to the fact that some of its concepts have entered everyday parlance (for example, karma); Buddhism itself has become a signifier that encompasses multiple images and meanings within the contemporary Western context.

Two factors can be identified which have been crucial in shaping Buddhism on Western ground in the late twentieth-century. First, Buddhism is but one tradition that has become incorporated in the rising trend of consumerist spirituality as outlined by Heelas (Chapter 11), resulting in individualistic and ‘hybrid’ spiritual orientations and identities. Secondly, the increased diaspora of Eastern Buddhists from first East Asia, and then South and Southeast Asia, have seen Buddhist migrants and their descendents settling in most Western countries. This has resulted not only in the establishment of Buddhist temples, which often act as important ethnic centres for their communities, but has also created a unique context for Western contact with all forms of Buddhism on home ground. Asian Buddhists living in the West have been distinguished as ‘cradle’ Buddhists as opposed that is, to ‘converts,’ although for many Asian Buddhists the meaning or significance of Buddhism, in fact, may be subsumed under their ethnic identity.[7] Moreover, the term cradle Buddhist needs now to include second generation Western (particularly American) Buddhists who are the children of first generation Western converts to Buddhism from the 1970s.

The notion of a convert suggests a self-conscious religious conversion to the extent that a previous religious identity is eradicated (if there was one), and a commitment to the new tradition undertaken. To be a Buddhist or more rightly to practise Buddhism, from a traditional view entails three aspects:

  • a way of viewing the world

  • a matrix of meditations, or ways of cultivating the mind

  • a way of life.[8]

There is a small but ever-increasing number of Westerners who more rightly fit this definition, especially within the Tibetan and Japanese traditions, where the formal structure of a teacher–student relationship is the basis of this commitment. The convert population of Westerners can, in the main, be described as householders; having taken lay precepts they undertake a commitment to certain practices and are actively involved members of a Buddhist Centre, whilst still maintaining their everyday life. There is also a significant number of Westerners who have ‘taken up robes’, many of whom continue to work, especially in professions such as palliative care or psychology, where their Buddhist orientation can be a self-conscious part of their working life.

However, aside from the population of Western converts to Buddhism whose identity can be said to meet the traditional criteria, there exist numerous forms of engagement with Buddhism within which people themselves may or may not identify with ‘being a Buddhist’. For example, there are those who participate occasionally in Buddhist meditation retreats, initiations, or group activities, many of whom may still retain another religious identity.[9] In trying to capture the diverse forms of Western engagement with Buddhism, Tweed makes the distinction between ‘night-stand Buddhists’, who may or may not identify themselves as Buddhists in some way and whose engagement is limited more to reading Buddhist literature; and ‘Buddhist sympathizers’, who may have had little actual engagement with Buddhism, but are sympathetic to its philosophies and may even see themselves incorporating some Buddhist ideas in their own lives.[10] These identities are, of course, fluid and in terms of the hybridity of spiritual identity as suggested above, in which Buddhism may be just one component, the necessity of understanding the meaning an individual attributes to and thus gains from the tradition(s) within which they are engaging is stressed.

In general, ‘to our Western eyes Buddhism has come to be seen as beneficent or at least inoffensive’; and for the many that are drawn to it, Buddhism is predominately seen in relation to ‘gentleness, to its compassion towards all forms of life, to its tolerance, to its nonviolence’. It may in fact have come to be seen as a remedy or a ‘kind or therapy’.[11] Within the context, that is, of an identified lack of tradition in the West; many Westerners have come to romanticize the East, Eastern people, and Eastern religions, to the extent that there is a projection of Western ‘yearnings’ associated with the ‘values of tradition, community, wisdom, religion, and modesty’.[12] At the same time, some Westerners have come to regard Buddhism as an ethnic ‘other’ tradition, which is neither reflective of nor responsive to modern Western experience. The ensuing Westernization of Buddhism has seen the religious aspects (for example, rituals, the status of monastics) rejected and even central beliefs such as karma, rebirth, and nirvana have become either de-emphasized or abandoned. Authors such as Stephen Batchelor[13] and Joseph Goldstein[14] are examples of this modernizing of Buddhism, who have placed emphasis on the practice, for example, of mindfulness decontextualized from its broader doctrinal context and then re-contextualized it as primarily a means of psychological healing and spiritual awakening within a kind of ‘secular spirituality’.[15]

