Mark Epstein, M.D.: The Guru of Our Own Intelligence
“But the true guru, you know, the Buddha came and turned all that inside out. You know the Buddha taught the Four Noble Truths and the word he used, “the Noble,” that came out of that, like the Brahmans were the Nobles. But the Buddha was like, no, the Nobles aren't, it's not that priest over there, lighting the fire, the sacred fire, the noble thing is like your own ethic, your own internal ethic, your own loving heart is the noble thing. The Buddha was all about that. He was a good, you know, cognitive therapist in that way, turning, turning people's concepts inside out.”
So says Mark Epstein, a psychiatrist and Buddhist who has written several brilliant and beautiful books about the Venn diagram of meditation and therapy. In his latest: THE ZEN OF THERAPY, he reveals more of his own backstory, how as a young med school student trying to bridge the gap between his role as a doctor and his love of Eastern spirituality he came to help Dr. Benson study meditation and its benefits for the body. He opens the books though, by explaining that meditation is not a panacea, it is instead a rare opportunity to get quiet with yourself, to observe your own mind, and to process your emotions.
In THE ZEN OF THERAPY, Mark recounts a year of therapy sessions where he was able to provide psychotherapy paired with Buddhist insights—it’s a wonderful and fascinating book—I personally LOVE reading about peoples’ therapy sessions—and it offers many takeaways for anyone, including the ways in which we fixate on our childhoods rather than focusing on the evolution of our own identities, and where our own resistance to change can point the way to healing. In today’s episode, we explore all of this.
EPISODE HIGHLIGHTS:
MORE FROM MARK EPSTEIN, M.D.
THE ZEN OF THERAPY by Mark Epstein, M.D.
ADVICE NOT GIVEN by Mark Epstein, M.D.
THE TRAUMA OF EVERYDAY LIFE by Mark Epstein, M.D.
OPEN TO DESIRE by Mark Epstein, M.D.
THOUGHTS WITHOUT A THINKER, by Mark Epstein, M.D.
TRANSCRIPT:
(Edited slightly for clarity.)
ELISE:
Congrats on your latest book. Do you find when you write about clients that some are disappointed that they're not included?
MARK EPSTEIN, M.D.:
The ones who are not included don't really know that they're not included. Yet! What I was surprised at was that the clients who are included, except for one person who I had only seen once for a consultation, everyone agreed to be part of it. And everyone read over what I wrote. And the only real commentary for many of my patients were about the pseudonyms that I chose for them. You know, some people wanted to be a different name and some people want, wanted to know why I picked that name for them. So that was pretty interesting.
ELISE:
How did you rename them?
MARK:
I pulled randomly from my, you know, my children's friends or my, my long distant past, or I pulled names that would have some kind of resonance for me, but that no one else would know about.
ELISE:
I loved, I can't remember his pseudonym, but the client who made the request that you describe him as a potential stunt double for, was it..
MARK:
Antonio Banderas. I know that's one of the things I'm proudest of in the book because I sent everyone, I, I wrote down, you know, a year's worth of psychotherapy sessions, but I had to force myself to do it because I don't normally take a lot of notes. So I wrote them down after the session and then typed them up on the, you know, my writing day. And then a year later I sent everybody, what I had written,about the session and then my reflection about the session, which I added later. And when he got what I had written, he said, oh it's fine. Mark's fine. I could find it if only if, if the only thing you didn't say was that I bore an uncanny resemblance to Antonio Banderas and I said, oh, I'm happy to insert that. So, so that's one of the good elements in the book, I think.
ELISE:
Yeah. It's interesting that you don't, this is something in my own therapy relationship because he also listens intently. And I don't know if he, I, I can't imagine he has time to take notes because I think he's packed in hour after hour, but how do you keep track of the details of people's…
MARK:
It's like being with your close friends? Like how do you remember the details of your friends? You know, what your friend told you about her marriage or her kid or something? In fact, I don't remember everything. I don't keep track of everything, and sometimes I really forget important things, but then they get brought up again. And when they get brought up again and then I have, then I'm like, oh yeah, right, you told me that before then. Then I know, oh this is actually a really important thing. And then I'll remember it, you know, when it's the second or third time I'll I'll remember it. I've learned to trust that I'll remember what's important and that it's okay to forget. And that, my patients will remind me if I've forgotten something important.
ELISE:
Yeah, no, because you would imagine in the therapy act and of course I don't hold it against, I am shocked that my therapist remembers anything, but I would imagine for some people it feels like an affront.
MARK:
People hold it against me, some people hold it against me. No, some people hold it against me, but then I'm very good at quoting one of my psychoanalytic heroes who was Donald Winnicott, British child psychiatrist. And he wrote a lot about how important it is for therapists, like parents, to fail. That it's, it's only in failing our patients, that they discover us as real people with our own flaws in our own. Right. And that lets them be real people in their own way, you know, with their own flaws. And that's the origin of compassion, according to according to Winnicott Anyway. So I, I comfort myself whenever I forget something important that I'm really doing my job.
