Attending to the sick

In any community that exists for more than a short time, someone will fall ill. Often when serious illness strikes, the family is the primary care-giving community, but sometimes friends become like family. When someone is sick, it tends to pre-empt petty concerns and reminds us that we do, at base, care about each other.

In describing how communities of the Buddha’s followers should work, the Buddha listed five qualities that those attending to the sick should embody, and another five that make a patient easy to care for. By considering them together, we acknowledge that at times in our lives we’ll be called on to give care, and at other times we will be the ones needing care.

Monks, possessing five qualities, an attendant is qualified to take care of a patient. What five? (1) He is able to prepare medicine. (2) He knows what is beneficial and harmful, so that he withholds what is harmful and offers what is beneficial. (3) He takes care of the patient with a mind of loving-kindness, not for the sake of material rewards. (4) He is not disgusted at having to remove feces, urine, vomit, or spittle. (5) He is able from time to time to instruct, encourage, inspire, and gladden the patient with a Dhamma talk. Possessing these five qualities, an attendant is qualified to take care of a patient.

Possessing five other qualities, a patient is easy to take care of. What five? (1) He does what is beneficial. (2) He observes moderation in what is beneficial. (3) He takes his medicine. (4) He accurately discloses his symptoms to his kind-hearted attendant; he reports, as fits the case, that his condition is getting worse, or getting better, or remaining the same. (5) He can patiently endure arisen bodily feelings that are painful, racking, sharp, piercing, harrowing, disagreeable, sapping ones’ vitality. Possessing these five qualities, a patient is easy to take care of. (AN 5:123-124, translated by Bhikkhu Bodhi)

The Buddha gives us practical advice on how to be a good care-giver and also a good care-receiver. Regarding item (5) in the first paragraph, not everyone feels qualified to share the Buddha’s teachings, nor would every patient welcome them. But regardless of our knowledge, we can try to encourage, inspire, and gladden the patient with whatever words or actions might work best for that individual.

Regarding item (4) in the first paragraph, many carers find themselves revolted by the prospect of dealing with bodily fluids and other “yucky” things. But if called on to perform such assistance, it can be a beneficial reminder to the carer that we are all in human bodies and this is how bodies function when they’re not well. Illness or disability is likely to come to all of us at some time in our lives. Why not face the reality now?

In the Buddha’s time, there were many fewer options than there are now for reducing physical pain related to illness. But even with excellent medications and care, we are all of a nature to experience physical discomfort at one time or another. In many situations, it can’t be entirely eliminated and patient endurance will be needed.

As we live through these experiences, either as carer or patient, we can use the opportunities presented to bring ourselves more into alignment with our highest aspirations.

Conditions for harmony

In AN 7:23 the Buddha outlines seven principles of non-decline in communities. There is a similar list in AN 7:21, addressed to a group of laypeople called the Licchavis (of the Vajjian confederation). Items five through seven address issues specific to lay and monastic communities, but the first two are identical (Bhikkhu Bodhi’s translation):

“As long as the monks (Vajjis) assemble often and hold frequent assemblies, only growth is to be expected for them, not decline.

As long as the monks (Vajjis) assemble in harmony, adjourn in harmony, and conduct the affairs of the Sangha (Vajjis) in harmony, only growth is to be expected for them, not decline.”

The fact that meeting frequently is the first item mentioned sets it as the basis on which communities thrive. The less frequently people meet together, the more likely it is for misunderstandings and resentments to grow. Meeting face to face encourages us to practice respect and kindness, which are sometimes sacrificed in on-line communications or when we’re behind the wheel of a vehicle.

In the second principle the stakes are raised: to assemble in harmony, adjourn in harmony, and conduct the affairs of the group in harmony. To do this, there must be a commitment on everyone’s part to practice respect and politeness when meeting. This commitment has to be explicit to overcome our natural tendency to argue with each other and object to ideas not our own.

