Chapter Five


When you see a sick person, the Buddha says that you should regard that person, like the aged person, as a messenger from the devas. And this messenger, too, is delivering two messages. The first is that you, too, are subject to illness. The proper response is to learn not to look down on those who are already sick, for they’re simply showing you what the human body—your human body—is capable of. For every part of the body, there are many possible diseases. At the same time, you have to learn to be heedful in your actions so that, at the very least, you have a refuge of good kamma to hold you in good stead when you yourself fall ill. At best, you want to reach the attainment that’s not affected by illness at all, so that you’ll be able to live in peace even when sick.

The second message is that all beings are subject to illness. This means that when you fall sick, you’re not being unfairly singled out for any particular injustice. It’s a natural process happening to everyone, so it would be childish and immature to react to your illness with feelings of resentment or irritation. Here again, you have to be heedful so that your emotions don’t blind you to the opportunities that still lie open to you, even when ill, to do good in your thoughts, words, and deeds.

As with aging, the Buddha regards illness as nothing out of the ordinary. It’s everywhere and always. He classes hunger—which all beings on Earth feel on a daily basis—as a disease, calling it the foremost disease (Dhp 203). There’s a passage where he ridicules a wanderer from another sect for claiming that his body is free from disease. From the Buddha’s point of view, the body is a nest of illnesses. The only true health is unbinding (MN 75).

It’s good to reflect on your reactions to the pains and weakness of hunger as a case study in how pain and weakness can easily skew your perceptions and lead you to do unskillful things. It’s because of hunger that people take advantage of one another. It’s because of hunger that people can kill, steal, and lie. And if we allow ourselves to be driven by these normal pains and weaknesses, what’s to keep us from acting even more unskillfully when struck by more serious illnesses? Or when death arrives and forces us, as we are struck by pain, to make choices with long-lasting consequences? When you reflect in this way, you can understand the importance of learning how to develop the mind so that it’s not swayed by illness or pain.

At the same time, it’s important to note the obvious fact that hunger can be assuaged if the right conditions are met. The pain of hunger as a general fact is inevitable, but individual attacks of hunger can be treated. And they should be treated to the extent that they allow you to continue practicing. This was one of the lessons the Buddha learned in his quest for awakening.

These facts about hunger and its treatment are reflected in his approach to illness in general. Illness as a general fact has to be accepted as inevitable, but individual illnesses should be treated. You don’t simply put up with them as an inescapable fate. You are right to treat them, at least to the extent that they will allow you to continue with the practice.

The Canon, when discussing illness, touches on the same three issues it focuses on in the context of aging—loss of beauty, loss of strength, and the weakening of one’s faculties—but it places its primary focus on a fourth issue, the issue of pain. Because we’ve already discussed the first three issues in Chapter Three, we’ll follow the Buddha in focusing on pain here, too.


To get the most out of the Buddha’s teachings on pain, you have to develop the same seven strengths we discussed under aging: conviction, shame, compunction, persistence, mindfulness, concentration, and discernment.

Conviction is required in the sense of taking the Buddha’s analysis of pain—its causes and its treatment—as your working hypothesis in dealing with it. In a broad sense, this means accepting the principle of causality that the Buddha discovered on the night of his awakening: that all experiences are a combination of three things—the results of past actions, present actions, and the results of present actions. It also means accepting the principle that mental actions, as opposed to physical or verbal actions, are the most important causes that have to be addressed when dealing with pain.

In general terms, this means understanding pain and illness as resulting both from past and from present actions. Because the results of past actions can play a role in causing illness, and because you can’t do anything to change your past actions, not all illnesses can be cured simply by a change of mind or a change of heart in the present. This is why, contrary to some theories, people who are spiritually very advanced can still experience pain and illness, because the presence of an illness doesn’t necessarily reflect your present state of mind. The Buddha himself was a case in point: In the last years of his life, he suffered from backaches, dysentery, and an unnamed illness that almost killed him (DN 16).

However, if disease were caused solely by past actions, you’d be condemned to letting a disease simply run its course untreated. It’s because present actions can also play a role in causing illness that it’s appropriate to try treating diseases. A change in how the body is exercised or fed could possibly cut a disease short. At the very least, you can train your present mental actions so that even in the presence of intense physical pain, your mind doesn’t have to suffer. In the Buddha’s terms, even if you are afflicted in body, you should train yourself so that you will be unafflicted in mind (SN 22:1).