ELISE:
You are only human. Not that I know everything about you or even that much about you, but I loved, I thought it was fascinating the beginning of the book. I had no idea that you had worked with Benson and had studied, had been sort of part of some of that formative work about the placebo effect and had worked with him to sort of understand the scientific mechanism of meditation. That’s such a fascinating backstory.
MARK:
It was a good beginning, right? It is. It is my backstory. It came about because my, my father was a professor of medicine, an academic professor first at Yale and then at Harvard, and a real scientist, a real researcher, and a very good clinician. And I sort of frightened him when I got to college and I was only interested in Eastern thought and spirituality and maybe psychology a little bit. And he was like, you know, I have this guy who's working for me and we don't quite know what to make of him, but he was a young cardiologist, Herbert Benson, and he's interested in meditation. Maybe you could go and work with him for a summer. He was trying to keep me, my dad was trying to keep me in the medical fold, I think. And I, so I was like, fine, I'll go and talk to him.
And we actually liked each other. And I became kind of like his point man in the underground Eastern, you know, counterculture interested in Eastern thought. So I would go, I would go on my meditation retreats and go to India and whatnot. And then come back and report to Dr. Benson who had already done some of the first, the most important physiological work on the health benefits of Transcendental Meditation. He's the one who showed how you could lower your blood pressure if you did the regular practice of Transcendental Meditation. But then, then he broke with the organization because he thought the special secret mantra was unnecessary, that you could use any word that you repeated. And he, he chose the word “one,” which he thought that was a benign, you know, like neutral word without realizing all the spiritual implications that the word “one” had.
ELISE:
I really appreciated too, at the beginning of the book, how you talk about sort of like, I don't know if it was the break with, with Benson and I mean, I would imagine you, you think, or I'm curious actually you sort of talk about the double-edge sword of the mainstreaming of meditation and what's been lost in a way that I thought was really beautiful, about how the mindset of the West, you say “threatens to reduce our ability to truly benefit from this integration. We want a quick fix with demonstrable results. We want to see changes in our brain. We want the experts to show us what to do. And even if we are lucky to do it for us.” And just the way that meditation has been so thoroughly absorbed, not only by the, by the wellness industry, but by culture at large. And obviously there are benefits, but what, what are your feelings about that sort of, as it stands?
MARK:
It’s sort of setting meditation up to fail is, is what I think, because people read all of this, and hear all of this, and believe that meditation is, is gonna solve their problems. You know, that mindfulness can replace psychotherapy, that meditation can replace the medicine for high blood pressure. And that all they have to do is this simple thing, and all these benefits will crew. And one, it's not a simple thing. It's a really difficult thing that, that even after, you know, throwing myself at it for 40 years, I still feel like I'm a beginner, you know? And it, it has so much to teach us, but we, we learn again by failing with it, you know. Because it's almost impossible to get it right and doing it wrong is really doing it right. And you know, the whole paradox of meditation.
So, um, people get frustrated with it when it doesn't solve all the problems and then move on to, you know, Ahayausca or, or microdosing or whatever it is, you know? And so I'm, I'm here to say that it's a, you know, it's a, it's a long struggle, but it, but it, it pays off in unanticipated ways I think. Maybe it doesn't give you the, the, the big benefit that you hope for right at the beginning, but, but it works slowly and steadily and helps you helps one get to know oneself, you know, in a deeper way.
ELISE:
Yeah. And to at least sit with ourselves. I thought that was not to jump around. I wanna talk about sort of guru-ification, which we've also sort of absorbed as a, a Western idea and then maligned or misunderstood. But I also, I think it was the founder of dialectical behavior therapy or DBT who was talking about the idea of Insight Meditation. You, I defer to you, but essentially she was saying like, or the idea of DBT is actually that people who are really emotional in their expression are allergic to their emotions. So we have like this inability to feel what we're feeling where meditation can help us actually sit in it. Right?
MARK:
Yeah, no, you have that exactly. Right. The, the founder of dialectical behavioral therapy is a woman named Marsha Linehan who was trained as a behaviorist. But she, in the, in her, the background of her personal life, she was interested in Zen Buddhism also. And, but she was a behaviorist working with a young suicidal, what, what were in those days called borderline patients who were seen by the field, the, the psychotherapy field as overly emotional quote, unquote hysterical, you know, acting out all the time. And therapists were afraid of them cuz they were, you know, so emotional, so manipulative, et cetera, et cetera, suicidal gestures, a lot of cutting, all that, all that kind of stuff that's still around. But Marsha Linehan because she was a behaviorist. She had the really remarkable insight that these called, you know, hyper emotional young people were actually phobic towards their own emotions that the feelings would come, you know, in their bodies, but they wouldn't know their minds were couldn't put together what was really going on for them.