Thus, in all kinds of ways Buddhism is assuredly on Western ground. Whether it is in a traditional religious form engaging both ethnic and Western populations; whether it has become Westernized as a kind of secular spirituality; or in the myriad ways Buddhism is part of individuals’ spirituality or philosophy of life or, indeed, co-exists with another religious identity (for example, being a Christian and attending Buddhist meditation retreats); Buddhism is both in and of the contemporary Western context.

Buddhism's interface with health in the contemporary West

It is evident that many people attracted to Buddhism have suffered a life crisis of some kind, often of a health nature. Indeed, many work within the health professions. This increasing interest in Buddhism and, in particular, the practice of mindfulness, is testament to the practical application it is seen to have not only in relation to general wellbeing, but for helping people live with and manage all kinds of physiological and psychological clinical presentations, popularized, for example, in the work of Kabat-Zin.[16]

In the work of psychotherapy, the practice of mindfulness has increasingly become accepted and often incorporated with another therapeutic modality, for example, cognitive therapy.[17] The application of Buddhist ideas and practices to psychotherapy reflects the different Western engagements with Buddhism as outlined above; as a result many can be described as incorporating more casual to hybrid understandings. At the same time from within the tradition of Tibetan Buddhism there have developed a number of institutes that have sought to bring traditional Buddhist ‘psychology’ together with Western psychotherapy. For example, in Denmark and now established in a number of other European countries the Tarab Institute founded by the late Tarab Tulku Rinpoche has developed a comprehensive ‘Unity in Duality’ psychotherapy training programme; and in the USA the Naropa University founded by the late Chogyam Trungpa Rinpoche has an extensive graduate contemplative psychotherapy programme. Both institutions have a long history reflecting the fact that, in first coming to the West, traditional Tibetan Buddhist teachers saw Western psychology as an appropriate ‘tool for communicating’ Buddhism, since it is essentially a method for ‘investigating the nature of one's own mind’.[18]

In addition, mindfulness has been identified as helpful to health practitioners themselves and, more recently, the benefits of mindfulness in relation to the therapist and the therapeutic process has been explored, suggesting that the therapist's ‘ability to be mindful positively impacts his or her ability to relate to patients’.[19] Teaching mindfulness meditation has been shown to enhance qualities such as empathy, openness, acceptance, and compassion that are core therapist qualities.

However, as we now turn to consider the Buddhist approach to health and explore the fundamental emphasis on mental health in terms of healthy attitudes to the experiences of ageing, sickness, and dying; it becomes evident that Buddhism offers unique, relevant, and helpful perspectives for healthcare workers. In the last section this will be demonstrated in relation to working with dying and death. The context in which to understand the development of this view lies in the origin of Buddhism within the experience of the Buddha, which we will now consider.

The tradition of Buddhism

As is well known, Siddhartha Gautama/Siddhattha Gotama (Sanskrit/Pali), who is known as the Buddha, lived approximately 2500 years ago. He began his life as a prince living in privileged circumstances protected from the hardship of the world. When he ventured past the palace walls as an adult and saw for the first time the all-pervasive suffering human beings endured, he began a quest to discover how human beings found meaning and solace in the face of the difficulties that circumscribed their lives. He engaged with the religious traditions around him and experimented with many ascetic practices in his search for spiritual realization. After exhausting the myriad of spiritual practices available to him, he concluded two things: first, no spiritual or religious practice could safeguard a person against the inevitability of sickness, old age, death, and the ever-changing nature of human circumstance. Secondly, although it was self-evident that these were all unavoidable sufferings, human beings compounded their suffering through all kinds of misperceptions about their condition. From this the Buddha identified that it was, in fact, the human mind that creates ‘avoidable’ sufferings, when in truth all human beings desire happiness. At this point he abandoned engaging in ascetic practices and simply sat in meditation to work with his mind. It was through his efforts in this way that the Buddha is then said to have overcome erroneous beliefs and, as a result, insight was born in him. Insight can be described as ‘seeing things as they are’, which relates to the realities of our lives as human beings.[20] The word buddha actually means ‘awakened’, so in this sense the Buddha moved from a state of ignorance or not-knowing, to a state of being awakened; thus, it is said that the ‘Buddha saw the world as it is and that was his enlightenment’.[21]