Still, even though the Buddha recommends giving primary attention to the mental causes of pain and disease—past and present—that doesn’t mean that he would recommend ignoring their physical causes. He was once asked if all pains came from past actions, and his response was No. He then proceeded to list the possible causes of pain, as understood by the medical treatises of his time, and many of them were physical: an imbalance of the physical properties in the body, the change of the seasons, improper care of the body, and injuries (SN 36:21). When we compare this list with another list in the discourses, which classifies experiences as to whether they are present actions or the results of past actions (SN 35:145), we can see that all of these possible causes for pain fall into one or the other of those categories, or a combination of the two: They’re the results either of past actions, present actions, or a combination both.

This means that there are times when the results of unskillful actions come back at you through physical means, and they can be counteracted through physical treatments. This fact, combined with the Buddha’s general teaching on the causality of experience, lies behind his observation that there are three types of disease: those that go away without treatment, those that won’t go away even with treatment, and those that will go away only with treatment.

The diseases that go away without treatment are those coming from actions whose kammic results happen to run out. Those that won’t go away even with treatment are those coming from past actions so strong that even the best present actions can’t counteract their effect. Those are the cases where you have to focus your efforts totally on the state of the mind in the present, so that it isn’t afflicted by the affliction of the body. As for diseases that go away only with treatment, they come primarily from present actions combined with the results of past actions that come at you through physical means: When you change the actions or the physical means, there’s nothing to maintain the disease, and it’ll subside.

It’s because of the third category that treatment is appropriate in all cases. After all, you don’t know ahead of time which category a particular illness will fall into, so the wise and compassionate policy—as recognized by the Buddha—is to assume it’s the third (AN 3:22).

Because the diseases that can be cured through treatment cover both those that come purely from mental causes and those that come via physical means, the Buddha recognizes that “treatment” of a disease can be either physical, mental, or a combination of the two. There are many cases in the Canon, for instance, where sick monks were freed from their illness simply on hearing the Dhamma or through practicing meditation (SN 46:14; AN 10:60). There are other cases, though, where even the Buddha himself needed medicine to cure his illness.

It was because of the Buddha’s teaching that illnesses should be treated whenever possible that the Vinaya—the collection of rules for the monks and nuns—includes detailed instructions on medical treatments and medicines for a wide variety of diseases. In fact, it was through the spread of the Dhamma and Vinaya throughout South, Southeast, and Central Asia that Indian medical knowledge spread far and wide in the pre-modern world.

The Vinaya also contains instructions on how to be an ideal patient. These include behaving in a way that doesn’t aggravate the disease, behaving in a way that will help hasten its cure, taking your medicine, and telling your doctor or nurse your symptoms as they actually are. The most demanding part of a patient’s etiquette is the ability to bear, without complaint, serious pain. This ability will be the focus of the remainder of this chapter, as it involves all seven of the strengths in our list.

Conviction plays a double role in helping you to deal with pain. On the one hand, it provides you with working hypotheses for understanding pain and illness. On the other hand, it helps you master the skill of how to withstand pain by enabling you to see the value of developing this ability. As you reflect on what the Buddha had to say about death—that your future course is shaped by your cravings—you realize that you will have to be mindful and alert at the moment of death. This means that you can’t let yourself be drugged and drowsy with painkillers at that time. However, you don’t want to be overcome by pain then, either. Otherwise, you’ll jump at the quickest possibility for rebirth to escape your pain—which may not be the wisest option available. So it’s often wise to determine the ideal dose for painkillers that will take the edge off the pain and yet leave you alert. The best course, however, is to remember the Buddha’s recommendation that you learn how not to be afflicted in mind even when afflicted in body.

In the discourse where the Buddha makes that statement (SN 22:2), Ven. Sāriputta explains what it means: Staying unafflicted in mind means that you don’t build any sense of self-identity around any of the five aggregates of form, feeling, perception, fabrication, or consciousness. You don’t assume your self as identical with any of the aggregates, as possessing them, as containing them, or as being contained within them. This definition fits in with the Buddha’s definition of how suffering in general is ended: You stop clinging to the aggregates. And because the Pali word for clinging—upādāna—also means taking sustenance, it’s easy to see why the Buddha saw hunger as the paradigm for all disease, physical and mental. It’s when you don’t have to feed the mind on the aggregates that you can be said to be truly healthy.