So they would have an aversive reaction whenever some kind of emotion started to brew. And she, she, the, the beginning of, of DBT was that she made like, uh, note cards, file cards. And she would write words like mad, sad, glad on the note cards and, and hold them up when her patients would start to describe what was happening in their bodies and, and, and in their minds. You know, what they were actually feeling. So they learn to put language on the feelings, which is an interesting, you know, that's something we do in meditation also, although it's, we don't always talk about putting language on it, but that's what our minds are doing when we're watching our own minds and bodies. We're identifying what our experience is. And, and in, in that second order way, you know, where we can reflect upon our own experience, that's a remarkable capacity that we have as human beings. That we think, and then we also can observe ourselves thinking. And so meditation puts that to use.
ELISE:
Can you actually take us through, it's funny because I know do Vipassana, which has always seemed so terrifying to me. And it's a little bit like Fight Club, right. Where I feel like people are like, you don't talk about what it's Vegas, like, what happens in Vegas stays in Vegas. But I felt like you actually sort of describe what starts to happen. Don't know. Is it the third day as you get really in it? I don't know. How do you, can you talk us through a little bit about this idea of like Insight Meditation and, and what that actually is?
MARK:
Sure. The way that I learned about Insight Meditation, the way it, the way it really came alive for me, you know, not just from the, and from doing it for half an hour, you know, uh, when I woke up in the morning. But the, the way that I actually learned about it was by going and sitting, we say sitting meditating, sitting, um, a number of two week or 10-day or week-long, silent meditation retreats that are structured so that all throughout the day, whatever you're doing, sitting still, or walking or eating or lying down, brushing your teeth, whatever everything's done silently, and, and you're attempting to do everything mindfully. So mindfully means you are keeping your awareness in the present moment based on whatever your experience is in, in that moment. And whenever the mind wanders away into the past, or future planning, or recriminating, or, you know, feeling upset with yourself or frustrated with yourself or wishing you were somewhere else, or, you know, feeling this is impossible or whatever the mind's commentary is, or whatever is distracting you from the present moment.
When you notice that your mind has wandered, you deliberately, like teaching a young child, bring yourself back without shaking your finger, you know, and, uh, judging yourself, but sort of kindly bringing yourself back to the present moment. So that the days are structured so that you can do that all day. You, you know, you, you can sit in meditation in the meditation hall for 45 minutes and then do a walking meditation for 20 minutes, or go take a long walk around lake for an hour and a half, or go to the dining hall and make yourself a cup of coffee or have a meal. But even the meals are done silently with attention placed on the lifting of the fork, and the putting the food in the mouth, and chewing the food, and swallowing the food, et cetera. It's really hard. And most people go sort of crazy for the first couple of days, cuz it's, you know, so difficult.
You have to keep bringing your mind back, without feeling like a failure, and without judging yourself too much. But after a while, you kind of get the hang of it. And these periods open up up where the mind is just resting on whatever your experience is. So it becomes easier if you're watching the breath, you can just watch the breath. If you're walking, you're just walking. If you're thinking you're like sort of seeing yourself thinking, which is a whole interesting phenomenon, it's not like you're are thinking stops, but realize that you're not only who you think you are, you know, so that this observing consciousness is being empowered basically. And one of those early retreats of mine, suddenly out of the blue, after three days, four days, five days, I'm not really sure how long sitting in the meditation hall just doing what the instruction was, I decided I'm not gonna fight with this. I'm just gonna do it. So if my mind wanders, I'll come back to the breath or, you know. And suddenly I was filled with, you know, loving feelings that seemed to come from nowhere. Much stronger than, uh, maybe I had felt similar things, you know, with my first girlfriend or something. But, this was like, there was no object to it. You know, it just was like something true inside of me that was beginning to express itself. And it was so moving. It was so powerful, like, oh really I'm capable of this kind of love, you know, out of nowhere? And those feelings persisted for a fairly long, you know, couple of hours or something. And then I spent many, many retreats there after trying to create the circumstance to, to bring them back.
But you know, that's a fool's errand. But it showed me something, it showed me it, it showed me something that there's more to me than I knew. And, and that's become a kind of mantra for me, you know, for myself. And also as a therapist for my patients, that people come in with all these ideas of what's wrong with them, who they are, where their problems came from, and so on. And, and I have this glimmer of understanding, you know, that we don't know, we really don't know, but this potential for something more, you know, more, something more, what more, more loving, more, more kind I say within this current book, you know, that the subtitle is “uncovering a hidden kindness in life,” so that this hidden kindness, it wants to show itself. If we can create the circumstances, you know, to get our regular selves out of the way, a little bit, it wants to show itself. So I think that's what Vipassana or, or Insight Meditation. I think that's what it's after. It's trying to, trying to give us insight into our truer nature.
