Abstract
By Elana Rosenbaum. Boston: Shambhala Publications, 2012, 150 pages, $14.95.
Being Well (Even When You're Sick): Mindfulness Practices for People with Cancer and Other Serious Illnesses aims to bring the approach and practice of mindfulness meditation to bear on the experience of serious illness. The author, Elana Rosenbaum, is a psychotherapist, a long-time mindfulness teacher and practitioner, and a cancer patient herself. She weaves together these different layers of experience to offer a book that uses the principles of mindfulness—deliberate awareness of moment-to-moment experience without judgment—to equip patients to face the challenges attendant with life-threatening illness.
Rosenbaum's premise is that mindfulness can be used to alter a patient's experience of illness from one of intense suffering to one that brings patients the opportunity for greater connection to themselves and others. She observes that patients' suffering comes from both the symptoms of the disease process and from the feelings of fear and powerlessness that arise in response to recurrent loss. While the course of illness or the symptoms that result may not lie within patients' control, Rosenbaum argues that patients' responses to them do. She encourages patients to practice taking each moment as it comes, paying attention to their bodily experiences, patterns of thought, and emotional reactions to stress. She coaches patients to notice these things and live with them in that moment, shifting the experience from one of blind reactivity, struggle, and fear to one of acceptance and equanimity, and even to empowerment.
The book is divided into chapters starting with an introduction to mindfulness and moving through topics such as taking control, awareness of the body, accepting change, anxiety, coping, loss and grief, and gratitude. Each chapter describes a mindful approach to the topic, gives examples of stories from Rosenbaum's clinical practice or personal experience, and includes practical suggestions and exercises for the reader to practice.
I found this to be a little jewel of a book. The writing is lyrical while remaining clear and accessible. While the tone can tend toward unalloyed earnestness, the real patient stories and the unmistakable thoughtfulness and utility of this approach to suffering keep the reader engaged. A strong attribute of this book is that, unlike some self-help books that aim to strengthen cancer patients' ability to cope, this approach does not rely on language of “fighting” or “staying positive” to empower patients, a tendency that can lead to a sense of failure if the disease progresses or if feelings of sadness or discouragement arise. Instead, Rosenbaum assumes that difficult feelings are integral to the experience of serious illness and offers suggestions to help patients keep their balance even while experiencing them. While the assertions seem at first blush to exaggerate the benefits of mindfulness, they rest on the layered experience of the author herself. Her experience as a practitioner and teacher of mindfulness might bias her to overestimate its potential to be helpful, but her experience as a clinician and, more importantly, as a cancer patient who has faced multiple recurrences, lend added credibility.
This book has the potential to be extremely helpful for many patients with serious illness, although some may find this approach difficult to embrace. The very qualities of illness that cause some patients to scan for tools to help them cope with difficulty cause other patients to close down and cling to patterns of coping that are most familiar, even if unhelpful. The task of the clinician working with very ill patients, then, is to be able to discern which patients will find this approach beneficial and know to recommend this resource to help them.
As I read the book I realized that while Rosenbaum was writing for patients and their families, clinicians may strongly benefit from reading it, too. The techniques that help patients stay grounded in the midst of great turmoil have application for clinicians who are charged with helping them. Clinicians, too, can be vulnerable to feelings of loss, guilt, and sadness, both because of their connection to patients who have those feelings but also due to their own close, ongoing exposure to suffering. Given this, clinicians are themselves are in need of tools to cope, especially since many may not recognize that such stresses are a core part of their experience and represent a danger to the ability to be present and connected to patients. Rosenbaum may have written this book for patients, but their clinicians may benefit just as much or more from reading it and using the tools she offers.