Acceptance and Discretionary Suffering

     The core of meditation practice IMHO is carefully investigating the difference between unavoidable vs discretionary suffering: investigating how we can minimize our tendency to unwittingly cause LOTS of unnecessary problems for ourself & those around us.
     A reasonable starting point is Reinhold Niebuhr's "serenity prayer":
          Grant me the serenity to accept the things I cannot change;
          courage to change the things I can;
          and wisdom to know the difference. 

     Let's look at the rather large & often frustrating "things I cannot change" category. Many people suffering with chronic pain, as well as a variety of mental health issues including addictions, can potentially benefit greatly from the following teaching:

     “Accepting and releasing into just what is, is the homeopathy of Zen. Being willing to settle into just this experience – this is the teaching of saying yes to our life, not giving in to thoughts of another life. We learn that our resistance strengthens whatever we want to avoid.
     Trying on the attitude of yes is the not-knowing mind, whereas the conditioned mind creates conditions. This is too much (or not enough). No way am I going to stay in this situation. The not-knowing mind is willing to know and feel whatever is happening.
     Recently I was thinking about a difficult situation in my life, trying to find a way to make it acceptable. For days I would think about it, invite my mind to reimagine it in a less painful way. After weeks of trying, I realized, I’m helpless. I can’t solve this by myself: I just have to be it. That realization was an enormous relief. Like Ram Dass saying, I’m going to be on this train forever, I settled into my own circumstances: There isn’t anything I can do about this situation. There is no way to escape it. I must live with it and let it become digested and transformed internally on its own. Thinking I had to solve the problem became the problem.”
        Katherine Thanas. “The Truth of This Life. Zen Teachings on Loving the World as It Is.” Shambhala, 2018.

Physical Processing & Neuroscience

     "primates have a distinct cortical image of homeostatic afferent activity that reflects all aspects of the physiological condition of all tissues of the body. This interoceptive system, associated with autonomic motor control, is distinct from the exteroceptive system (cutaneous mechanoreception and proprioception) that guides somatic motor activity. The primary interoceptive representation in the dorsal posterior insula engenders distinct highly resolved feelings from the body that include pain, temperature, itch, sensual touch, muscular and visceral sensations, vasomotor activity, hunger, thirst, and 'air hunger'. In humans, a meta-representation of the primary interoceptive activity is engendered in the right anterior insula, which seems to provide the basis for the subjective image of the material self as a feeling (sentient) entity, that is, emotional awareness." 
     Craig AD. Interoception: the sense of the physiological condition of the body. Curr Opin Neurobiol 2003; 13(4): 500-5.

     Anxiety sensitivity (AS) ... is the fear of arousal-related sensations, arising from beliefs that the sensations may have harmful physical, social, or psychological consequences. AS is composed of 3 (or 4) dimensions: 
• fear of physical sensations, 
• fear of cognitive dyscontrol,
• fear of publicly observable anxiety reactions ±
• fear of respiratory sensations. 

     AS is a potential common vulnerability factor in PTSD & chronic pain.
     "Interoceptive exposure (IE) is among the most effective methods for decreasing AS. IE involves exposure to feared bodily sensations through harmless, brief exercises (e.g. repeatedly hyperventilating). Through repeated exposure to these sensations, patients learn that the sensations do not lead to catastrophic outcomes, and thus their AS abates." 
       Wald J et al. Posttraumatic stress disorder and chronic pain arising from motor vehicle accidents: efficacy of interoceptive exposure plus trauma-related exposure therapy. Cogn Behav Ther 2010; 39(2): 104-13.

     "Approaching the pain itself, wherever it is most prominent in the body, with bare attention, open-heartedness, and alert interest even for very brief moments, if that is all that we can muster in any moment, can be profoundly healing, restorative, and illuminating. And if practiced over days, weeks, and months, potentially it can make a difference in the quality of your life for years and years going forward. What we are talking about is really befriending your experience at the level of the body and at the level of the mind and heart, and seeing what unfolds.”                           Jon Kabat-Zinn 
       Gardner-Nix, J. “The mindfulness solution to pain. Step-by-step techniques for chronic pain management.” New Harbinger Publications Inc, Oakland CA, 2009.

Photo: Janolus   www.dpreview.com