These are simple guidelines that can make a profound difference in our actions. Recently, I fired off a sarcastic email to a reporter who I thought had failed to maintain his own journalistic standards. Surprisingly, he responded. Unsurprisingly, he wasn’t impressed. I realized (too late) that I had written in haste, used a negative tone in expressing my irritation, AND that if I’d been speaking with the reporter in person, I would have taken an entirely different approach. I deeply regretted that I’d created unnecessary bad feeling for the reporter and myself, and have reflected on the process that caused the action. In a fit of righteous indignation, instead of considering whether I would use these words if I were speaking to the reporter in person, I just went ahead and sent the email. I felt sure that it would be ignored, which might have helped unleash my negative energy. After I saw and thought about the response, I was troubled by remorse and have written again to apologize and explain what I hoped for.

If we want to bring peace to the world and to ourselves, we can start with treating people in our communities with respect and kindness. We can also take the same care and extend the same consideration to others not in our physical presence.

How to get along with each other

From AN 10:50, translated by Bhikkhu Bodhi:

… Monks, it is not suitable for you clansmen who have gone forth out of faith from the household life into homelessness to take to arguing and quarreling and to fall into a dispute, stabbing each other with piercing words. 

There are monks, these ten principles of cordiality that create affection and respect and conduce to cohesiveness, to non-dispute, to concord, and to unity. What ten?

1. Here a monk is virtuous..
2. Again, a monk has learned much, remembers what he has learned, and accumulates what he has learned…
3. Again, a monk has good friends, good companions, good comrades….
4. Again, a monk is easy to correct and possesses qualities that make him easy to correct; he is patient and receives instruction respectfully….
5. Again, a monk is skillful and diligent in attending to the diverse chores that are to be done for his fellow monks;….
6. Again, a monk loves the Dhamma and is pleasing in his assertions, filled with a lofty joy pertaining to the Dhamma and discipline….
7. Again, a monk has aroused energy for abandoning unwholesome qualities and acquiring wholesome qualities; he is strong, firm in exertion, not casting off the duty of cultivating wholesome qualities….
8. Again, a monk is content with any kind of robe, almsfood, lodging, and medicines and provisions for the sick. [I.e., content with simple necessities]…
9. Again, a monk is mindful, possessing supreme mindfulness and alertness, …
10. Again, a monk is wise; he possesses the wisdom that discerns arising and passing away, which is noble and penetrative and leads to the complete destruction of suffering….

This seems to me a comprehensive and useful list of qualities that would make members of a community get along with each other – or, if they hold the opposing views and behaviors, not.

A few adjustments to the language might be useful to encourage our use of these guidelines. We could substitute the word “practitioner” for monk, meaning simply an individual who is part of a community that intends to live in cooperation. “Loving the Dhamma” describes a dedication to shared goals.

Items 9 and 10 imply a mature wisdom, which takes time and dedication to embody, so we could use those as aspirations rather than berating ourself for failing to have extraordinary accomplishments.

In sum, these are the qualities we might look for, in ourselves and in others, as descriptors of good companions:

1. Ethical behavior
2. Learned
3. Having wholesome associates
4. Willing to learn/be taught
5. Doesn’t shirk duties or one’s fair share of work
6. Joyful
7. Dedicated to refining one’s behavior
8. Contented with little in the way of material goods
9. Mindful
10. Wise

Which of these qualities do we possess in better-than-average measure? Are there any that are conspicuously absent? As we think of our friends and associates, which of these qualities can we admire and be grateful for in them? Which missing items can we notice but decide to overlook or bring to their attention (at the right time)? Would we welcome shared reflections on these aspects of our own behavior?

Why community?

The reason I’m going on about communities is that we live in a time of atomization; many civic and religious communities are weakening (see Bowling Alone by Robert Putnam). We can try to replace these groupings with individual friendships, which are important, but they are intrinsically less stable. Communities nourish our mental, emotional, and spiritual health in a way that individual friendships cannot. Doing things together has many benefits, including supporting our motivation to keep developing and providing a more beneficial influence in the wider community.