This type of health is achieved at a very high level of Dhamma practice—at least the first level of awakening—but the discourses in the Canon and the teachings of the Thai Forest masters take the path leading there and break it down into more immediately manageable steps.

One of those steps is to develop a sense of shame around the issue of pain, in that healthy shame can help motivate you to develop the ability to withstand it. You think of the Buddha’s disciples of the past who were able to face pain and illness even when stuck in the remote wilderness. Ven. Vakkali is an example from the Canon (Thag 5:8). Ajaan Lee Dhammadharo is an example from more recent times: Having hiked three days into a location deep in the forest where he expected to spend the three months of the Rains retreat, he suffered a series of heart attacks soon after his arrival. With no medicine to treat his heart, he fell back on his breath and his powers of concentration, using the breath energies throughout the body to heal his heart and regain his strength. At the end of the three months, he was able to hike back to civilization, and he taught that approach to the breath until his death eight years later.

Both of my own teachers—Ajaan Fuang and Ajaan Suwat—told me that some of their most important insights in meditation came during severe illness. In Ajaan Fuang’s case, it was a series of unrelenting headaches. In Ajaan Suwat’s, it was a bout of malaria. As he once said to me, “If malaria were a person, I’d bow down to him in gratitude.” I also know of many lay practitioners who died of cancer but who, through their meditative abilities, were able to deal with the pains of their illness peacefully with only minimal use of pain medication.

It’s easy to say that these people were tougher than you, so they were better able to withstand pain. But what’s accomplished by saying that? And how did they become tough? Pain was as painful for them as pain is for you. It was because they saw the value in learning how to withstand pain that they were able to learn how to do it. They trained themselves to meet the Buddha’s standards for a good patient. It would be a shame if you didn’t train yourself to acquire the same ability, too.

And more than a shame: Compunction teaches you that if you don’t learn how to withstand your pains now, you’re setting yourself up to come back and suffer more pains indefinitely. If you want to get past pain, you have to face it directly. Nobody else can face it for you. And it’s not going to get any easier as you get older, so why not learn how to master this skill now?

The lessons of conviction, shame, and compunction come together to motivate persistence in actually ridding the mind of unskillful attitudes toward illness and developing skillful intentions in your quest to learn how to master pain.

When illness strikes, the primary unskillful attitude you have to get past is the grief expressed in questions like, “Why is this happening to me? Why am I being singled out to suffer at such an inconvenient time?” You have to remember that illness is normal. It strikes everyone at one time or another, so you’re not being singled out for unfair punishment. When you think of all the other people and living beings who are suffering from illnesses, it should give rise to an unlimited feeling of compassion for beings at large. We’re all in this together. This thought should actually make your own pains easier to bear. The more expansive your attitude toward pain and suffering in general, the less your particular pains will weigh down the mind.

This point is so important that the Buddha devotes a number of similes to illustrate it, giving guidance in how to employ verbal fabrication and mental fabrication to talk to yourself around the pain of illness (AN 3:101). These similes help you understand how, if the range of your mind is limited, the pain coming from past bad actions will be intensified. But if your mind is broadened and enlarged, the pain coming from past bad actions will be much less intense.

One of the similes is this: A narrow mind is like a small cup of water, whereas an enlarged mind is like a broad, clean river. If you throw a lump of salt into the cup of water, you can’t drink the water, because it’s too salty. But if you throw the same amount of salt into the river, you can still drink the water in the river because there’s so much more water than salt.

Another simile concerns being fined for stealing a goat. If you’re poor, you may not be able to pay the fine, and you could easily get thrown in jail. If you’re wealthy, you’ll hardly feel the inconvenience of the fine at all.

Thinking about your illness in line with the teachings on kamma can also have the effect of expanding the range of your awareness. You may not know the particular kamma that brought you this illness, but you can accept the general principle that kamma has a role to play. Instead of complaining about it, you can be a good sport about it. Don’t be too proud to admit that you probably have done some pretty unskillful things in the past—like everyone else in the human world. This thought opens the mind to want to comprehend the pain—and especially your present mental kamma around the pain—by meditating while you treat the disease.

As for the inconveniences that come from illness—in which you’re unable to do your work or meet your family responsibilities—remind yourself that understanding your relationship to pain is ultimately more important than many of your other plans, for it’s a skill that you’ll have to depend on more and more as you approach death. There will come a day when you have to abandon all your other responsibilities for good, and the world will have to go on without you, so here’s your opportunity to give some time to focus on the skills you’ll need at that time.

