David Rakel - The Compassionate Connection: The Healing Power of Empathy and Mindful Listening

This book would not have been possible without the kind support of the Mental Insight Foundation. Their grant provided resources that allowed for its completion with the goal of creating an educational guide that would help shift societys focus from disease toward the healing potential within everyone.

Char Luchterhand, my longtime colleague at the University of Wisconsin, was pivotal in helping organize this and many projects that we worked on for more than a decade. Thanks Char!

I am grateful to Kate Ledger, a gifted writer who helped me get this book started. She introduced me to my literary agent, Laurie Abkemeier, who helped secure a publisher at W. W. Norton. I couldnt have navigated this new world without her. I am also grateful to Jill Bialosky, our editor at Norton, for her feedback and guidance, which helped make this a better book.

The stars aligned when they connected me to Susan Golant. Susan is a gifted writer who beautifully channels the person she is writing with, using her skills to make the message understandable and enjoyable. Thank you, Susan, for your partnership, mentoring, and friendship.

I am grateful to the teachers I have been blessed to learn from. Andrew Weils commonsense genius helped me understand how to learn from and respect the wisdom of nature. Thanks to Jon Kabat-Zinn for introducing me to mindfulness, and a big thanks to Katharine Bonus, longtime director of the UW Mindfulness Program, who has filled me with all sorts of ah-ha moments through her gifted teaching style. Thanks to Tracy Gaudet for being there at the beginning of this Integrative Medicine journey and for the opportunity to work with shifting the VA health delivery system. Thanks to Rachel Naomi Remen for introducing me to the Healers Art.

I am also very grateful to be part of an academic community of faculty and staff at the University of New Mexico who are dedicated to making this world a better place. I am honored to be able to work with you.

And most of all, to my patients, who have taught me so much over the years. It is such an honor to be able to make a living taking care of my friends.

David Rakel, MD, Albuquerque, New Mexico

For my part, I am grateful to my agent, Madeleine Morel, for introducing me to David Rakel and to our editor at W. W. Norton, Jill Bialosky, for her insightful and cogent direction. Without them, this book would not have come to fruition. Im also most grateful to Davidone of the kindest and most compassionate human beings Ive ever met. I feel blessed that he took me along on this journey of learning with him. And finally, as ever, I am grateful for my husband, Mitch Golant, himself a master of the compassionate connection and a constant source of strength, light, and love to me and our family.

Susan K. Golant, MA, Los Angeles, California

Compassion Training

T hroughout The Compassionate Connection, I have written about how to be mindful in interactions with the people you want to help. On several occasions, I have recommended mindfulness mediations. This is different from simply being mindful and aware of what youre doing. Structured exercises such as these ask you to set aside five or ten minutes several times a week to draw on your inner resources for strength and compassion. They can exponentially enhance your ability to connect in a positive way.

Until I started to practice mindfulness meditation, I was unable to fully get my mind out of my own cluttermy biases, my busyness, my distractions. But the repeated act of pausing and focusing the mind that occurs during mindfulness meditation allowed my mirror neurons to be more sensitive to others feelings. I had never experienced this prior to having a centering practice.

Practice is the operant word here. We build biceps at the gym with more curls... but we can also build conscious insightthat wonderful moment when two well-established synapses start to cross-communicate in our brainwith mindful compassion training.

In the Dhammapda, the sayings of the Buddha, it has been written:

The thought manifests as the word;

The word manifests as the deed;

The deed develops into habit;

And habit hardens into character;

So watch the thought and its way with care,

And let it spring from love born out of concern for all beings....

Some practical hints before you begin: Read through the meditation. Its difficult to meditate and read at the same time, so your next step will be to record it, imagining that youre speaking to yourselfbecause, in fact you will be. Read slowly, stopping between sentences, allowing each word to sink in. I have indicated some natural pauses where you may want to allow a few minutes of silence to go by. Once youve created the recordings, find a comfortable place (either seated or reclining), make sure you wont be interrupted, and close your eyes.

Focus on your breathing. Place one hand on your chest and the other on your abdomen. When you take a deep breath, the hand on your abdomen should expand more than the one on the chest. This ensures that your diaphragm is expanding, pulling air into the base of your lungs. Take a slow deep breath in through your nose, imagining that you are sucking in all the air in the room, and hold it for a count of three or four. Slowly exhale through your mouth for a count of six to eight. The exhalation should be twice as long as the inhalation. Repeat the cycle four more times for a total of five deep breaths. Try to reduce your breathing to six breaths per minute (one breath every ten seconds). This is the optimal rate to stimulate relaxation of the autonomic nervous system.

THE LOVING-KINDNESS MINDFULNESS MEDITATION

The loving-kindness meditation comes from Buddhist philosophy. This twenty-five-hundred-year-old practice creates and reinforces the consciousness that a web of interconnectedness exists among all people. The bond to everyone in the world is also spiritual and emotional. Rachel Naomi Remen has written, When we know ourselves to be connected to all others, acting compassionately is simply the natural thing to do. The realization that you are part of an interconnected universe helps you understand that if you are not well, I am not well; and if I am not well, you are not well. The loving-kindness meditation can be used to reinforce unconditional love and open the heart toward others and oneself. It is another way in which people can grow and find joy when they step into a caregiving role.

The UCLA Mindfulness Awareness Research Center (MARC) has a free version of the loving-kindness meditation that can be listened to online: http://marc.ucla.edu/mpeg/05_Loving_Kindness_Meditation.mp3. The University of Wisconsin also has a number of guided meditations on their website that can be logged into and followed: http://www.fammed.wisc.edu/our-department/media/968/guided-loving-kindness. Readers who wish to create their own practice can just follow the directions below. They are adapted from the University of Wisconsin model.

Before beginning, please follow the breathing and recording suggestions made above.

The Loving-Kindness Mindfulness Meditation

[BEGIN AUDIOTAPING HERE.]

The loving-kindness meditation evokes compassion, kindness, and acceptance toward ourselves and others. It will reconnect you to the heart of tenderness inside you. Its like meeting a wise being who understands your life and holds it dear. Even in the greatest of suffering, it is possible for the heart to hold it all.

Release any tightness in your bodyyour belly, arms, shoulders, face, jaw.

Now sense the part of your body in which you feel compassion, kindness, and caringit