A Good Dose of Medicine

Thanissaro Bhikkhu

November 13, 1996

The Buddha often compared himself to a doctor, healing the diseases of the hearts and minds of his listeners. Now, we normally think about heart disease as meaning hardening of the arteries, and mental disease as insanity, but he said the real diseases of the heart, the real diseases of the mind, are three: passion, aversion, and delusion. They burn like a fever in the heart, a fever in the body. And the reason he taught about these diseases is because there is a way to gain release from them. If they were impossible to cure, he wouldn't have bothered to teach. So we have to learn to take his teaching as treatment for our own hearts, our own minds. That’s when we’re using them properly.

Treating these kinds of diseases is in some way similar to treating ordinary mental diseases, ordinary bodily diseases. And in some ways it’s different. With ordinary diseases, the doctor can give you medicine, you take the medicine, and that’s it. With the Buddha’s treatment, though, you are the one who administers the cure. You simply learn about the cure from the Buddha. As he says, he simply points out the way, but you’re the one who actually has to carry through and administer the treatment to yourself. So you’re both the doctor and the patient—you’re a student doctor. You’re learning the treatment. Sometimes the symptoms of the disease don’t quite match what’s printed in the texts, don’t quite sound like the things you’ve heard people say: That’s why you need an experienced doctor to help you along. But also you need your own ingenuity because there are times, as in a hospital, when the experienced doctor isn’t on call. Sometimes a really drastic case comes in and there’s nobody but interns around. The interns have to figure out what to do on their own. So it’s not simply a matter of following what’s in the books. You also have to learn how to apply the teachings to all kinds of unexpected situations, to learn which teachings are the basic principles and which are secondary details.

The similarity between the two types of diseases—outer diseases and inner diseases—is that in both cases there are two kinds of sources for the disease: inner and outer. Some bodily diseases you can blame on germs. They come in from the outside and they wreak a lot of havoc in the body. But on a more basic level the question is, “Why do the germs take over?”— because sometimes you have enough resistance to fight them off and sometimes you don’t. In this sense the basic cause comes from inside, from your inner lack of resistance. The same holds true with the mind. Many times we blame problems within the mind on things from outside—what other people do, what other people say, the general atmosphere around us, the values we grew up with, the things we learned as children. And these do play a role, but the most important problem is what comes from the mind. Why is it susceptible to those influences? After all, you find some people staying in a certain environment and they’re perfectly okay, they pick up no negative influences, while other people get into the same environment and come out all warped. Two kids growing up in the same family hear the same lessons from their parents but take away totally different messages. This is because of what you bring to life when you come, what weak points and what strong points are already there in the mind. So you have to focus in on the mind as the main problem. You can’t go blaming things outside. If the mind had really good powers of resistance, a really good immune system, nothing could stir it to passion, nothing could stir it to anger, nothing could stir it to delusion. Fortunately, you can train the mind develop that immunity. That’s the kind of mind you want to develop. That’s the mind that the Buddha defines as health. This is why the training focuses inside, looking at your own mind and seeing where things set it off. When germs come into the mind, where is your resistance strong and where is it weak? What is your line of resistance? This is what we’re developing in the meditation: lines of resistance. Concentration, virtue, generosity: these are all our first lines of resistance against the invading germs.

Sitting here with our eyes closed, instead of trying to change things outside, we change things inside. Some people think that the practice is simply a matter of learning how to accept everything just as it is. Well, some things you do accept and some you don’t. You learn to accept the fact that the outside world is going to be the way it is. There are always going to be external problems. And the phrase “outside world” here doesn’t refer just to other people. Your own body is part of the outside world from the point of view of the Dhamma. And the body contains aging, illness, and death. That’s the nature of the body. You can’t change that, but what you can change is the mind. This is where you can’t just sit around and be equanimous, accepting the mind as it is. You’ve got to accept that the mind has the potential to change. So you’ve really got to stir yourself to look into the mind, to see which potentials need to be weakened and which ones need to be enhanced.

This is where right effort comes in—when you learn how to distinguish skillful and unskillful states in the mind. The skillful ones are the ones that can keep up your resistance against greed, anger, and delusion. The unskillful ones are the ones that give in, the ones that are susceptible to infection. And because delusion is part of the problem, the first thing you need to learn how to do is to distinguish which states are skillful and which ones aren’t. This is why you need instructions. This is why you need a technique in your meditation—you’ve got a focal point, the breath, as a measuring stick for the movements of the mind. You watch the breath as it’s coming in and going out, and you notice when you get pulled away from it: That’s a good measure of when the mind is being influenced by something. If you don’t have this kind of focus, it’s hard to tell when anger comes and when it goes. There’s nothing to measure it against. Like the clouds in the sky: You can’t tell how fast they’re moving unless you’ve got something still and solid on the ground to use as your reference point—a tree, a telephone pole. If you focus on that one point, then you can see whether the clouds are moving north or south, and how fast they’re going in relation to that point. It’s the same with the mind once it has a focal point like the breath: As soon as your attention gets pulled away from the breath, you know something has happened. Then you check to see what it is. In the beginning you simply notice what it is and—realizing that if you follow that, you’re drifting away from where you want to be—you bring the mind back. This is on the basic level of just getting the mind to learn how to be still for a while, how to stick with your original intention to stay centered, and how to settle down. But as your powers of concentration, your powers of mindfulness get stronger and stronger, you find you can actually investigate what’s pulling you away—or what would have pulled you away if you hadn’t caught yourself in time. This is when your powers of resistance are getting stronger: when you begin to see exactly how you get hooked to that pull.