Another set of questions you have to put aside is, “How much longer before I recover? Will I recover?” Thoughts of how long you’ve been suffering from the illness in the past, or how much longer you’ll be suffering in the future, simply weigh the present moment down with more weight than it can bear. Remind yourself that past pains are no longer there, future pains haven’t arrived yet, and you don’t want to burden your mind in the present with thoughts of either. Let the past take care of the past, and the future of the future. Your best course of action is to focus on your relationship to pain right now. The better you master this one issue, the better you’ll be prepared for whatever the future will bring.

To comprehend your relationship to pain in the present moment will require not only persistence, but also all the remaining strengths: mindfulness, concentration, and discernment.

The main role of persistence here lies in getting your motivation straight. We’re often warned that when contemplating pain, you can’t do it with the purpose of wanting the pain to go away. While this warning is true to a certain extent, it’s often misunderstood, so we have to qualify it to get the best use out of it.

The warning is frequently justified on two grounds: (1) If you want the pain to go away, that counts as craving, which is the cause of suffering. Your desire will backfire on you and simply pile on more pain. (2) The duty with regard to pain is to comprehend it, not to make it go away. To comprehend it, you simply have to accept its presence as it appears—“There is pain”—and not muddy the waters by trying to do anything to alleviate the pain.

These two justifications, however, miss several important points and, in doing so, actually get in the way of properly comprehending the pain.

To begin with, as we’ve noted several times in this book, not all desires come under the truth of the origination of suffering. Some actually come under the truth of the path, in the factor of right effort, which is identical with the strength of persistence. An important part of right effort is generating the desire to abandon unskillful mental qualities and to develop skillful ones in their place. These desires are necessary for putting an end to suffering. So the proper attitude in dealing with pain is not to try to contemplate it without desire. It’s to figure out which desires around the pain actually make the pain worse, and which will help in alleviating suffering.

The Canon in several places defines the skillful desire around pain in very clear terms: You want to learn what to do so that the pain doesn’t invade the mind and remain (MN 36; SN 52:10). Your ultimate goal should be the ability to experience pain but with a sense of being disjoined from it (MN 140; SN 36:6).

To understand what would be required to gain a sense of being disjoined from pain, you need to consider why the mind would feel conjoined with it to begin with. And there are two reasons: One is that you’re doing something in the present moment that inadvertently contributes to the pain. The other is that even though you wouldn’t want to cling to the pain, you’ve unconsciously conflated it with something that you do cling to as you or yours in body or mind.

So to become disjoined from pain, you have to figure out (1) what you might be doing to aggravate it and (2) what you might be clinging to that you feel has been invaded by the pain. When you figure out these issues to the point where you’ve stopped aggravating the pain and stopped clinging to something you’ve conflated with the pain, that’s when you’ve comprehended the pain.

The skill of comprehending pain in this way requires patience and endurance, because you’ll have to be willing to stay with pain long enough to observe it and your actions around it properly. But this is not the kind of endurance that simply puts up with whatever’s arising. You need to be strategic in knowing which pains are worth enduring, and which ones are not.

A basic principle in the Buddha’s teachings on endurance is that you don’t weigh yourself down with unnecessary pain, and you don’t reject pleasure in accordance with the Dhamma—although you’re careful not to let yourself get infatuated with that pleasure (MN 101). When dealing with the pain of illness, this means that if you can discern what you’re doing to aggravate your pains, it’s perfectly legitimate to change what you’re doing so as to stop the aggravation. You can also induce feelings of pleasure, based on skillful mental states like concentration, in place of the pain. This allows you more easily to contemplate where you still might be clinging.

To become conscious of what you’re doing to aggravate the pain requires that you understand the causal factors surrounding it. And as you’ll remember from Chapters One and Two, this is precisely what comprehension entails. In the Buddha’s analysis, comprehending pain doesn’t mean simply witnessing the fact of pain. It means correctly identifying it and developing dispassion around it. You develop that dispassion by teasing out the causal factors that give rise to it, so that you can develop dispassion for them. That’s what allows you to become disjoined both from the causal factors and from the pain itself.

