| I leaned back in my chair and breathed a heavy sigh. | | | | know after I told him my other patient's story. |
| My patient, Mr. Rodriguez, noticed my discomfort. "I | | | | In fact, one meta-analysis tells us on average only 2 |
| know I should quit," he told me with a guilty shrug of | | | | out of every 100 smokers told by their physicians to |
| his shoulders. | | | | quit will succeed in establishing long-term abstinence. |
| "Have you ever tried?" I asked. | | | | It's less clear how many alcoholics or drug addicts |
| "Once," he replied, "but it didn't stick." | | | | who recognize they're addicted and need to quit |
| Mr. Rodriguez had been a pack-a-day smoker for the | | | | actually do. But the principle remains the same: some |
| past 20 years, something he'd only begrudgingly | | | | people can digest intellectual knowledge and translate |
| confessed in response to a standard inquiry I make | | | | it into deep and motivating belief, belief they must |
| of all my first time patients. He didn't see it as a | | | | change their behavior despite all the obstacles--and |
| problem himself. Or at least he hadn't mentioned it | | | | some simply can't. |
| when I'd asked him at the beginning of the visit why | | | | Specifically, with regard to smokers, 98 out of every |
| he'd come to see me. | | | | 100 can't. What, then, is the difference between |
| "Are you aware of all the ways cigarette smoking is | | | | those two smokers who hear their physicians' |
| bad for you?" I asked. | | | | warnings about the dangers of smoking and for the |
| An alarmingly high proportion of patients know | | | | first time truly understand it's time for them to quit |
| surprisingly little about all the potential consequences | | | | and the other 98 who agree they should quit, who |
| of tobacco smoking. Mr. Rodriguez, however, was | | | | may even want to quit, but repeatedly fail in their |
| able to come up with two of the major ones: heart | | | | attempts? Why did the possibility of losing his wife |
| attacks and lung cancer. | | | | motivate one of my patients but not Mr. Rodriguez? |
| "Why do you keep smoking when you know it | | | | Or asked from a Buddhist perspective, why do some |
| causes heart attacks and lung cancer?" I asked him. | | | | find the wisdom and others do not? |
| He shrugged, obviously embarrassed to be caught in | | | | One could argue that Mr. Rodriguez did in fact believe |
| a contradiction. | | | | in the dangers of nicotine, both to himself and his |
| But even as I tried to shame him into wanting to quit | | | | wife, but that he was simply too addicted to |
| by preying on his need to appear consistent, I knew | | | | succeed in quitting. I would argue, however, the |
| no contradiction actually existed. I knew this not | | | | problem lay less with the strength of his addiction |
| because of my medical training or subsequent years | | | | and more with the weakness of his belief. If those |
| of medical practice, but rather because of my many | | | | dangers, which he only weakly believed applied to |
| years of practice as a Buddhist. | | | | himself, could have in some way been brought home |
| THE KEY INGREDIENT TO HAPPINESS | | | | to him--as Ebeneezer Scrooge's impending death was |
| The kind of Buddhism I practice isn't Zen or Tibetan, | | | | brought home to him by the Ghost of Christmas Yet |
| the two most popular forms in the United States, but | | | | To Come showing him his own tombstone--I'm |
| rather Nichiren Buddhism, named after its founder, | | | | convinced Mr. Rodriguez would have been able to |
| Nichiren Daishonin. The practice of Nichiren Buddhism | | | | resist the pleasure smoking provided and managed |
| doesn't involve meditation as do the other more | | | | the pain of withdrawal abstention would have |
| popular forms but rather something even more | | | | produced. |
| foreign and discomforting to those of us raised in the | | | | Nichiren Buddhism argues that the true reason for |
| traditions of the West--chanting. Every morning and | | | | the emergence in the human mind of new and |
| every night I chant the phrase | | | | powerfully motivating belief is mystic--meaning, |
| nam-myoho-renge-kyo with a focused determination | | | | simply, unknowable--which is why I teach residents |
| to challenge my negativity in an effort to give birth | | | | and students to ignore the odds and counsel all of |