Social capital is defined as the networks of relationships among people who live and work in a particular society, enabling that society to function effectively.

From Wikipedia (https://en.wikipedia.org/wiki/Social_capital) – In the first half of the 19th century, Alexis de Tocqueville had observations about American life that seemed to outline and define social capital. He observed that Americans were prone to meeting at as many gatherings as possible to discuss all possible issues of state, economics, or the world that could be witnessed. The high levels of transparency caused greater participation from the people and thus allowed for democracy to work better. The French writer highlighted also that the level of social participation (social capital) in American society was directly linked to the equality of conditions (Ferragina, 2010; 2012; 2013).

We could conclude that the documented decline in social capital in the USA and other places is a causal factor in the decline of participatory democracy and equal opportunity.

And what’s causing the decline in the fabric of our cultures? Robert Putnam names technology as a factor, starting with television in the 1950’s. Before then, we used to do all manner of activities in person, together. Once each home had it’s own television, interest in being with others dropped off. This trend has only been magnified by the development of more and more attractive opportunities to live in our isolated electronic universes.

In such a world, how can we resist the tide? It’s true that many wisdom teachings, including the Buddha’s, are now more widely available than ever through electronic channels, and no doubt this is a great benefit. But to put those teachings into practice, we must have real relationships with real, living, breathing, imperfect humans. It might take an act of will to participate in an activity that cuts into our “down” time surfing the net or living in a fantasy world. But, even if there are inconveniences about communal activities, it usually feels good to participate in a situation where our awareness of others is heightened and we are encouraged to connect. Too much time looking inward without a skilful framework is a recipe for delusion. We each need to find our own balance of looking inward and embracing others.

What holds us together?

We live in a time where it seems that there are more forces pushing us apart than holding us together. If we are to live in community, we have to make a conscious choice that living in close proximity to others is worth the bother.

In an intentional community, there is a purpose or a mission that holds people together, or at least channels their energies in a similar direction. Sometimes there are rules, as in Alcoholics Anonymous. The Buddha’s community of monks and nuns didn’t start out with a set of rules, but as the community grew, new rules were added to address things that came up.

In AN 20:31 Venerable Upāli asked the Buddha what the purpose of his rules was. This is the answer he got (Bhikkhu Bodhi’s translation):

1. For the well-being of the Sangha (the community of the Buddha’s followers);
2. for the ease of the Sangha;
3. for keeping recalcitrant persons in check;
4. so that well-behaved monks can dwell at ease;
5. for the restraint of (unwholesome) influxes pertaining to the present life;
6. for the dispelling of influxes pertaining to future lives;
7. so that non-believers might gain faith;
8. for increasing the faith of the believers;
9. for the continuation of the good Dhamma; and
10. for promoting discipline.

The purpose of the Buddha’s community was to practice according to the Dhamma and share the teachings so that as many people as possible could attain freedom from suffering. It was narrowly focused and very much against the grain of the dominant culture. As soon as the Buddha died, perhaps even beforehand, senior monks were complaining that the purity of intention was deteriorating or had already been lost. It is hard to hold a community together, even one with such a healthy purpose.

We can start with our own behavior, and move towards spending time with those who share our values. We may share moral values with people we disagree with politically. If a person’s actions tell us that they are motivated by care and kindness, then how they voted might matter less. It’s important that we don’t play into the hands of those who would polarize us. By keeping an open mind, we can act from an open heart towards everyone, and perhaps recognize others’ good intentions in surprising contexts.

Whether or not we are part of an intentional community, we may have to be the keepers of our own rules, and those rules should be coherent. What direction do we want to face in? How are we hoping to grow? Knowing for ourselves that we value truthfulness and harmlessness in all situations can give us a firm foundation for all of our interactions.