A number of points can be highlighted here that clarify Buddhism in relation to its content and purpose. Foremost, the Buddha is neither the incarnation of a higher being nor an intermediary or messenger of any kind; he demonstrated through his example that anyone who spent the time and made the effort could gain the insights he had realized.[22] That is, since the insights he gained arose from his own human experience without reliance on the ‘supernatural powers of any being or creator’, the teachings of the Buddha are ‘related to the actual lives of all people’ and, consequently, reflect ‘natural principles’.[23] In this way, Buddhism can be understood as a tradition sourced in human experience and as a consequence, its primary orientation is to offer practical help to human beings.[24]

The story of the Buddha as presented above in fact outlines the development of the Four Noble Truths, which form the basic orientation of Buddhism.[25] The First Noble Truth the Buddha realized was the truth of the nature of suffering—our human life is circumscribed by impermanence, which reflects the nature of all things and results in kinds of unavoidable and, indeed, intractable sufferings (decline, the inevitability of change). However, the suffering we inevitability face as human beings become compounded by our misperceptions of the reality of impermanence. That is, the cause of avoidable sufferings is related to our attitudes and beliefs that he identified in the Second Noble Truth: the ‘main suffering that afflicts us is created by our own mind and attitude’.[26] From his own experience as outlined, the Buddha discovered that it was possible for the mind to attain peace and contentment, even in the face of unavoidable sufferings, encapsulated in the Third Noble Truth—that is, the truth of the cessation of suffering. Finally, the Fourth Noble Truth outlines the Path to this cessation. The Eight-fold Noble Path describes the practices that develop the three aspects considered exemplary of an ideal person:

  • having wisdom as to the nature of the human condition

  • being moral in action and thought

  • demonstrating mental fortitude in the face of unavoidable sufferings.

From a Buddhist view, these three aspects in fact exemplify a healthy mind, which will be demonstrated in the examples that follow.

Sickness, old age and death: developing healthy attitudes

As suggested in the First Noble Truth the truth of suffering is to be understood in relation to the fact of impermanence. Just by having been born a human being we suffer the inevitable disease of ‘decline, degeneration, and breakdown of the life process.’[27] Deterioration and death are merely the natural processes of the life cycles of all sentient creatures and living matter; as, too, is the deterioration of ‘non-living’ phenomena. In traditional teachings, the example of mountains that appear so solid, stable, and enduring are given as subject to change; how much more so our own bodies it can be asked. Our physical bodies, that is, are ‘completely vulnerable and exposed to the elements, to external forces and to internal disease and breakdown of the organism.’[28] Even in the moment-to-moment pattern of our lives, our cells are dying and being replaced in never-ending cycles of birth and death; thoughts and emotions are arising, abiding for a time, and then dissipating. Once something comes into being, its passing is said to be certain.

Everything is said to be marked in this way; in the sense that ‘impermanence is a universal reality.’[29] As a result, impermanence is to be understood as ‘neutral, neither good nor bad’, since it is the ‘common nature of all things’. However, as identified in the Second Noble Truth, the Buddha identified ignorance of the ‘nature of things’ as the basis of avoidable suffering. That is, to not know ‘things according to their nature is to lack fundamental knowledge and understanding of important questions: “What is life?”, “What is old age and decay?”, “How should we act in the face of old age?” When people lack knowledge and a correct way of thinking, then when they think about or come face to face with old age, various foolish, cowardly, and depressing feelings, and symptoms arise.’[30] Without a doubt, it is understood from the Buddhist point of view, it is a person's mental attitude that makes sickness, ageing, and dying ‘unbearable.’[31] Simply from the Buddhist view, when it comes to attitude it is said: ‘Whatever is destructive to you is unhealthy. Whatever integrates your life is healthy.’[32] Two common unhealthy attitudes to ageing, sickness, and death; and their alternative healthy attitudes represented in Buddhism can illustrate this.