The first step in this direction lies in identifying exactly what is the pain that’s affecting the mind. In the first noble truth, the Buddha defines mental pain as clinging to any of the five aggregates. Now, these moments of clinging don’t come with little badges, saying, “Hi, I’m clinging.” And they don’t come with their boundaries clearly marked, showing where they begin and where, say, a physical pain associated with them ends. To develop your discernment, you first need to see the events of the mind as separate events, and not conflated or glommed together as they most commonly appear. Then you have to experiment to see exactly which of these events cause which other events.

This can’t be done through passive observation. Instead, you have to single out and change the factors of the mind surrounding the pain, to see which changes can have an effect on how you experience pain and how far it invades the mind. This is similar to scientists trying to figure out, say, what will kill a certain type of bacteria. They don’t simply observe the bacteria in its natural environment. They isolate it and then expose it to different substances until they find the substances with the desired effect.

The Buddha’s teachings on dependent co-arising show where to look for the factors immediately surrounding pain. In those teachings, painful feelings often appear in clusters of physical and mental factors. Our language distinguishes clearly between physical and mental pain, but in actual experience, the line between physical and mental causes for pain is not all that clear. A pain may be caused by a physical imbalance in the body, but the way you perceive that pain may also have a strong effect on how intense it feels. Sometimes, in fact, the original physical cause for the pain may have long since disappeared, but the mental factors aggravating the sensation of pain can still keep it going.

So it’s good to know the various clusters of factors that can surround pain, so that you can gain an idea of what you might try changing to test its effect on your experience of the pain.

The major factors are these: Under the factor of fabrication in dependent co-arising, feelings of pain are accompanied by the in-and-out breath, by directed thought and evaluation, and by perception. Under the factor of name and form, they’re accompanied by the four primary properties of the body—solidity, liquidity, energy, and warmth—and by the mental factors of perception, intention, acts of attention, and contact (which here may mean either contact among mental events or between mental events and physical events).

The fact that there’s such a wide range of factors that might potentially be aggravating the pain is one of the reasons why pains can be so bewildering. But you can learn to rise to the challenge, seeing these factors as giving you many things to experiment with: If one approach doesn’t work, you can always try others. We’ll discuss some possible experiments below. Here it’s important to note that because some of the physical factors—such as the breath—can be controlled through your intentions, you can approach a pain both from the physical and from the mental side. This means that there may be times when you change, say, your intentions around the pain, and the result is that the pain disappears. That would mean that the pain would come under the category of “unnecessary weight” and the ensuing pleasure would be in accordance with the Dhamma. When you stop aggravating the pain in this way, you’ve found one way to keep the pain from invading the mind and remaining.

So even though, in your efforts to comprehend your pains, it’s not wise to give priority to the desire for the pain to go away, it is perfectly legitimate to want to see if you’re doing anything that’s making the pain unduly severe. If your investigations don’t seem to lessen the pain, take it as a good sport and focus on trying to figure out the other way that pain may be invading the mind: through your assumption that the pain has invaded something you cling to. If your investigations do lessen the pain, you’ve not only lifted an immediate burden from the mind, but you’ve also developed your discernment into the causal factors that can lead to suffering.

The context for these investigations is supplied by the practice of right mindfulness. This is the practice that the Canon highlights as the ideal means for making sure that pain doesn’t invade the mind and remain (SN 52:10). However, there’s very little information in the Canon as to how to apply right mindfulness in the face of pain. The Satipaṭṭhāna Sutta (MN 10)—which describes the role of mindfulness and alertness in the practice of right mindfulness—simply notes that you should try to note when pains are present and when they’re absent, when they’re pains of-the-flesh or pains not-of-the-flesh. However, because this discourse doesn’t go into detail on the role of ardency in the practice of right mindfulness, it doesn’t give any directions on what to do once you’ve noticed that pain is there.

Somewhat more helpful is the Ānāpānasati Sutta (MN 118), which does include the role of ardency in its discussion of mindfulness practice, and which lists four steps in its description of how the contemplation of feelings relates to the practice of keeping the breath in mind. These steps come in the second tetrad in the Buddha’s instructions. As you may remember from Chapter Three, the four steps in that tetrad are these: breathing in and out sensitive to rapture or refreshment, breathing in and out sensitive to pleasure, breathing in and out sensitive to mental fabrication, and breathing in and out calming mental fabrication. These steps, in the context of the discourse, refer to the stages in getting the mind to settle into deeper and deeper stages of concentration. But the teachings of the Thai forest masters show that these steps can also be applied to the contemplation of the pain of illness as well.