Showing we care

Giving, endearing speech,
beneficent conduct, and impartiality
under diverse worldly conditions,
as is suitable to fit each case:
these means of embracing others
are like the linchpin of a rolling chariot.
– – from AN 4:32, translated by Bhikkhu Bodhi

The title given to this sutta in Bhikkhu Bodhi’s book, The Buddha’s Teachings on Social and Communal Harmony, is “Four Means of Embracing Others”. This is how we show others we care, whether they are family members or strangers, participants in a community we are part of or from a group we are suspicious of.

We can think of each of these actions and their opposites to gauge the likely results. When we are generous to others, the mood of the recipients and any others who witness the exchange is likely to be lifted, even if the gift is as simple as a smile. If we send signals that we are protecting what we consider ours, we draw away from others, and they are likely to notice and respond in kind.

Endearing speech is probably the most useful way of neutralizing tension and promoting good will. If our tone of voice carries the clear intention of kindness, it shifts all the conversation in a positive direction. Likewise, if our words are combative or sarcastic, we spread a bad feeling and might cause others to withdraw.

An easy way to practice beneficent conduct is simply to move out of others’ way, whether in a vehicle or on foot. There is an art to creating space for others, and when we practice it, it may not be noticed, but it will have an effect, at least on us. Another type of beneficent conduct is when people help each other out unexpectedly. There were some recent stories in the news of people getting into strife in swift waters and the people nearby forming a human chain to rescue them. Most of us respond when we see others in difficulty, especially if it’s a dramatic situation. But even in mundane ways, we often take up opportunities to be of service to others. We can recognize these moments and appreciate them for the skilful actions they are.

“Impartiality under diverse worldly conditions” – what does that mean? We could think of it as a sense of fairness, of treating others and ourselves as equals. How this is embodied is not always obvious, but it could start with simple politeness.

When these four ways of being are practiced, the wheel of life runs smoothly; and when this linchpin is missing, the wheels are bound to fall off. We can prove this principle in our own lives. No matter what we’re up against, giving, kind speech, respectful conduct and fairness will help set things right.

Community formation

Monks, it is by way of elements that beings come together and unite: those of a low disposition come together and unite with those of a low disposition. … Monks, it is by way of elements that beings come together and unite: those of a good disposition come together and unite with those of a good disposition. (from SN 14:16, translated by Bhikkhu Bodhi)

Further along in Samyutta Nikaya 14 the Buddha says that those having faith will seek each other out and likewise those lacking faith are drawn together (SN 14:17); those who keep the precepts and those who don’t will each unite with similar people in those two groupings (SN 14:25); and those who follow the eight-fold path and those who don’t will naturally congregate in separate communities (SN 14:28). In all of these cases, we are describing intentional communities, not our families or other “natural” groups we have no choice in joining or leaving.

Who we spend our time with is probably the most important decision we can make, day by day. It’s a truism that our choice of a life partner is the most significant factor in our quality of life. If we have a partner who supports our skilful instincts and serves as a check on our baser motives, we have the most important factor working for us. On the other hand, if we are in an abusive relationship at home, it’s hard for anything else to go right.

We don’t choose our extended families, but we can decide how close to stay to them. We can help family members who need it, but we have to recognize when our actions are actually helping and when they’re not. The boundary between supporting and enabling is often hard to discern, but unreserved kindness is never wrong.

When we have children, we take responsibility for creating the most nourishing environment we can for them. We can’t expect them to fulfil our needs or meet our expectations. When children are grown, they may or may not reciprocate by caring for us, but our intentions can’t be transactional; we need to focus on caring for everyone in the household (including ourselves).

Let’s consider how the communities we are part of reflect our aspirations, including if we are not part of any intentional communities at all. Are we spending time with people who seem to hold us back or keep us down? Could we find others who reflect and support our strengths? Could we make time for a regular, wholesome activity where we could interact with people we respect and admire?

Some folks have limited choices, but few are so trapped that they can’t consider moving, looking for a better job, or seeking professional advice or support for making beneficial changes. If there’s no available company around that lifts us up, we may be better off on our own for a time.