First, it is evident that, without understanding the universal reality of impermanence and its manifestation in human beings as sickness, ageing, and death, people take these personally. They feel that in some way they are ‘being singled out’ and, as a result of this, their anxiety and suffering increases.[33] Buddhism identifies the fact that when things are felt personally then a person ‘increases their attachment to the pain and suffering they are experiencing. The more a person focuses on the pain and discomfort, the deeper the suffering.’[34] A well-known story within the Buddhist Canon is of the woman overwhelmed by grief at the death of her baby through illness; she asked the Buddha to bring him back to life. In response, the Buddha said before he would talk further with the woman she was to bring him an ordinary mustard seed from any household she visited, which when she enquired, had not suffered the loss of someone through accident, sickness, or old age. Of course, the woman returned empty-handed and, in the process, awakened to the reality of death within the human condition; this is what helped her overcome attachment to her own grief.

This story demonstrates the ‘all pervasiveness of death … If you think only of the person you have lost and concentrate on your own grief about them, your focus becomes very narrow and your loss may seem overwhelming. But if you think of all the mothers in the world who have also lost their children and experienced the same grief as yourself, then the experience is more encompassing, it is no longer such a personal problem.’[35] From a Buddhist view, it is in the universality of our individual experiences that we can take comfort. In fact, because of the universality of our human experience in relation to sickness, ageing, and death, there is nothing ‘particularly special or terrible’ within it. From the perspective of Buddhism this attitude does not undermine the relative suffering of an individual human being or, indeed, the actual suffering experienced in sickness, ageing, and death; but rather serves to support genuine openness to our experience and circumstance. In this way, a healthy mind can be said to be associated with ‘some kind of psychological openness’ to experience.[36] A healthy attitude is one that understands the universality of impermanence and this understanding is what will increases the ability to relate to situations in a much more positive manner. ‘Recognizing and acknowledging where one is and working with whatever situation life presents—accepting it just as it—is an important step towards mental and spiritual maturity.’[37] Understanding the universality and non-personal nature of impermanence in the most immediate and direct way—in relation to the demise of ourselves and others—is the basis for a more open and positive attitude to both life and death. As a result, the mind also becomes more stable; in the sense that one is ‘ready to move forward in life, to face up to and deal with everything in the world with determination and joy.’[38] From a Buddhist view, it is this attitude that reflects a healthy mind. Otherwise, as the story of the woman and the mustard seed exemplifies the attachment and aversion that arises from our desire for things to be a certain way or other than they are, compounds the suffering we experience in the face of ageing, sickness, and death.[39]

Secondly, it is evident that rather than appreciating sickness, ageing, and death as natural consequences of the life process, increasingly in our modern Western context, these have come to be seen as ‘something extra’ or even an enemy to human beings.[40] As a result metaphors such as fighting, killing, cheating, or taming sickness, old age, and death are commonly employed. These examples suggest sickness, ageing, and death are in some way ‘external events imposing themselves upon us’ to which, in turn, we have mistakenly come to view ‘our desire to get rid of disease as a desire to live’.[41] It is evident that worrying about sickness, old age, and death is neither going to improve one's health or ‘make dying any less eventual’. At the same time, ‘applying fixation’ cannot ‘cure change;’ nor should we spend our time ‘feeling sorry for ourselves’ in the face of the inevitable deterioration and death of our life cycle.[42] Rather, the focus in Buddhism is on cultivating an attitude that helps us relate to the circumstances within which we find ourselves without going to these kind of ‘extremes’.

