Greg Sazima, MD is a psychiatrist, educator and author based in Northern California. He teaches physicians-in-training at Stanford’s Family Medicine Residency Program. His new book, Practical Mindfulness: A Physician’s No-Nonsense Guide to Meditation for Beginners, is available now.
Q: What inspired you to write Practical Mindfulness?
A: Hmmm … two inspirations come to mind: a pet peeve and death. Perhaps I should explain that!
As for the “pet peeve,” I have studied, taught and benefited from mindfulness practices for around 25 years, and know the potency of meditation for my patients as a stress management tool and as a complement to our work in psychotherapy. Both my “day job” as a psychiatrist and my lecturing gig (I’ve been teaching behavioral medicine to family medicine residents at Stanford’s program in the Bay Area since 1991) have cultivated in me a drive to be clear, informal and practical in conveying concepts and tactics.
Meditation books—and I’ve read a lot of them—can be fussy, gilded with mystical/New Age elaboration and psychobabble. That’s fine, but some folks are wary of an approach that leans spiritual; others are turned off by a grand, “look how smart I am” writing style. I think there’s room for a practical, informal guide, one that physicians, therapists and educators would be happy to recommend to their patients and students. And, of course, read themselves.
The “death” part: My immersion in mindfulness practices has also been personal. It became a kind of lifeline in the last decade in helping me cope with an aggressive bone cancer, with three recurrences, surgeries and radiation treatment. I’d been organizing the book in between recurrences and treatments, then got really busy on it in 2015 when things were looking dim prognostically for me. The threat of terminality can be a potent motivator! I’m truly blessed to be in a sustained remission now, albeit with some manageable, residual medical issues to handle. My meditation practice continues to help me there in terms of adaptation to suffering. It helps keep my attitude in a place of gratitude and compassion in my clinical work and with my loved ones.
Q: What is a wavicle?
A: Thanks for asking! It’s a mash-up of “wave” and “particle.” A “wavicle” is my nickname in the book for phenomena that come and go in our every moment, in my attempt to practically explain the complexity of deeper, non-dual states of consciousness.
A humble intention in the conceptual part of PM (practical mindfullness) is to make the case for our actually proceeding through our moment-to-moment lives on two “tracks:” the usual self/other, me-and-not-me, “particle” experience, and also some sense of a unity, non-dual “wave” experience. Ironically, both quantum physics and wisdom traditions align on the idea of all of us operating as separate selves but also ultimately connected.
Does our consciousness reflect that? Many of us have experienced moments that stand out from the usual “separate me” sense of self—states of deeper belonging, spacious consciousness, the boundary of self-getting “fuzzy,” if not dropping away altogether, however briefly.
We have an opportunity to observe our usual, separate self, “particle me” life, but also dip into that “wave” state. Part III of the book carefully walks through some practices that can allow for dropping into these deeper unity/non-dual states. “Wavicle” represents that wave/particle thing together in a shorthand way.
Q: Why is mindful breathing so important and how should one stay focused when breathing?
A: Well, there are two aspects to that issue. “Mindful” breathing, also called “relaxation breathing” or “belly breathing,” is an intentional tactic of optimizing oxygen intake. Many of us learn it in yoga, meditation or pre-natal classes. We slowly inhale bottom up, filling like a water balloon, starting with pushing out the abdominal muscles, then expand the upper chest; then a pause; then a slow exhale to empty. It’s an essential tactic to help reduce anxiety; a hunk of neural tissue near the heart, called the sino-atrial (SA) node, is exquisitely sensitive to changes in oxygenation of the blood. The SA node not only modifies heart rate and blood pressure in response to mindful breathing, but sends messages upstairs to the brain to signal calm. Getting familiar with this technique is so important for folks with anxious tension, and everyone else, since uncertainty and anxiety are inevitable states.
The other bit is that in sitting meditation, we may start with a couple of belly breaths to settle in, but then we drop any intentional control of breathing and just observe it, the in and the out-breath. So this is being mindful about breathing. It’s about using it as object of observation, whether it’s shallow and rapid or full and calm. The breath is a “wavicle,” always there to attend to (if not, call 911) and even more importantly, to return to when we inevitably lose attention.
Q: Please explain progressive muscle relaxation. What benefits does it offer meditation practice?