ELISE:
Yeah, no, I mean, you have this great line meditation lets us see something similar. This is in the context of how mothers, you know, how wild it is that we grow and entirely, a person inside of our body.
MARK:
Some of you do. Yeah. The men are all jealous. The men are jealous. They won't tell you, but they are.
ELISE:
And you write:” Meditation lets us see something similar. It shows us how we are continually constructing a self out of the raw material of our everyday experience.” And I love, you know, you mentioned Winnicott and he obviously shows up throughout the book because know many of us like that's what we're trundling around, right? Like our childhoods, what is it called? The, the violent nostalgia for what went wrong in our childhoods and how hard that is for us to let go of. What do you think that that is? Because clearly that must be it's formative. Like nobody has a perfect childhood. Hopefully we have like to quote Winnicott, “good enough mothers.” Good enough fathers. Although I know he was only talking about mothers in that context, but it was a long time. Yeah. The long time ago we forgive him, but you talk about Buddhism and this idea of injured innocence. How is that sort of your first work as a therapist to help people move past that into a, a new or fresh construction of who they are?
MARK:
I think it's complicated. You know, in the Buddha’s time and really almost up until Freud's time. Although I think that's probably ans exaggeration. But in, in the Buddha’s time, they didn't pay attention to early childhood experience, you know, to the, the formation of the personality, the way we think about it or to childhood development, you, you know, it's not, it's not part of the Buddhist psychology, uh, or if it is, it's kind of hidden and I've done other work in the past to try to bring it out. But it's, it's not an obvious part of, uh, Buddhist psychology. And even the, like the Tibetan teachers who come and are teaching Westerners, I've had conversations with them about, you know, we all think that who we are was formed in our childhoods, you know, and that we have these scars that come because of the way our families, you know, either intruded upon us or ignored us and abandoned us, you know. And many of us are carry a feeling of emptiness, you know, not Buddhist emptiness, but emptiness of…poverty of self, you know, like only if only we had been acknowledged for who we are or seen for who we are, you know, recognized in some way, instead of just made to be the, the people, our, our family, our parents, our schools, our, you know, wanted us to be.
And, and the Tibetan teachers, when they here, they, they have no, oh really, you know, like, I, I, I didn't, that's not our experience, you know, coming, coming from a more traditional society based in Buddhist culture. Although I think it is their experience in a lot of ways that they just haven't found words for. So I think on the one hand, that's, that's a lot of what we do in therapy is, is take that seriously, you know, those feelings of being neglected and, uh, so on that people come into their adult life with. That often gets played out in our intimate relationships, you know, where we're trying to get our partners to take care of us in that way, you know, to see us in, in ways that maybe we, we weren't seen or held when we were younger. So, uh, and people put that on their therapist, too.
So that's all very relevant, but from the Buddhist side and, and this helped me immensely in my work as a therapist, I relate this, uh, conversation I once had with, with Ram Dass, who was an early and then late influence on me, the, the former Richard Albert, who went to India and became Ram Dass, who I knew, well in my twenties. And when he found out that I had become a psychiatrist and a therapist, you know, he, he said to me, “Well, Mark, do you see your patients as already free?” And I, I understood after a moment what he was asking, you know, that I don't have to see people only from the place of, you know, what we call in psychoanalysis, the basic fault. I don't have to see them only as what was scarred from childhood, but I can recognize we are all carrying within us, not just who we were as children, but also what our potential is as parents, you know. When a woman has a baby, she instinctively, you know, naturally loves that infant. You know, like what, what is it that comes out of, you know, it's, it's built into us, even a father, you know, even the father it's wired in that maternal capacity. And, and I think that I think meditation is designed in some wise way. You know, it's designed in some way to release that capacity, you know, to show us who we are, not just as what went wrong when we were children, but, but what our potential is, whether we have children or not, but what our potential is in a generative way.
ELISE:
You write “Buddhism and its teachings about injured innocence says, see it clearly, but don't get caught up in an overidentification with being wronged. Holding a grudge against one's family, situates identity in a backward direction, and keeps us stuck in an outmoded concept of ourselves.” And similarly it's like it happened. So it's hard. I mean, as you say, and you talk a lot about very serious childhood traumas in the context of the book. So not to denigrate those or to suggest that they're not incredibly hard wounds, but it is an interesting idea like how, how much we can get, or you quote, gets Adam Phillips. “The wish to be understood may be our most vengeful demand, may be the way we hang on as adults to our grudge against our mothers.”
