How To Be Sick by Toni Bernhard
22nd October 2014
‘How To Be Sick; A Buddhist-Inspired Guide For The Chronically Ill And Their Care Givers’ by Toni Bernhard, Wisdom Publications, Boston, 2010. Review by Dr Richard Maddicks
A truism it may be, but the thing about many chronic illnesses is that, by definition, it is persistent or does not get better. The multiple implications of this for the sick person themselves are obviously often profound and far reaching, but mediated by many factors, including their own medical and psychological history, personal relationships, family, work, as well as the specific nature of the condition itself. However, the implications of chronic illness for healthcare professionals and the sense of frustration, helplessness and impotence that these conditions might evoke is often less considered. Whilst I don’t believe that it was Toni Bernhard’s intention to provide a compelling argument for the use of Mindfulness with health care professionals, her book has as much relevance for those working with people suffering chronic illness as it has for those individuals living with a long-term health condition.
Toni Bernhard tells a sad but hopeful, and even inspirational, story beginning in the summer of 2001 when she became unwell on a trip to Paris. Her retrospective view on persevering with her work in the relatively early stages of her illness and how this might have actually made things worse will certainly have relevance to many people facing the challenges of the early onset of illness. Clearly, the financial implications of stopping work coupled with uncertainty or denial regarding the severity of symptoms will lead to decisions later viewed as unwise or self-defeating, but this aspect of her book, like so many other parts, is not a lecture or an admonishment and deals with these issues sensitively and carefully.
The author comes to her illness with a strong background in Buddhist practice and chapters 3 and 4 provide a background to core Buddhist ideas including suffering, impermanence, equanimity and compassion. These chapters provide an excellent, accessible and concise outline of Buddhist philosophy for anyone starting out in the practice of meditation. The contrast between the author’s use of meditation before and after her illness is instructive, underlying many of the specific challenges associated with dealing with illness, including loss, solitude and fear.
Generally, the shortness of the chapters is likely to help many people seeking assistance in the midst of debilitating illness. Furthermore, the final section provides a guide to using the practices to help with specific challenges, signposting specific issues, such as pain, fatigue, insensitivity of others (including medical and healthcare professionals) and the uncertainty and anxiety associated with many chronic health conditions. Helpfully, many chapters end with a short practice, making the book a practical self-help text, rather than just a story or theoretical or ideological narrative.
Importantly, this book does not sugar-coat or dumb-down Mindfulness, nor does it present it as magical or a panacea. It meets many of the challenges of chronic illness head on and avoids the evangelical tone of some of the self-help literature supporting the use of Mindfulness. The use of Mindfulness in the NHS, like CBT and other psychological therapies, has long since been hijacked by the health economists and politicians who appear to know the cost of everything and the value of nothing; lest we forget the Layard Report (London School of Economics 2006) and its associated multimillion pound psychological therapy experiment ‘Improving access to psychological therapies’ was premised on reducing absenteeism, getting people with anxiety and depression back to work and reducing welfare benefit pay-outs. It was never built on the foundations of altruism or compassion and as such, the way in which Mindfulness is being shoehorned into NHS psychological treatments appears morally bankrupt and bears little scrutiny. Toni Bernhard’s book puts the practice of Mindfulness back into its proper context and presents a real, honest and personal account of dealing with chronic illness, which I am sure many people suffering illness will find helpful, as will carers and healthcare professionals alike.