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A Guide to Skillful Action for the Chronically Ill

A Personal Perspective: What to do and not do to improve your health.

Key points

  • Skillful action lies in finding the middle ground between too much and too little.
  • Mindfulness practice helps because, unless you pay attention to the present moment, you can find yourself engaged in too many tasks.
  • When considering skillful action, it’s also helpful to pay attention to skillful inaction.
Tony Bernhard, used with permission
Your author on a slow stroll
Source: Tony Bernhard, used with permission

Skillful action is on the Buddha’s eightfold path to peace. That’s why I pay careful attention to it. Simply put, actions that ease emotional and physical suffering are to be cultivated, and actions that exacerbate and intensify suffering are to be avoided.

One question this raises is whether chronic illness (which includes chronic pain) is an insurmountable obstacle to finding fulfillment and even joy in life when actions (and thus, options) are severely limited.

Finding the Balance Between Too Much and Too Little

Skillful action is a challenge for me because I’m still trying to overcome a lifetime of conditioning that led me to believe it was essential to always be active. For example, the house always had to look its best, the walkways always had to be free of leaves in autumn, and every meal had to be delicious.

Suddenly and unexpectedly, these became actions that exacerbated my symptoms, with the result that both my physical and emotional suffering intensified. These were no longer skillful actions for me. In addition to physical suffering in the form of worsening my symptoms, these actions intensified my emotional suffering because I felt like a failure.

It takes discipline and practice to overcome this lifetime of conditioning—that is, to avoid overexertion and to feel okay about it.

I’ve discovered that skillful action lies in finding the middle ground between what I used to be able to do and the alternative of giving up on almost all activity out of fear of worsening my symptoms or out of anger over my perceived misfortune. The challenge is to find the balance between too much and too little.

In A Still Forest Pool, Thai Buddhist master Ajahn Chah writes about his teaching method. I use his discourse as a guide for determining what is skillful action, given my limitations:

It’s as though I see people walking down a road I know well. To them the way may be unclear. I look up and see someone about to fall into a ditch on the right-hand side of the road, so I call out to him, “Go left, go left!” Similarly, if I see another person about to fall into a ditch on the left, I call out, “Go right, go right!” That is the extent of my teaching. Whatever extreme you get attached to, I say, “Let go of that too.” Let go to the left, let go to the right. Come back to the center, and you will arrive at the true Dharma [teachings].

The key to skillful action for the chronically ill, then, is to avoid extremes. If you veer too far to the one side and act as if you have the stamina and physical abilities you used to have, you risk overexertion that could land you in bed for days. But if you veer too far to the other side and avoid all activities and all contact with people, you risk missing out on experiences that are likely to be fulfilling and emotionally nourishing. Even worse, you risk falling into despair.

Either extreme increases your suffering, and so is not skillful action. The challenge is to find that balance between too much and too little.

Avoid Multitasking

A valuable guideline for skillful action comes from the Korean Zen master Seung Sahn: “When reading, only read. When eating, only eat. When thinking, only think.” I look upon this as a caution about multitasking.

Doing one thing at a time is particularly good advice if your symptoms are exacerbated when there’s too much sensory input—watching TV at the same time you’re texting at the same time you’re eating! It takes discipline to break the multitasking habit. Mindfulness practice helps because, unless you consciously pay attention to the present moment, you can find yourself engaged in multiple tasks without even realizing it.

Multitasking rarely mixes well with chronic pain and illness. Of course, some multitasking is okay, but when an activity requires concentration, I suggest you resolve to do one thing at a time.

Skillful Inaction

When considering skillful action, it’s also helpful to pay attention to what I call skillful inaction. Some years ago, I started thinking of it as the practice of “doing nothing.” It was inspired by an anecdote I heard many years ago about a college student in Japan who told a Zen monk that she wanted to meditate but was under too much stress.

The monk said to her: “Don’t meditate. Just sit and do nothing.”

I decided to turn his comment into a practice. I don’t know if this is what the monk had in mind, but it works for me. Once or twice a day I stop whatever I’m doing and do nothing for a few minutes. You can do this lying down, sitting up, or even standing.

Most of us never learn to do nothing because our culture doesn’t value it. I’ve discovered that when I’m doing nothing I feel calm and receptive. Whatever comes to my attention, I simply receive it in a relaxed nonreactive manner. Sounds come and go; sights come and go; physical sensations come and go (or at least change); thoughts come and go; the dog comes and goes.

Sometimes thoughts start piling on top of each other, and I start to get lost in an all-too-familiar story I tend to spin—typically regrets or worries about the future. As soon as I become aware that this is happening, I say to myself, “Right now I’m doing nothing.” Usually, that’s enough to cause the thoughts to go away. If not, I treat them as meaningless chatter in my mind.

“Doing nothing” is calming and feels good. I hope you’ll try it.

My best to everyone as we work to find the balance that opens the door to living well despite our limitations.


You might also find this helpful: “Things to Do When You're Mostly Housebound.”

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