We think of disease as infirmity, disability, and tragedy, or reify it as "enemy" and project our aggression onto it, as though flesh could ever be preserved from decay. In looking at how great spiritual masters handle disease, other possibilities begin to appear. His Holiness the Sixteenth Gyalwang Karmapa, Tibetan buddhist of the Kagyu lineage who visited America twice in recent years, died of cancer in 1981.  Right up to the final moments, he never uttered a word of complaint and was totally concerned for the welfare of those who waited on him. In a real sense, the cancer was not "his" cancer, any more than life itself was "his" life; because he was on this planet for us, whatever he suffered was part of that gift.

The late Chogyam Trungpa Rinpoche, my root guru and student of the Karmapa, was paralyzed on one side of his body throughout most of his teaching career in America. He limped, wore a special elevated shoe, spoke (and sang, comically) with one vocal cord, used a wheelchair, and endured intense pain without pity, hope, apology, or false heroics of any kind. His response to anyone in pain was not "quit your whining and be like me," but limitless compassion and sense of humor. Affliction was his principal teaching tool. He transformed it into dignity and presence simply by the way he took his seat on the vajra throne. The concept of "disability" melts before such an example like a shadow in the sun.

The ignorance which results in karma is a kind of localized or attenuated intelligence, falling away from the luminous emptiness which is the ground of our being, into identification with structures of this and that. The unconscious components of personality are formed out of whatever we ignore. Having invented ourselves, for example, we forget that we have done that, and then we generate a story-line to maintain our invention: other people become characters in our own melodrama; we define them as "good guys or "bad guys" according to how they fit the labels and preconceptions of the story, and project mental systems of aggression or seduction onto them, which might be interpreted as "relationships." Then we forget that we have a story-line, or a labeling system that keeps it going. The projections appear to us as an external "reality." Our emotional responses are shaped in terms of these ignored and forgotten systems; eventually our illnesses begin to be shaped by them as well. In this way, our physical and mental functioning becomes determined by skeins of psychic energy that we have frozen, from the very beginning, by diminishing luminous-emptiness-without-boundary into ego-form.

Perhaps this description can be understood more clearly by the image of looking at a light source, like a bulb on a Christmas tree, through half-closed eyes. The light is all over the place: it takes the shape of your lashes, and spreads out to fit the contours of the lachrymal fluid; some photons bounce and smear off the icy window and head for the stars at 186,000 miles per second. Others might be glimmering on the snow across the street, or entertaining an amateur physicist next door by making an Airy pattern on her wall. (Airy patterns are shapes of concentric light and dark areas made by waves; in quantum physics they describe probabilities of finding particles, such as photons and electrons, at a particular place and time.) There is no way to separate the light from the electricity, the eyes, the snow, the total environment. Likewise, there is no way to find the essential reality of the situation, the ultimate source, where the photons begin or end. This is luminous-emptiness-without-boundary.

When the eyes open, the streaks disappear, the fovea pins down the bulb, and the brain perceives it as a bulb on a Christmas tree. The localization of the light is an equally valid experience, if we know what we are doing; but typically that awareness is lost. We are heavily invested in losing it: a local reality solidifies the self and gives it something to relate with; a reality with no reference point turns the self into an Airy pattern on a wall that isn't there.

With loss of awareness, the total environment is taken for granted, and forgotten; the mind wanders away into discursive thought. This is the ignorance, the attenuation of intelligence into structures of form. This creates the setting for the karma of disease.

The first stage in our habitual response to disease is to crank up more ignorance — that is, to deny anything is wrong. Denial is ignorance at a hysterical pitch; by the time you reach the point of denial, you know that there is something to deny, that the ignoring process is falling apart, and you are beginning to panic. You say, “No, it isn't true," but you have a pretty good idea that it is.

When the ignoring process falls apart, there is a possibility for luminous emptiness to re-emerge. Disease always brings a friend: unconditional intelligence and compassion. It is like a door, through which the friend may walk. Because you have this door, she can return. Chronic disease is like an unwanted baby you could grow to love, because it brings something out in you that you may not otherwise have felt.