MARK:
Yeah, that's one of my favorite, that's one of my favorite quotes. I, I love Adam Phillips for that. From the Buddhist side, and this really helped me. I've learned this first from, from Robert Thurman, who's a professor of Tibetan studies at Columbia, who I have been able to teach with sometimes. From the Buddhist side, you're always trying to find the self you, you know, like, but the, but Buddhist psychology says that doesn't exist the way we imagine that it exists. You know, they have this teaching of “no self,” which everyone misunderstands or the, the voidness of self. So, but in order to find the self that the Buddhist, that the Buddhists say doesn't exist, you first have to find it in yourself. You know, the way you think that it's real. If, if this makes any sense. So you have to, a lot of what meditation becomes is this search for who do we think we are?
You know, and that's this, uh, thing of injured innocence or what went wrong in childhood, or we could call it developmental trauma, our identities coalesce around those traumas. You know,around those, around those things that went wrong, where we were, you know, mishandled say, and that becomes, uh, like a pearl in an oyster sort of thing. You know, like what's wrong with me? You, you know, that becomes for a lot of us that becomes our identity and that, so that's the self, the self that we take to be so real that the Buddhist psychology is suggesting might not be as real as we think it is. But in order, in order to actually experience that self losing its grip, you first have to locate it in your awareness. You have to locate it with your meditative mind, you know. And one of the ways of doing that is by remembering when you were an innocent, you know, and you were injured. And the feelings that come as a result. Like they say when someone you love accuses you of doing something that you didn't do, that, that that's the best time to find the self that doesn't exist.
I always like that. That's helped me a lot.
ELISE:
Question, and this might be, I might be misunderstanding this too, but I was thinking about in the context of Lakshma, the patient who you write has this need to compulsively, objectify as a way to provide cover for himself, for his own deteriorating, the illness and deepening needs. But do you think to, to,
MARK:
To objectify women in particular women who he's looking at on the subway or wherever.
ELISE:
Yes. Right. Which leads me to my question in terms of the self and you about, you can think of our creation of the self within is our own objectification of ourselves. Do you find that wome…because we are so used to being objectified, culturally, that we have a better grasp on what that is and a firmer…I don't know if you've had the experience as, but as a woman, I've certainly the experience of, you know, being with a guy or making out with a guy in my early days Mark. And being like, wow, this guy doesn't even see me or going on a date with someone and being like, this person has this perspective on me that is so far removed from who I am, but it's part of their objectification process of how they're gonna present me to their family. Right. So, whereas I don't know if that happens to men to the same degree that I think it's probably happened to every woman I know. Do you see it as gendered or do you feel like women or men have a better understanding of, I guess you guys might be better at objectifying? I don't know this might, this might not be…
MARK:
Women. Definitely women, women have to deal from the very beginning with being objectified, you know. So women really have a sense of how destructive it is to be objectified, and many girls growing up internalize the objectification in the form of shame, where they feel like they're not measuring up or in terms of competitive feelings, you know, and envy and so on. Competitive feelings, which are rampant among, among young women, you know, comparing one self in one way or another to this person, or that person. I have a friend who's a feminist psychoanalyst who, uh, tells a story about going to visit one of her friends in the hospital after she gave birth. And that even in the bassinet, there were, there would be pink cards for the girls saying, “It's a girl,” and there would be blue cards for the boys, “I'm a boy.”
So that even from the very beginning, you know, and those places are mostly run by women, those, those nurseries, but from the very beginning, this gendered thing of, you know, the boy gets the agency, the boy gets the I'm, uh, the subjectivity and the, and, and the, the objectification is put on the girl. But I think that, that the tendency to objectify oneself or another is probably not gendered. I think we might do it differently. The, the boys are so conditioned from the beginning and the girls are so conditioned from the beginning in this gendered way that we're talking about. It's in an instinct of the mind to try to fix reality with a concept you, you know, and it's a real achievement to experience one's self as a subject, and a further achievement to experience the other person, you know, the mother, the father, the lover, the girlfriend, the boyfriend, to experience the other as a person in their own right. Not as you know, who you want them to be or who you think they should be, or who they're supposed to be to satisfy your needs, or that that's the, you know, the beginning of kindness or compassion, uh, comes out of confronting that tendency to objectify.
ELISE:
Yeah. And do you think within Buddhist psychology sort of when Tibet, et cetera, that there's less of that objectification of women mindset. Is that why they're sort of a cultural divide or do you think it's cross-cultural?
MARK:
Oh I think it's cross-cultural no, I think, I think, I mean the, the traditional societies, I hate to say it, but, but there is, they're terribly sexist. Buddhist culture from the, from, from the Buddha’s time on, has been terribly sexist. You know, the, the, the monks and Tibetan monasteries are conditioned from the very beginning to see their attraction to women as a grave threat to their vows, you know. And as a result, there's a lot of homosexuality in the monasteries, cuz they would rather have that going on than have the monks leave for the women, you know?
