Love remains…

When Alzheimer’s disease progresses—annihilating ability to word-find, understand language, and speak cogently to loved ones—what remains is affect; particularly affection. In the early stages, this disease has periods where sufferers exhibit highly reactive emotions that often present as angry, nonsensical or delusional. These periods are particularly hard on close relations and caregivers.

One very difficult experience I recall happened eight years ago in a favorite Upper East Side restaurant. Mom and I were dining and suddenly her neighbor came up to the table to say hi. Startled that she didn’t recognize him, Mom launched into a hysterical rant about how I was planning to kill her. Increasing agitation caused her to suddenly get up and leave the restaurant. I ran after her knowing she would never calm down if I caught up with her. So instead I followed her as she wandered the streets agitated and lost; finally ending up at her building. From across the street I saw her smiling and talking with the doorman. When I entered the lobby she sneered at me. Then let me accompany her up the elevator and into her apartment. She never spoke of what happened in the restaurant. Just as she never admitted to having Alzheimer’s, even through the five years she spent living in a Memory Care facility.

Four months ago her deteriorated physical condition required a transfer to a medical model nursing care unit for memory patients. Though it is considered the best unit of its kind, it is nothing like the family-oriented, loving memory care environment she thrived in. She no longer eats and sleeps most of the time. Mom is making it clear: I am ready to bring this horrible last 10 years of my life to a close.

For the last four years Mom has not known who I am. Yet, when I arrive, though she cannot speak much, she immediately brightens in her affect. The love is palpable. She laughs when I make jokes. I can’t tell if she understands anything I say, but her eyes display interest as I relay the goings-on of my life. I hold her hand when she lets me. Play Beatles songs she and my Dad adored. If she gets agitated I stand behind her wheelchair holding her shoulders gently to restore parasympathetic response.

These days it is especially hard to leave at the end of a visit, knowing it may be the last time I see her alive. Sadness pervades the field between us. We stand together in the awful knowing that she, a highly intelligent and deeply caring woman, has been utterly decimated by Alzheimer’s. And even so, our mutual love remains… triumphing spectacularly over this dread disease like a victorious army refusing to lose its most precious treasure.

Meditation is not an antidote.

If you think meditation alone will ‘cure’ the deleterious characteristics of humanness, like anger, violence, greed, hatred, fear and bias… think again. These qualities arise from an experientially shared, all-pervasive perceptual feeling of separateness—I am inside, everyone else is outside.

Cutting through that misapprehension requires both conceptual training and contemplative practices for cultivating cognitive-affective quiescence and profound insights into what is known in Buddhist philosophy as the Three Marks of Existence—impermanence, unsatisfactoriness, and not-self.  Most clinical and non-clinical applications of mindfulness teach meditation devoid of information about the way in which humans misapprehend the Three Marks of Existence, and how this mistaken perception becomes the proximate cause of all forms of human suffering.

Let me be absolutely clear. Noticing 1) how thoughts come and go; 2) how much time we mentally spend in the past and future; 3) cultivating compassion; 4) and that basic physical pain is worsened by mental anguish about painful stimuli—all these insights will decrease cognitive-affective symptoms, which makes them appropriate Western psychological interventions. However, when ‘Buddhist-derived’ mindfulness meditation practices are offered as a means to attain happiness and/or reduce distress, those meditators remain largely unaware of the root causes of their suffering.

The main reason Buddhist psychology does not view symptom relief as an end goal is because non-suffering is ultimately an outcome of the fearless pursuit of non-delusion. That pursuit includes the recognition of and liberation from two basic causes of human suffering—our deluded belief in a substantive, separate self; and our deluded belief that happiness is conditioned upon comfort, certainty and security.

In the Tibetan Buddhist tradition that perceptual distortion is called, innate reification, which is viewed as largely unconscious; functioning at a very basic level of cognitive processing. The pervasive and assumptive nature of innate reification is a primary obstacle to direct realization of how all perceptual phenomena (including the self) interdependently co-arise moment-to-moment. Separate self-existence is illusory. But that illusion makes harming doable—particularly the false perception that harming another does not simultaneously also harm the harmer. Imagine how different the world would be if all human beings recognized how intimately connected they are to all other beings through their thoughts, words and deeds.

Because this profound insight into reality is not a predetermined outcome of meditative practice, it must be pointed out directly. Clear conceptual understanding proceeds and fortifies accurate perception of reality. Experiencing the Three Marks of Existence and cutting through the perceptual distortion of innate reification requires both concentration meditation and analytical meditation practices. Just practicing mindfulness and compassion is not enough. Concentration meditation alone is not enough. Conceptual understanding is not enough. Going beyond antidotes requires all of these together.