| to wisdom. Wisdom, Nichiren Buddhism argues, is the | | | | their smoking patients to quit each and every time |
| key ingredient to achieving happiness. | | | | they see them. Despite our preconceived |
| And wisdom, rather than knowledge, is what my | | | | expectations that most of our patients won't be able |
| patient, Mr. Rodriguez, seemed so desperately lacking. | | | | to listen, clearly we have no way of predicting which |
| He knew intellectually he shouldn't smoke, but that | | | | 2 out of every 100 will. |
| knowledge hadn't yet penetrated to become | | | | HEALTH AND HAPPINESS |
| wisdom--to become, in essence, action. Despite his | | | | I would argue, therefore, there are two possible |
| embarrassment, Mr. Rodriguez presented no | | | | approaches to the practice of medicine and that the |
| contradiction because action never arises from | | | | second of the two is better. The first involves |
| knowledge alone. It arises from knowledge that is | | | | diligently providing appropriate advice about smoking |
| believed. | | | | cessation, abstention from alcohol for those who |
| How often do we understand with our intellects how | | | | abuse it, or pharmacological management of |
| we ought to behave but find ourselves unable to do | | | | depression and anxiety (to name only a few of the |
| so? Why, for example, do some people know how | | | | common ailments that affect my patient population). |
| to set appropriate boundaries with others, but other | | | | The second approach, however, involves becoming |
| people can't bring themselves to say no to anyone? | | | | interested in the beliefs patients hold that keep them |
| Why do some alcoholics figure out they need to stop | | | | trapped in harmful behavior patterns. It involves |
| drinking and stop, while others state they know they | | | | embracing a view of the human mind that recognizes |
| should, but never do? Why do some people hear | | | | all behavior arises out of belief and that if we could |
| advice to quit smoking and quit that very day, while | | | | only help patients find their way to wisdom, their |
| others smoke on even after heart attacks and | | | | lives might then become governed by actions that |
| strokes? | | | | lead to happiness and joy rather than pain and |
| The answer lies not just in what we believe but also | | | | suffering. |
| in the degree to which we believe it. Deeply held | | | | This, then, is how I view the proper role of a |
| belief--Buddhism (and psychology) would | | | | physician: not just as an advocate for patients' health |
| argue--introduces a critical ingredient necessary for | | | | but for their happiness as well. While I certainly don't |
| change: motivation. One of my patients tried and | | | | believe I have all the wisdom my patients would ever |
| failed to quit smoking for several years until his wife | | | | need to solve every problem they face, I am equally |
| casually mentioned one day how much she hated | | | | certain they do themselves. My ultimate aim, then, |
| coming home to a smoke-filled house, and he | | | | and, it turns out, the most enjoyable part of my day, |
| stopped for good the next day. He'd finally | | | | involves encouraging patients to challenge their |
| discovered the motivation to quit: a sudden, | | | | deeply held beliefs that, in my view, obstruct their |
| burgeoning awareness (that is, a deeply felt belief) of | | | | ability to change maladaptive behaviors. Though I |
| the harm his smoking was doing not to himself but to | | | | often fail, I am never able to predict with whom I will |
| his wife. He was ultimately more capable of believing | | | | succeed, so I approach every patient as a mystery |
| that his wife's life was at risk than he was his own. | | | | to be solved, always full of hope. |
| Not surprising when you consider most of us tend to | | | | And as he left my office that morning no more |
| deny the possibility of our own death far more | | | | determined to become a non-smoker than when he'd |
| vigorously than we deny the possibility of everyone | | | | first entered, I wondered: what do you need to hear, |
| else's. | | | | Mr. Rodriguez? What experience will cause some |
| HOW EFFECTIVE IS A DOCTOR'S ADVICE? | | | | critical piece of wisdom to penetrate into your heart |
| "How many of your patients actually quit because | | | | and somehow motivate you to save your own life? |
| you tell them they should?" Mr. Rodriguez wanted to | | | | |