ELISE:
This is a while ago when you had to go to an internet cafe to check your email, but I was in Luang Prabang in Laos. Yeah. And I went to an internet cafe. It was just full of young tween and teen monks looking at internet porn. And I was like, oh, I see, I see what's happening here.
MARK:
Yes, yes. Thailand too.
ELISE:
Yeah. Anyway. So obviously the book is sort of this Venn diagram of your two interests, and the way that they dovetail and you picked you cherry picked sessions. Although you come back to some people a few times. Within your practice, do you one, I'm curious because you are a psychiatrist and I don't know how often, like you, you, how often you prescribe or how you, like, how do you think about that in the context of pathologizing struggle, or pathologizing the reality of life, or do you sort of, is that in a box? How do you think about that?
MARK:
No, I think that's part and parcel of what, of, what, of, what I have to do, being a psychiatrist. You know, I sort of went to medical school, kicking and screaming. I went wanting to be a therapist, and I was suspicious of the pharmaceutical industry, and you know, the medicalization of psychological, emotional distress and whatnot. But then I worked or four years in a psychiatric hospital on an inpatient unit and saw, oh, this is what severe emotional illness, you know, like real depression or manic depression or, you know, psychotic breaks. This is what it really looks like, panic attacks, you know, this is what it really looks like. These people are really suffering, you know, and what can we do to help them? And, you know, mindfulness was not gonna help any of these people. Meditation was not, you know, you know, psychotherapy… just sitting and being, uh, like, you know, being a good listener that is, that was helpful, you know, to, so that they would trust me.
But there's really a roll for the pills, you know, there's like to have an antidepressant that works is, is, it's a, it's a gift, you know, it's a miracle. It’s such a satisfying thing for not just for the doctor, you know, but for the, the suffering person. So, so I feel very grateful that I had that training because I have a pretty good sense. I'm not a psycho-pharmacologist. If it, if it gets too complicated, I'm I, I tend to refer people, but, but I have a pretty good sense. You know, a family doctor would know how to treat, uh, diabetes or high blood pressure or something. I have a fairly good sense of what medicines would be useful when the medicines would be useful for postpartum depression, or panic attacks, or moderate to severe depression or, you know, bipolar disorder that's first showing itself.
And I don't hesitate to use them. Especially at the beginning of my practice, a lot of spiritual teachers or people who had been in those worlds for a long time, who were, who were suffering from something that meditation wasn't curing them of would come to see me. Because they would know that I wouldn't think they were crazy for their spiritual pursuits, but they wanted someone who could help differentiate. And I think the most widely circulated article I ever wrote, I wrote for this Buddhist magazine called Tricycle, which was, I think they titled it “Awakening with Prozac,” but it was, it was about how, you know, it's not a failure if you're a meditator and you still need Prozac, you know. And I always talk about, there are these paintings in the, a Tibetan tradition of the medicine, Buddha, who's a blue Buddha. Who's, who's portrayed as sitting with vats of, you know, herbs of medicinal, uh, herbs overflowing sitting in front of him. And I always think that the Prozac, or Xanax, or what, whatever we might use are just like those, those herbs, anything that can be used of help relieve suffering, you know, should be acceptable. So I think about it like that, I prescribe fairly, if I feel like it's gonna help, I'll prescribe or I'll recommend it, you know?
ELISE:
Yeah, no, I think we've become very binary. And as you said, this idea of like sort of this, the rugged individualism of our culture that would suggest that we should be able to solve anything ourselves, or that needing help is a sign of weakness. Although clearly needing psychotherapy is not a sign of weakness, but there is this sort of again, wanting meditation or at the beginning, we were talking about guruification, this, these panaceas right. This idea like, and it's the same could be said for prescription medicine. It's this like..
MARK:
One thing, one thing to fix. I know that's, it, it, it, you know, it takes to multi-pronged approach. Most of us, most of us need help from whatever side, you know, from so many sides.
ELISE:
I want to talk about the, the guruification, and then I wanna talk about resistance, because I thought that section was really fascinating, but I loved going back to, to Robert Thurman. And you were, I think teaching with him and you were recounting how someone essentially was like asking about. I think maybe they were wanting a guru or asking who they should follow. And his response is amazing, which is like, it's this paternalistic idea, and the real guru is your own intelligence, which I loved. Because I think we were, we, I see this having worked in sort of the wellness industry for so long, which was in some ways supposed to be an antidote to this idea of giving away all of your power to outside authorities, to tell you how to comport yourself, or how to heal. And that the idea originally was to like give people autonomy and to make them feel like they could participate and at least have a conversation if not guide their own internal transformation. And now within wellness, it's the same thing of like finding people and being like, here, I'll give you all my power, tell me what to do. So I loved that answer. And what's your feeling? I mean, as you see, so many of the things become more mainstream, like how do you, and you're part of that world, but an early person. How do you reckon with it?