The Buddha's teachings are summarized as the Middle Way; and serve as a practical instruction for living without extreme. From the Buddhist view, this is the most fundamental healthy attitude we can adopt since extremes create attachment and aversion (for example, wanting things to be a certain way or not wanting things to be a certain way), and result in fixation (for example, ‘if I only had x, then everything would be perfect’), thus leading to further suffering. The Middle Way is thus a practical instruction to relate to the circumstances and conditions that circumscribe our lives as human beings. For most of us living in the contemporary West, we have what Buddhism would call the good fortune to be born in a time and place where there are unprecedented advances in medical technology and treatment. Having a healthy attitude to sickness, ageing, and death in this context does not presuppose at the one extreme denying oneself access to medical intervention and adopting some kind of fatalistic attitude. One can adopt an appreciative attitude, which expresses an acknowledgment of the good circumstance one has to be able to access treatment for illnesses, which at one time in history (and still in some parts of the world) were untreatable. At the other extreme it does not mean clinging to treatment (and thus to life) at all costs and denying the realities that our medical condition may present. Death and sickness are not enemies to be fought; nor is physical health a sovereign right. A healthy Middle Way attitude rests between these extremes to relate both appreciatively with what treatment is available and realistically, with the inevitability of unavoidable suffering. Furthermore, maintaining a positive frame of mind and sustaining realistic hope in relation to one's condition is important; whereas ‘cutting off all hope’ may, in fact, be counterproductive to feeling empowered to deal with our situation [43]. ‘Trying to live with sickness is a much healthier attitude than doing something that is not conductive to our own wellbeing, such as denying the reality of the illness or having misguided confidence in our powers of recovery’ [44]. From a Buddhist view, adopting a Middle Way attitude serves the foundation for increased mental fortitude in the face of whatever circumstance encountered in our human condition.

These two examples of ‘healthy attitudes’ demonstrate the teaching of the Buddha when he said that we must train ourselves to think: ‘Even though my body is plagued with illness, my mind will remain healthy.’[45] As these examples illustrate, Buddhism is orientated to fostering a ‘healthy mind’ in practical terms, in relation to what to both refrain from and cultivate in terms of attitudes. Buddhism can be described as providing methods to cleanse the ‘mind of all mental illnesses, eliminating all knots and impediments to its smooth functioning’; resulting in a ‘general sense of healthiness, or intrinsic goodness in your state of mind.’[46] A healthy mind in Buddhism is one that reflects understanding in relation to the impermanent nature of our condition as human being and, as a result, mental fortitude can develop to help us face the circumstances in our living and dying as they arise.

The analogy between mental and physical health can be applied here to further elaborate the perspective of mental health from the Buddhist view. A ‘state of perfect mental health can be compared to a body in perfect health, when in the absence of any disturbing illness; all of its organs function smoothly, to full capacity with complete efficiency.’[47] In this way, like the body, if the mind is not properly trained it becomes lethargic and lazy: ‘a lazy mind is an irritable mind. Everything becomes irritating, there is no resilience, and so everything becomes a source of discomfort.’[48] Thus, as the body requires care in the form of discipline, nourishment, and ‘exercise designed to sharpen its abilities and maintain healthy tone’, the mind too needs the discipline of restraint to protect it from harmful attitudes that destabilize and compound suffering; nourishment in the form of healthy attitudes, which bring a sense of peace and contentment to the mind; and exercise in the form of meditation and contemplation.[49] As has been demonstrated in the examples above, this notion of restraint and cultivation can be applied. That is, one needs to learn to refrain from the mental habits of taking things personally and falling into ‘extreme thinking’ and, at the same time, cultivate understanding of the universal reality of impermanence and adopting a Middle Way view.

Buddhism, in fact, emphasizes preparing ourselves for the inevitable suffering of sickness, ageing, and death; understanding impermanence is, in fact, the best preparation for the time of death. From a Buddhist perspective we need to ‘familiarize ourselves with our sense of mortality and impermanence.’[50] Buddhism recognizes that, in particular, the situation of death may indeed be painful and frightening; as a result it is preferable to come to it with some preparation through cultivating ‘the kind of attitudes that we and others need when faced with death.’[51] We now turn to consider the Buddhist approach to death.

