The mind is its own place,
and in itself can make a Heav'n of Hell
or a Hell of Heav'n.
John Milton

      To one who has not experienced the torment of a clinical depression, it is hard to put this pain into words. It cannot be described as stabbing, shooting, or burning; neither can its sensations be localized to any one part of the body. It is an all-encompassing malignancy-a crucifying pain that slowly permeates every fiber of one's being. Falling prey to a depressive illness is not like being gored by a bull; it is more akin to being eaten alive by an army of starving termites.

      In the midst of my depressive episode, coping with such unbearable pain became my central task, especially when the pain became so overwhelming that my thoughts turned to suicide. "But reduce the pain?" I thought incredulously. "How am I going to find relief from an agony this extreme?" I remembered what author William Styron had told his daughter on the eve of his hospitalization-"I would rather have a limb amputated without anesthesia than to suffer the kind of pain I am feeling right now."

      It was at this point that an old college friend of mine serendipitously reentered my life. Teresa Keane was a registered nurse who worked at the Oregon Health Sciences University Medical School where she taught stress reduction to patients with chronic pain. Her classes were based on the groundbreaking work of Jon Kabat Zinn, a meditation teacher featured in Bill Moyer's 1996 PBS documentary, Healing and the Mind. Kabat Zinn teaches the Buddhist practice of "mindful meditation" to patients suffering from intractable physical pain. Through employing his techniques, patients alleviate not only their physical discomfort, but the accompanying emotional distress as well.

      I met up with Teresa in her office at OHSU where I described the nature of my torment.
     "Facing pain is a learned skill," Teresa responded. "When you are in a lot of pain, whether it is a migraine headache or suicidal torment, the pain dominates all of your awareness and becomes-all encompassing. It's hard to remember a time when the pain was absent, and it's hard to believe that it will ever go away. It's as if both past and present are blotted out, and you are left stranded in your present misery."
      "At least you understand," I remarked.
      "However," Teresa continued, "If you can release your judgment about pain and just observe it, you will notice a very important fact about the nature of pain-pain comes in waves!"

      Upon hearing these words, I remembered my experience of grief after my separation from my wife, Joan. There were days when I was so overwhelmed by sorrow and loss that I could barely function. After a time, however, the pain and the longing would let up, perhaps for a day or two. Yet, invariably the heartache would return and begin the cycle all over again-pain turning into relief, which turned into more pain and then more relief, etc.
      "This is the body-mind's built-in protective mechanism." Teresa explained. "If the pain were truly nonstop, you wouldn't survive. And so you are granted a few gaps in between the intense sensations while you stop and catch your breath."
      "But it feels like the pain is unrelenting," I protested. "If you were clinically depressed, you would understand."
      "The key to reducing your perception of pain," Teresa continued dispassionately, "is to uncouple the sensations in your body from the thoughts about them."
      "What does that mean?"
      There are two levels of pain that you are feeling. The first level is physiological-the raw pain in your body. The second layer (and this is where you have some control) consists of how you interpret your experience. Perhaps you may be thinking, 'This torment is killing me,' or 'This will last forever,' or 'There is nothing I can do about it.' Each of these despairing thoughts creates a neurochemical reaction in the brain that creates even more distress. If you can learn to detach yourself from these judgments, much of the pain that arises from them will diminish."
      "How do I do this?"
      "Think of your anxiety or depression as a large wave that is approaching you. As the wave makes contact, see if you can ride the wave by focusing upon your breath. Breathe through the sensations, breathing in and out while attending to the sound of your breathing. Don't fight against the pain-that will only make it worse. Just breathe. It's not even about getting through the day; it's about getting through each breath."

      When I had worked as a salesperson in the corporate world, I learned the skill of breaking large goals into manageable parts. Now I discovered that one could also divide pain into manageable parts. If I couldn't handle getting through the day, I would try to make it through the next hour; if an hour seemed too long, I set my sights on the next minute or second.
      Teresa showed me another powerful technique to use when my pain became intense. Calling her on the phone I would say, "My pain is unbearable."
      "It is barely bearable," she replied. "Can you feel the subtle difference between those two sentences?"
      "The pain is barely bearable," I repeated to myself. There was a shift and I felt it.
      In another session I screamed, "I can't take it anymore!"
      "You can barely take it," she responded.
      "I can barely take it," I replied.

      What Teresa was teaching me was the practice of mindfulness, the spiritual practice of staying focused on the present moment. In traditional meditation, when the mind wanders, one gently brings it back to a central focus (the breath, a candle, etc.). Teresa challenged me to do the same in response to intense emotional pain, especially when I projected my present condition into the future using catastrophic self-talk that led to suicidal thinking-e.g. "If I have to put with this pain for 30 years, I might as well end my life now."

      "Just refocus on the present moment," Teresa would say. "Over a period of time you can learn to relate differently to your pain. You can work with the pain and live around the corners of pain and develop your life around it. Eventually the turbulent emotional waters will become calm again. In the meantime, you can find inner stillness and peace right within the most difficult life situations."
      As a way to keep me safe, Teresa and I devised a simple but powerful three-step technique for responding to my catastrophic and despairing self-talk. I have rewritten these steps in a prescriptive fashion so that they can be used by others.

1. Notice what is happening. Become aware that your mind is dwelling on thoughts of catastrophe and doom. Identify the catastrophic thought-e.g., "This pain will never stop. The only way out is suicide."
2. Realize that these fearful thoughts are describing not the present but the future. Since the future has yet to occur, it cannot harm you.
3. Refocus onto the present moment through positive self-talk and constructive action. For example, you might replace the statement "I'll never get better" with "Right now I am going to choose a self-care strategy to get me through this period (e.g., calling a friend, going for a swim, taking an antianxiety medication, etc.)." Then, put your strategy into action.

      I cannot recall how many times this simple process allowed me to endure a day, an hour, or a minute of intense pain. In giving me a way to manage my catastrophic (and potentially dangerous) thinking, this technique kept me alive while I waited for the pattern of my illness to shift.

      In his classic book, Man's Search for Meaning, Victor Frank, while imprisoned in a Nazi concentration camp, discovered that "everything can be taken from a man but one thing-the ability to choose one's attitude in any given set of circumstances." While we cannot always avoid the pain of a depressive illness, we can direct our thoughts about it, and thereby modify our experience of the pain at the level of perception. While the subsequent pain-reduction may be subtle, it can be enough to make the suffering "barely bearable."