According to buddhist teaching, from ignorance we create neurotic tendencies in our stream of being that will ripen at some future date into painful results. The ripening process is karma. A painful result always removes the particular cause of the karma, although we can renew the cause by our failure to understand it.

My case is a clear demonstration of this process. Begin with a weakness in the lungs, which itself is a karmic result of some kind, carried in the chromosomes perhaps, or in what biologist Rupert Sheldrake would call the morphogenetic field — a good Western synonym for the buddhist concept of a being-stream. Add now the attenuation of intelligence, which creates the belief in me and that, which is the beginning of the neurosis characterized by grasping pleasure and avoiding pain. Viewing the source of pleasure as outside of myself, but somehow necessary for the well-being of me, I begin to smoke. By smoking I induce euphoria and dispel boredom and fear. At this stage a full-blown conditioning process is under way: behavior, reinforcement, strengthened behavior. It is part of an addiction to pleasure. Additional psychic factors might be a general holding back, holding in, a tendency toward intellectual fixation and brutal self  criticism which is let go only by more smoking, and which slowly begins to manifest as a swelling of lung tissue leading toward complete suffocation.

The ultimate purpose of it all is to maintain ignorance — that is, to confirm ego. How does this happen? Boredom, loneliness, and fear unconfirm the notion of self: they are the first re-assertion of luminous emptiness manifesting as a gap, a space with nothing to do, nowhere to stand, nothing to hope for. That experience brings on fundamental uncertainty; from ego's point of view, it is a living death. You could go mad in such a space; you could shuffle from room to room haunted by guilt and failure. We call it "the pits," "the black hole," showing by our choice of terms that we know perfectly well it is a gap; it is open space, no boundaries, no definitions, no beliefs. Trying to avoid the gap, I set into motion the chain of causes leading to physical infirmity. I do it to myself as an individual; we do it collectively to each other as a social system.

My first step toward self-healing may seem almost masochistic to a non-buddhist, but it makes good sense and has very far-reaching effects: I allow the disease to be there and make friends with it.

Tai Situ Rinpoche, in Way To Go, writes that we can be grateful for affliction, once we have understood that it is the ripening of karma and that its appearance removes the cause. This traditional buddhist doctrine resembles the view that fever is the body's healthy response to the intrusion of harmful microbes; by means means of the fever, the microbes are processed out. The buddhist approach is not merely physical, but comprehends our totality over unlimited vistas of time. Affliction inspires wakefulness, which in turn removes ignorance, which is the ultimate cause of suffering.

It is important to distinguish between this approach and "positive thought." Both agree that illness is strongly connected with mind.

The notion that illness begins in the mind has gained widespread credence in our culture, but what that means is still not properly understood. "Positive thinkers" generally perceive that sickness originates in, or is in some way supported by, negative mental attitudes — such as the desire to be punished or taken care of in a dependent role — and the suggested treatment might include looking in the mirror and telling yourself how wonderful you are, pacifying your anxiety with soothing cassette tapes, lying in a circle with a support group for mutual strokes, or forcing yourself to continue performing difficult physical tasks of self-help even while your strength is ebbing away.

But something is lacking in this kind of technique. There is still an underlying assumption that death is terrible and that we can talk ourselves out of it. What shall we do with patients who refuse to be "positive" — lecture them on their inadequacy? Or do we simply write them off, saying they cannot — will not — be helped? Negativity is real; it does not fade away because I listen to ocean waves and tell myself jokes.

For the most part, we want to understand disease only in order to get rid of it as quickly as possible, just like we want to get rid of the inconvenient tasks of caring for the old and the homeless, and disposing of the dead; as though we could thereby reach some dreamland of health and happiness, where people never get sick and die. Hearing that disease is caused by improper diet or unhealthy attitude, we might become health-food fanatics and search aggressively for the mental hang-ups that make us fat or cause our skin to break out in a rash. But our desire to reject negativity and cling to pleasure has been the problem from the very beginning.