MARK:
Well, the thing, the thing I love about Thurman is that he's, he understands the languages. So, you know, he, he can translates Sanskrit. He speaks Tibetan. So the, the person in our seminar, who I wrote about had just read a famous book called, Autobiography of a Yogi, you know, by Yogananda was when I was in college. Everybody was reading that book and it's, it's still around. And so, and that book is all about the glorification of the, of the guru, which is a thing in those traditions, you know, but Thurman has this expression that he gets from, he said, the Tibetan say the best guru is one who lives three valleys over, you know. You can imagine him as a, as an embodiment of perfection and use that in your meditation where you're, you're visualizing this, you know, the way we think about God, basically that you're visualizing this, the perfection of the guru, and then you're we reaching for it.
We would say praying, praying to be touched by it, but they're, they're reaching to be enveloped by that perfection, you know. But if the, if the guru is, if you're too close, then you see all their imperfections and then it's too much cognitive dissonance. But I, I sort of look at it the opposite way. My happened in my life was that I met all these people in, when I was very, very young in my early twenties. I, I met all these, you know, the first Americans to transplant Buddhism. I met Ram Dass, Joseph Goldstein, Jack Kornfield, all these people who seemed all grown up to me, even though they were like, you know, 30-years-old or 40 in Ram Dass''s case. But I got to know them somehow, not just as teachers, but as friends. And so I could see they were just people and they had their own imperfections.
And I found that comforting because then I couldn't idealize them. And I knew my own imperfections, some of them, but it, it gave me the freedom in a way to, to it be the self that I was kind of scared to be. You know, like, okay, I'm just me, you know, and they're just them and they're doing their, you know, they're doing some good. So Thurman in answering that question, you know, the guru, the word he said, in Sanskrit means heavy. You know, it's like a, it comes from the paternalistic attitude of ancient Vedic culture, you know, where the priest, the Brahman sits like a heavy paternalistic thing on your forehead, you know, and tells you how to behave, what you have to do, et cetera. But the true guru, you know, the Buddha came and turned all that inside out. You know, the Buddha taught the “four noble truths” and the word he used, the noble that came out of that, like the Brahmans were the Nobles, but the Buddha was like, no, the Nobles aren't, it's not that priest over there, lighting the fire, the sacred fire, the noble thing is like your own ethic, your own internal ethic, your own loving heart is the noble thing.
So that the Buddha was all about that. He was a good, you know, cognitive therapist in that way, turning people's concepts inside out.
ELISE:
Yeah. Well, it's so important because I think we all have had that experience, that higher self, you know, that 4-D version of ourselves when we're like really singing, right. Like we're up in our integrity and we are completely in alignment and it's everything we sort of how we wanna show up in the world. And then we all have our deeply human Earth 3-D avatar. Right. Which is yeah. Stuck in the same shit and that that's life. Right. Trying to like be in that 4-D space as much as possible.
MARK:
But also being able to be compassionate to the 3-D one, you know? Yeah. Rather than ashamed or rather than hiding it or to be, to really use all of those quote unquote failings, you know, or vulnerabilities to use them as opportunities to strengthen that compassionate thing that we're all capable of. Cause we are all just human.
ELISE:
Yes. Sadly.
MARK:
And that was the thing with my that, that not so sad. I mean, sadly my, that the patient, you talked about Laksham in the book who is objectifying the women on the subway, he goes to visit Ram Dass, he's like close with Ram Dass, and describes that his whole internal process. And he's sort of ashamed of it, but he can't really let go of it and doesn't really wanna let go of it. And, and what's Ram Dass's intervention, you know, he doesn't say stop. And he doesn't criticize him. He, he says, “love the thoughts,” you know, which is so radical, you know, like love, like he's not supposed to love those thoughts. Those are like the worst male thoughts, you know, like “love the thoughts” Ram Dass says. And then he says, “see yourself as a soul.” And if you could see yourself as a soul, maybe you could start to see the women as souls, you know? So he doesn't start with, see, those are people that, you know, those women are people too. He says, see yourself as a soul. You know? So somewhere in this, this person Lakshman, he's objectifying himself. Also. He's not able to see himself in that 4-D way that you're talking about. So I think that he's an extreme, an example in one way, but I, but I like it because I think in, in, you know, in each and our own way, we're similar.
ELISE:
No. And loving the thoughts is really hard when our really hard instinct is to lash ourselves for everything that doesn't align with, who we wanna be in the world. All right. So I know we're almost out of time, but very quickly you talk. Because I feel like this is such a basic tenant of Buddhism. If you can sort of take us through it, you're talking about you, you write Insight Meditation is designed to counter-resistance to these three marks of, of existence. Dukka, Anicca, Anatta. I'm sure. I just butchered all of those words, but that's okay. I'll say em, for you. Thank you. And it's focus on clinging as a source of suffering. It counts this resistance called ignorance or delusion as the principle object of investigation. So can you take us through sort of what that means and attachment, clinging, resistance?