Working with the dying: the role of compassion

This chapter began with the assertion Buddhism is a religious/ spiritual tradition on ‘Western ground’ in a variety of forms representing diverse meanings. Within the healthcare context a survey of the literature reveals that the primary emphasis has been on the spiritual needs of Ethnic Buddhists.[52] More recently, there has been recognition that the first generation of Western Buddhist converts is the ageing ‘baby boomer’ generation and as a consequence, their health and dying needs will reflect their religious and spiritual preferences.[53] However, some general points can be made that reflect Buddhism's main focus in relation to death: ‘Dying at peace is dying skilfully’. This can be related to three aspects:

  • letting go of the things that attach one to this life

  • letting go of past wrongs and mistakes

  • being emotionally undisturbed.[54]

In these ways, it can be said that, in Buddhism, the process of dying is more about life than ‘death’ as such. As Sogyal Rinpoche says: ‘The most important thing is not so much the kind of preparation that you have had [to die], but the life that the dying person has left to live. If that life is well spent, if it is meaningful, shared, celebrated, that leads to a meaningful death.’[55]

Thus, as it is in living, so too it is in dying: ‘it is a person's attitude and the whole orientation of their being that has the biggest effect when they come to die.’[56] It is acknowledged in Buddhism that death raises particular difficulties for human beings, given as Chogyam Trungpa suggests the ‘vanguard of death is uncertainty and complete bewilderment’; even our attempts to ‘hold onto life’ are described as having the ‘sense of death rather than life.’[57] At the same time within the contemporary Western context, death has become sanitized to the point of seeming unnatural. Even the dying in movies which is ‘acted out by people who then get up and star in another movie’ creates a ‘kind of illusion’ around death suggests Tai Situpa.[58] However, it can be simply said that a ‘fear of death arises precisely because of the fact that we die.’[59] As a result of this fear, ‘at the moment of death we need so much help’.[60] Within this context it is then the attitude towards death of those who are caring for the dying person, whether a family member, friend, or health professional, that is critical. The most important attitude we can adopt when being with someone who is dying is to help make them ‘feel real, rather than some kind of species apart.’[61] As Sogyal Rinpoche reiterates, ‘some kind of physical show of love and acceptance is very important, because one fear that many dying people have is that they will become an outcast or no longer loveable.’[62] In Buddhism, the development of compassion is crucial to working with others in sickness and death.

Compassion in Buddhism engenders the positive desire for the pain and suffering of others to cease, in the Eight-Fold Noble Path (the Fourth Noble Truth) compassion is associated with the development of morality, since it concerns how we relate through our thoughts and actions to others. Within Buddhism, the emphasis is on learning to ‘extend compassion to others not because we are attached to them or afraid of their pain but because we know that all beings want happiness, just like ourselves. Just like us, they do not want pain.’[63] In Buddhism, compassion is understood to arise from the understanding of our impermanent nature. As a result, compassion is in fact the genuine understanding ‘that one has to become one with the situation.’[64] To do so entails overcoming our own barriers to certain experiences like pain and death; it is a process of ‘learning how to soften and open’ to what ‘is there’ in our human condition.[65] In this way, it can be seen that understanding the impermanent nature of our existence and the inevitability of ageing, sickness, and death, can become the basis for an ‘open heart.’ In Buddhism, the knowledge that arises from this understanding assists us to be compassionate: with more clarity we can look for ‘ways in which we can actually be of help … We need to apply compassion intelligently.’[66] This is particularly relevant when working with sick and dying persons, ‘intelligent compassion’ expressed, for example, in kindness and concern can inspire confidence and trust in patients.[67]


The Buddha's insight was into the nature of the human condition, giving primacy to the human mind in discriminating what can bring a sense of either suffering or real happiness; concluding that ‘everything has to do with attitude.’ It is then right to say that ‘Buddhism promises nothing. It teaches us to be what we are, where we are, constantly, and it teaches us to relate to our living situations accordingly.’[68] From this, the notion of spirituality can be further elucidated: the Buddhist view of spirituality is one that is ‘based on a realistic approach to oneself and to the world.’[69] Since this approach corresponds to mental dispositions and attitudes, the notion of health in Buddhism is then relative to a healthy mind, which can be characterized as one that prepares ‘us for suffering and death.’[70] From the perspective of Buddhism, when we understand and relate realistically and with an open heart to our human condition, in essence, we ennoble both our own life and death, and that of others.


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