The first two steps receive a great deal of attention from Ajaan Lee. His instructions for breath meditation focus on the breath energies throughout the body that accompany the in-and-out breath, and he shows how these energies can be very useful in exploring what you’re doing that may be contributing to physical pain.

The first step he recommends, when there’s a pain in the body, is not to focus attention directly on the pain, but instead to focus on a part of the body that you can make comfortable by the way you breathe and by the way you allow the breath energies to flow freely through that area. Sometimes the best place to focus is in a part of the body immediately opposite to the pain: For example, if the pain is in a spot on the right side of the body, you focus on the corresponding spot on the left. If it’s in the back, you focus in front. Or you may find that the pain in one part of the body is related to an energy blockage in another, more remote part of the body: In my own experience, I’ve had migraines that were alleviated when I focused on clearing up energy blockages in my lower back.

Eventually, you’ll want to be able to focus directly on the pain itself, but Ajaan Lee’s first step in approaching pain accomplishes three things: (1) It gives you a beachhead to which you can retreat if you find that the pain becomes overwhelming. (2) It gives the mind a solid basis in concentration, which can provide a sense of nourishment for the work of contemplating the pain. (3) It gives you practice in learning how to focus on a part of the body without tensing up that part of the body. This will be an especially useful lesson in learning how to pay direct attention to pain without aggravating it.

Working with breath in this way also involves discernment, as you explore the three types of fabrication in relationship to the pain. You start with bodily fabrication—the rhythm and texture of how you breathe in and out—and also bring in verbal fabrication: talking to yourself about how to make the breath comfortable, how to maintain that sense of comfort once it’s there, and how to spread it through the parts of the body that are receptive to that good energy.

This, of course, also involves mental fabrication in terms of the perceptions you use to experiment with the breath energies in different parts of the body. Ajaan Lee also recommends two perceptions to help in this step in dealing with pain: Think of the body as a house with a few rotten floorboards. If you’re going to sit or lie down on the floor, choose a spot where the boards aren’t rotten. Or think of it as a mango with a rotten spot: Leave the rotten spot to the worms; you eat the good part remaining.

Then, when the breath is solidly comfortable and the mind feels ready, drop those two images. Now think of spreading the good breath energy through the pain. For example, if there’s a pain in your knee, think of the good energy going down the leg through the knee and out the tips of the toes. Don’t let there be a perception of the pain blocking the breath. Remind yourself that breath is energy, and energy can go through anything. I’ve found it helpful to think of the area of the body that’s in pain as being composed of atoms, and atoms are mainly space, so the breath can penetrate easily through the space. The perception of the pain as a blockage is actually conflating the pain with the solidity of the body. As long as you cling to the body, that would be a recipe for allowing the pain to invade the mind and remain.

There are also other questions you can ask about the pain and its relationship to perception at this stage. Do you perceive the pain as being blocked off from the breath? Are you using the parts of the body that are in pain to do the breathing? If so, think of those parts relaxing, and allow other parts of the body to do the work of breathing instead. You can also experiment with the perception of having the breath go straight into the pain when it first enters the body. See what that does to your experience of pain.

Sometimes, when you follow this step, the pain will go away or will be greatly reduced. Even if it doesn’t, you will have established an important relationship vis-à-vis the pain: You can be proactive in dealing with it. You’re not afraid of it. You’re not the passive victim. When you’re proactive, you’re not a stationary target of the pain, so it can’t hit you so easily. At the same time, by learning to question your perceptions around the breath and the pain, you’ve learned how arbitrary some of your original perceptions were. By sensitizing you to the role of perception—mental fabrication—around the pain as you try to find perceptions that help to alleviate the pain, this insight makes some beginning forays into the third and fourth steps in contemplating pain.

These are the steps to which Ajaan Maha Boowa devotes a great deal of attention. He recommends a wide range of questions that you can ask yourself about how you perceive pain. For instance, do you perceive the pain as being the same thing as the part of the body that’s in pain? If the pain is in the knee, do you see the pain and the knee as being the same thing? This question may seem strange, but remember: We may have picked up some strange ideas about pain when we were children, and often these ideas are still lurking in our subconscious. The only way to dig them out is to ask questions like this.