A: I include progressive muscle relaxation (PMR) in the book with relaxation breathing as preparatory stress management tactics. In PMR, we “locate” an area of the body, like a hand, a shoulder area or the gut muscles, by first tightening the area carefully for a couple of beats, then relaxing it. We proceed sequentially up each arm, down the torso, down each leg, pausing to attend to how each area responds to locating, then relaxing it. It can be truly therapeutic for folks who manifest stress somatically via musculoskeletal tension, which includes back, neck and shoulder pain and tension headaches.
PMR is also a nice way of introducing the sense of mindful awareness as a capacity that we can direct and move around. We’re using a sequence of bodily locations as the target for our attention, rather than the breath. By the way, guided audio exercises for both relaxation breathing and PMR are in the podcast series, “A Practically Mindful Moment,” that I developed as a complement to the book. There are also handout PDFs on both tactics in the “Resources” link on the book website: www.practicalmindfulnessbook.com. That’s an easy way to teach it once and then provide a printed recipe for patients to take home with them or link to.
Q: How do chakras connect the body and emotion together in meditation practice?
A: As I discuss in PM, as a Western-trained doc, I’m “chakra agnostic” when it comes to the subtle energy centers or nodes framed in the chakra system. But also recognize humility is key for attending to what I may not fully understand. I can’t claim some certitude around whether they represent true but poorly measurable energetic areas, or perhaps helpful somatic “metaphors.” There are a substantial subset of humans who have benefitted from Eastern subtle energy practices, something there to be open to. For the practical approach in PM, I find that a sequential “walk through the chakras” meditation exercise is an elegant way of opening to both somatic aspects of our inner landscape and emotional qualities that are historically easily associated with each of those chakras. With practice, sitting with, say, the associated somatic pair of the heart and passionate energy (fourth chakra), or the throat and the energy to communicate and be heard (fifth chakra) just become regular, useful associations to tune into.
Q: The pandemic has been hard on many practitioners and their patients. Can you offer any tips that practitioners can share with their patients and also use themselves to reduce COVID-related stress?
A: As you might expect, this is a pressing, common question I’ve been asked as we enter year two of this crisis. We are guiding, then leaning on our patients to maximize their own mindful self-care as they surf this long, difficult wave. As you rightly suggest, we’re on the same wave, and not always self-aware about the impact of our own stress, in terms of burnout and compassion fatigue. It’s easy for us to drop the self out of the equation in our work, rather than modeling mindful self-care by our own actions. I’ve pondered a “practical” (heh) way to keep that task in front of mind—a brief set of questions to regularly ask ourselves, caregivers and receivers alike, in this difficult moment. I organize these four questions in a holistic way:
1. Physical: How am I taking care of my body?
Check in about how you are sleeping, about healthy eating and getting some exercise, however limited that can be currently. This also includes a regular reminder on the “big three” take-care-of COVID behaviors of hand washing, masking and social distancing. A regular check-in helps reinforce these well-known but easy to drop routines.
2. Emotional: How am I taking care of my heart?
Check in with your emotional state—how are you holding up? Is there a predominant “weather pattern” inside? Lots of us are in states of flux lately—anxiety, anger, sadness, boredom—and also gratitude and compassion. Most of it is appropriate to this moment, but intensity can be difficult, and made more adaptable if we pay regular, mindful attention to our feeling states, and even compare notes with trusted loved ones.
3. Mental: How am I taking care of my mind?
Check next on the “landscape upstairs.” Are you tuning out? Overly glued to the news, or social media, or something else? Regular investment in mindful practices like meditation can help keep an eye on mental burnout and distraction. Taking up some “growth” practices—reading about new things, taking an online class or learning a language, an art form or a musical instrument—can make fruitful use of a difficult time.
4. Reaching Out: How am I taking care of my connections to the world?
Lastly but sometimes overlooked, especially in this moment, is the care and feeding of our connections to the world and relationships outside of us—to family, friends, community and beyond. Tuning regularly into whether we are staying connected, even if virtually, helps us overcome loneliness, isolation and helplessness. Especially potent is finding some ways to be of compassionate help: phone contacts to others in need, letters to relatives, and even Zooming into volunteer groups and meetings. This “four-step,” mindful check-in routine need not be a trial; some folks make it a couple of bullet points in a daily journal, or part of a check-in with me at a virtual therapy appointment. The additional value-add here is that in regularly tuning in to body, heart, head and beyond cultivates mindfulness, our trainable capacity for self-awareness. It’s a benefit that we can carry with us, long after these tough times ease off.