MARK:
Yeah. Well I think the first thing to focus on in that is what do we mean by, by resistance. And in therapy, like if you read Freud and if you, if you train as a psychodynamic therapist. In therapy, what you learn is that the patient, the client is always gonna be like a little nervous, and a little ashamed, and hiding something and not really looking you in the eye, and not really telling you the whole truth. So that's called the resistance. Okay. And part of the resistance is they're gonna be seeing you the therapist as some kind of either guru figure, or judging figure, or parental figure. You know, they're not gonna be seeing you the therapist really as who you are. They can't, they're too many screens, too many projections in the way. So, so that's all the resistance. And this is Freud at, at his best. Freud was like the therapy is of the analysis of the resistance.
So all we're doing in therapy is trying to expose, gently, you know, kindly, but trying to expose, look what you are doing to avoid me, look what you're doing to avoid yourself. Look what you're doing to avoid the moment, being here, us now in the present, you know. Yhat's all the resistance and the therapy is the confrontation with, or the analysis of the resistance. So take that to the meditation hall, you know, and what does the Buddha say in his basic teachings? You know, he says the, the, the truth about reality is that everything is impermanent. You know, everything hard to argue with that. Everything is transitory, nothing lasts. That there's an underlying trauma. He used the word dukkha, when you take the word apart. And I learned this from Therman also just means do a co cause face do cuz it's difficult. So there's something difficult to face.
So there's an underlying thing in life, old age illness, death, separation, loss, discomfort, you know, there's an underlying thing that we're all subject to. That's difficult to face. We don't wanna look at it, but it's there, you know. And then we're all trying to be these selves. That's the Anatta thing. We're all trying to be these selves that we're not that we can't be, because we're, you know, we don't exist as objects. We're actually just subjects with, you know, so. But that's all very hard to get your mind around. So really we're just in a similar kind of resistance to those ideas, you know, to those truths. We're in resistance to those truths. What, what, what you see when you sit and meditate and look at your own mind is how much you're re resisting, you know, oh, everything's changing, I don't wanna want it to change. You know, like where, you know, that person is mistreating me, I don't want that mistreatment. I'm feeling abandoned, I don't wanna feel this one. You know, so I'm saying meditation, therapy, they're both very similar, more than we would, you know, normally think, because it's really all about dealing with the resistance. And, and when we learn how to, when we learn how to let those truths in, you know, then there's some kind of some kind of freedom as a result of that. And things get, get a little bit easier.
ELISE:
Well thank you for your time. Thank you for your book. I loved reading it. I love reading case studies. I'm sure I'm not alone.
MARK:
I hope you're not alone!
ELISE:
No, no, I'm not alone. It's so interesting. And it's, it's normally, you know, the structure of books like this, or you follow someone for a prolonged period of time. So it's kind of nice to get like the poo platter.
MARK:
The idea was that you really you're following my me, you know, me as the therapist as well as the patient. So, and that was, that was, I think the risk that I was taking with the book was to put myself out there a little bit.
ELISE:
I love Mark Epstein's books, I think they're really interesting reads. We were just talking about Ppen to Desire, which is another. And he also wrote a book called Advice Not Given, which is amazing where he talks about we didn't get to this in our conversation, but he talks about it in the context of Winnicott, too. How being a therapist, the thing that you're ultimately trying to not do is to fix people's problems ,and you want people to arrive there on their own and how that becomes ultimately the greatest reward of being a therapist rather than, um, I think Winnicott calls it, um, the sense of having been clever. And I would be a terrible therapist because I love to fix things, And I love to tell people what's wrong with them ,and to bring things to their, a in or patterns that they might not have observed in a way that's probably really annoying.
But I remember, I think it was an Advice Not Given which as the title implies, he just talking to a client who essentially arrives at this idea that he needs AA. And he, after he gets sober, he's talking to Mark or Dr. Epstein I guess we should call him. And he's essentially like, why didn't you stage an intervention? I'm I'm curious, like this must have been so obvious to you that I needed help. Or, maybe the patient arrives at this himself where he was like, thank you for not insisting because I needed to arrive there on my own. And I think that it goes back to that conversation we were having about guruification, but we really just wanna be able to do this ourselves. I think that's, it goes to that Robert Thurman quote of you are the guru, your own intelligence is the guru.
And really this, you have therapists or therapy or any doctor really helping you get back to that place of homeostasis, helping you do it yourself. So, the real guru is your own intelligence. I love that idea. And may we all be in our higher selves as much as we would like to be.