As long as our goal is to hang on to something, or get rid of our own mortality, then we are still only suppressing symptoms. "Healing" could become one more ambitious project by which we try to ignore the message of luminous emptiness: that there is no place to stand in the endless cascade. We thought that we had a cozy little observation balcony, but it is all Niagara Falls no matter where we turn. Even the parking lot is being swept away. On the other hand it might be fire, too; we are on fire every moment, dying and being born all the time, spreading out everywhere. The work of ego is a mode of experiencing the heat and the color; within that mode, enlightenment is the ash.

Making friends with the disease leads to discoveries of the sort that I have described earlier: slowing down, shedding excess baggage, observing without struggle, deepening mindfulness, letting go of attachment to pleasure, feeling the texture of discomfort and pain, finding the roots of fear. Slowly the ground of ignorance is dispelled, like beginning to recognize a landscape in the very early dawn.

Ignorance is the environment of the whole karmic chain. If there is no ignorance, then the concept of "disease" becomes superfluous, as do the other "dis-" categories: discomfort, discontinuity, disillusion, disability, dissonance, disappointment, disbelief. Some buddhist masters wake themselves up further with a practice in which they invite all the demons of chaos and disaster to visit them. My little self says, "I am not at that point," but a braver, more expansive self answers, "Maybe that is what I have already done."

But whether I am brave or not, the "dis-ease" is here, however it is defined. By using it as path, and as a means to inspire someone else, I am hanging out with the masters. That is not such a bad result. If it means that I can hang out with the likes of Trungpa Rinpoche and His Holiness the Karmapa, then bring on the demons; they can sit on my shoulders while I type. (The mouse, getting drunk, bangs his tankard on the bar and declaims, "Bring on the cat!")

Another method to reject luminous emptiness and cling to the ground of ignorance is to make affliction mean something: to say, for example, that it ennobles the human spirit, toughens our courage to endure, takes away our sins — or even that we are being punished for our sins.

The second of the four stages of dying outlined by Elisabeth Kubler-Ross, in her classic study of the death process, is bargaining — the attempt to hang on to some kind of ground by giving up something else: "I will give all my money to the church if only I can get well." (The four stages are denial, bargaining, anger, and acceptance. These stages are all from ego's point of view, and they are encountered also in meditation practice as we slowly give in to the experience of egolessness.)

Interpreting pain and loss as meaningful in a philosophical or religious context is another form of bargaining, a consolation prize: "My legs are gone, I have been tortured, my children went to a concentration camp, my tumor is inoperable, but there is a reason for everything: it is to test my faith; it is all for the greater glory of God or the Party; it brings humankind to a realization of existential despair; even from the jaws of defeat we can salvage a mustard seed of victory, we shall rise from the ashes, we shall be changed." Explanation is still the game of hope and fear: "If I submit to suffering, then maybe I will gain a higher truth."

The pressure of affliction tends to blow these answers away like chaff. A political prisoner being drowned in a bucket of floating sewage is interested in only one thing: the next breath. Sarcoidosis is not quite as severe, but the concern is the same. Beyond that, I want to open completely, without disguises, consolations, or illusions of any kind. By refusing to assign meaning to it, we stay with the emptiness of suffering, and thus begin to live in a reality that is luminous, limitless, unconditional, and immediate.

The cheerfulness that results from this renunciation of meaning cannot be destroyed, because it does not deny anything, and it does not have to be maintained. Misery and death are included, and allowed. It is not "my" cheerfulness; it does not come from anywhere. You can let go of it and laugh. You could drink from skull cups and make trumpets from human bones.

Remaining with emptiness is also a gift of compassion — to myself, and perhaps, to others; instead of giving the arrogance of Job's comfort, we can offer the witness of silence, and the example of path. It may be a more generous and intimate experience, for both parties, to wait on someone who is disabled than to preach a sermon on self-reliance. Where action is called for, it comes best from an empty mind.

The basic terror of nihilistic despair seems to arise from sensing the truth of emptiness, and yet not living it. Can we open that final closet door? With the best intentions, our comforters say, "No — keep it closed."

Even if all the pain in the world means absolutely nothing, can we admit that and live? Can we still wake up? The answer is yes — with a smile. But not until we give in to that "nothing," and know it in our bones.

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