If the pain and the part of the body seem to be one, remind yourself that your experience of the body is made up of the four properties of earth, water, wind, and fire, but the pain is something else. The pain may seem solid or hot, but remind yourself that solidity and heat are properties of the body that you’ve conflated with the pain. Can you perceive the pain as being separate from the solidity or the heat? To counteract the perception of the solidity of pain, you can try to perceive it as distinct moments, arising and passing away in quick succession.

A related question is: Does the pain have a shape? If you perceive it as having a shape, again you’ve glommed the pain together with a property of the body.

Similarly, you can ask yourself if there are pains in several parts of the body that seem to be connected with lines of tension. This is actually another way of giving the pains a shape, and of conflating the pains with the body. So ask yourself if you can see the pains as separate from one another. Or try to counteract the perception of a connection with an alternative perception: You have a knife that you can use to cut any connections as soon as they appear.

Another question: Do you perceive the pain as having an intention to hurt you? Remind yourself that pain is not a conscious agent. It has no intentions at all. It’s just an event that depends on other events. If you perceive it as having an intention to hurt you, you’re creating a sense of self around the perception of being the target of malicious intent. When dropping the perception of its intention, you can also ask yourself why you’re identifying yourself as the target.

Another question: Where is the most intense point of pain? If you look carefully, you’ll see that it moves around. Try chasing it down. This line of questioning not only helps to loosen up any fixed perceptions you might have around the pain, but it also gives you practice in being courageous in the face of pain. Instead of trying to run away from it, you run toward it—and it’ll run away from you. This exercise also helps to guarantee that in your contemplation of pain, you haven’t allowed the desire for it to go away to slip into first place in your motivation. You’re hunting it down to understand it.

In addition to applying these questions and perceptions—verbal and mental fabrications—to your own pains, you’ll also need to come up with some questions of your own around your perception of pain to see what helps you to detect perceptions you may not have noticed and to loosen them up.

A question I’ve found helpful, once you can perceive the pain as occurring in discrete moments, is to ask yourself: When the moments of pain arise, are they coming at you or going away from you? See if you can hold in mind the perception that they’re going away, going away. It’s like riding in a train in a seat with your back to the engine. As the train runs along the track and you look out the window, you’ll see that whatever comes into the range of your awareness in the landscape outside is already going away from you as soon as you see it. This perception helps to get rid of the perception that the pain is aimed at you. This also helps to detect and loosen up any tendency you have to cling to the perception of yourself as a target.

When you loosen up and drop your perceptions around the pain, either the pain will go away—sometimes in some very uncanny ways—or you’ll arrive at a state of mind where you sense that the pain can still be there, but your awareness feels separate from it. The body is one thing, the pain is another, your awareness is yet another. They’re in the same place, but they’re separate, just like the radio waves transmitted from different stations going through the air all around you. They’re all in the same place, but at different frequencies. If you have a radio that can distinguish the frequencies, you can tune into the different frequencies without having to move the radio to one place for one frequency, or to another for another one.

Ajaan Maha Boowa notes that a strategy for dealing with pain that works today may not work with a different pain tomorrow. And given what the Buddha teaches about the many factors surrounding pain, it’s easy to see why. One day a pain may invade the mind when you conflate it with one aggregate—form, say, or a particular perception—and on the next day, another pain may invade the mind when you’ve conflated it with another one.

If you compare the ajaans’ strategies with the various causal clusters described in dependent co-arising, you’ll see that they deal not only with the issue of perception, under the factor of fabrication, but also with the issues of attention and intention under name in name and form. Attention determines not only where in the body you focus your interest, but also which questions you focus on asking and answering. Intention, of course, deals with your reasons for contemplating the pain. As noted above, the quest not to have the pain invade the mind can include within it the desire to see the pain go away, but it can’t allow that desire to be prominent. For your contemplation to get results, the desire to understand the pain always has to come first.

When you understand these exercises in this way, it gives you an idea of the range of different questions you might try in your own investigation of pain to develop dispassion for the two reasons why pain could invade your mind and remain: what you’re doing to aggravate the pain, and what you’re clinging to that you’ve conflated with the pain. When you understand these two issues, you’ve gone a long way in unraveling the problem of suffering.

The important point is that you don’t make illness an excuse for not taking a proactive approach to understanding pain. I noted above that both Ajaan Fuang and Ajaan Suwat gained important insights into pain—and into the mind—while contemplating pain while they were sick. Many other people in the Forest tradition, ordained and not, have also reported similar results. If they can do it, so can you.

Which means that it’s possible, even when ill, to accomplish great things.