It’s as if your mind is covered with Velcro hooks and you investigate to see what comes along and ends up stuck in them. Actually, those little Velcro hooks are choices. They’re not necessary. You don’t have to get stuck on things. There is actually a place in the mind where you’re making a choice to latch on. Only when things get really still in the mind and your awareness is really clear can you see that choice as an act—that you made the choice to lower your resistance and latch onto the germs when you didn’t have to. That’s where you can let go. One, you see the drawbacks of the diseases caused by the germs and, two, you realize that you don’t really have to come down with those diseases. They’re not really necessary. When you can identify the particular disease patterns, they will never be necessary. They seem necessary only when you can’t conceive of anything else. “Things have to be that way,” or so the mind tells itself. If the mind had to be that way, there would be no purpose in meditating, there would be no purpose in the Buddha’s teaching. He could have sat around under the Bodhi tree for the rest of his life and just enjoyed the bliss of Awakening. He realized, though, that teaching would serve a purpose. So that’s what we’re doing—we’re carrying out that purpose, putting his teachings into practice so we can gain the results that he wanted to see from the effort he put into his teaching. All this comes under right effort, realizing when you have skillful states, realizing when you have unskillful states, and being determined that once an unskillful state has arisen you’re not going to feed it, you’re not going to follow along with it. Some people have problems with this, especially with the issue of struggling or effort or having a goal. The problem, though, doesn’t lie with effort or goals in and of themselves. It lies with your attitude toward them. You need to have a healthy attitude toward this struggle. You need to have a healthy attitude toward the effort, toward the goal, because the goal is what gives you a direction in life. Without goals, life would just be floundering around, like fish flopping around in a puddle.

So you need to have a direction. You realize that maybe this is a bigger task than other tasks you have taken on, so you don’t berate yourself for not getting to the goal immediately or not catching on right away. You learn through experience what your pace is and you stick to it. Sometimes you push yourself a little too hard in order to know what it means to push yourself too hard, and then you let off. And you find that you tend to vacillate back and forth between pushing too hard and not pushing enough, but as long as you’re sensitive to this fact you begin to get a better and better sense of what “just right” is.

When the Buddha talks about the Middle Way, it’s not necessarily what our preconceived notions of the Middle Way are. You have to test them. And the effort required is not blind effort. Right effort involves using your eyes: knowing what’s skillful in the mind, what’s unskillful, being determined to let go of anything unskillful that arises in the mind, and trying to prevent more unskillful things from arising in the mind. At the same time, you try to realize when skillful qualities have appeared. You try to maintain them, develop them, make them strong. So there’s both the letting-go and the developing, and the function of discernment is to tell when which is appropriate. You have to listen very carefully to what's happening in the mind, watch things in the mind, be observant. This is why a lot of the meditation instructions throw things back on you, on your own powers of observation, because only by developing those powers can you develop the discernment you’re going to need. Sometimes in the Buddha's teachings, it’s almost as if he purposely leaves a few blanks, doesn't explain everything, leaves things for you to figure out on your own, because if everything were handed to you on a platter where would your discernment get engaged? How would it develop? You’d be a restaurant critic, picky and choosy about what’s served to you, but totally ignorant about how to fix the food yourself. So sometimes the Buddha gives the teachings as riddles, and your willingness to try to figure them out, make mistakes, come back and try again, is what will make you grow. This is the healthy attitude toward right effort, realizing that sometimes it’s going to take a lot of persistence, a lot of endurance, a lot of tenacity. But not always. There are times when it gets very easy and enjoyable, and everything seems to flow. So you learn to adjust your effort so that it’s just right for whatever the situation. That’s when right effort is really right, when you start getting your own sense of how things vary and how things need to be adjusted. That’s when the practice becomes more and more your own practice, the practice you’ve made your own, not just something that somebody outside is telling you to do. And this is where you turn from a student doctor into an experienced doctor.

Luckily with the diseases of the mind, it’s not the case that your patients are all going to die. This particular patient, the mind, keeps coming back. So there’s room for mistakes—but you can’t be too complacent. After all, you’re the patient. You’re the one who suffers from the mistakes. Some of those mistakes can lead you down a path that ends up far away, and it’ll be a long time before you find your way back. So again you need an attitude of balance: You don’t berate yourself for not attaining the goal, but at the same time you don’t get complacent. Much of the practice is this one issue: figuring out where that balance is. Other people can help give you pointers, but you yourself really have to listen to your own practice, look carefully at the results as they come—because this ability to see cause and effect in the mind is what lies at the essence of discernment, and discernment is what makes all the difference. It’s the ultimate medicine in the Buddha’s medicine box—and yet he can’t just hand it to you. It’s like an herbal medicine that you have to grow yourself. He describes it and tells you how to find it, how to grow it, and then how to take it.

So get used to this image that you’re both the doctor and the patient, and learn to have a very strong sense of the doctor looking after the patient. Don’t identify totally with the patient because if you do it’s hard to see a cure, hard to see even the possibility of a cure. But if you have the attitude of the doctor, there has to be a notion of what health is and how to recognize illness whenever it shows its face. At the same time, you have to develop the ability to step back and look at the whole situation to figure out the cure.

Here’s another image: Ann Landers. People who write letters to Ann Landers are so thoroughly immersed in their problems that they can’t step back. They have trouble even formulating a letter. But all Ann Landers has to do is read the letter once it’s formulated and usually she can give an answer right off the bat because she’s not immersed in the situation. From her perspective, the issue is already formulated. Her job is not all that hard. You’ll find your own practice gets a lot easier too when you can step back to recognize the problem and articulate it to yourself. Once the problem is clearly delineated, you’ve got your answer. As in the case of the doctor, the real difficulty lies in learning to diagnose the illness. Once you’ve got the diagnosis right, the choice of medicine is easy. So the first step is learning how to be the doctor. Identify at least part of your mind as the doctor. This is the part you want to train. And the funny thing is that in training the doctor, the patient gets cured.