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Here you are with a chronic illness, maybe an incurable one. You've been to all the doctors, taken your prescribed medication, maybe changed your diet or gone to physical therapy if that applies. But have you done anything for your spiritual health? What coping skills do you need for what might be a lifetime of sickness?

In "How to Be Sick", Toni Bernhard recognizes the immense challenge of thriving emotionally when your quality of life is no longer what you expected. She herself experienced severe chronic illness of sudden onset. She went from having a fulfilling career as a law professor and going on a dream vacation to Paris to a woman who was bedridden, sometimes for months at a time. She went through the initial reactions most of us have experienced - bewilderment, anger, grief, misplaced hope, depression. But over time, she realized that her faith was the key to regaining equilibrium.

While the author is a practicing Buddhist, the reader does not have to be one in order to be enlightened by "How to Be Sick". The goals for the chronically ill and their caregivers are nearly universally the same: to promote calm and satisfaction, to develop acceptance of life changes while not extinguishing hope, to find beauty in the world again. Through the various practices outlined in the book, the reader is given the basics with which to proceed.

How many times have we pined for the past when things were "normal"? In life there is one certainty, and that is that everything changes. Some of the changes are upsetting, like the onset of chronic illness, but some are sweet, like finding love or the joy of new life. We have a tendency to focus more on what's going wrong in our world than what's going right. In the chapter on the Universal Law of impermanence, Bernhard reminds us that without winter, we wouldn't fully appreciate the beauty of spring.

Another universal truth is that unpleasantness is a part of every life. The details of unsatisfactory experiences and circumstances vary from person to person, but could you name anyone who hasn't been disappointed by something? While this may seem like pessimism, it means that no one is alone. The knowledge of this can be quite important to those who feel isolated by illness.

One practice that Toni Bernhard recommends is cultivating joy and compassion for yourself and others. Most faiths have some variation of The Golden Rule, which states, "do unto others as you would have them do unto you". Having compassion for others is therefore something with which most of us are familiar, but how do we treat ourselves? Most of us are much harder on ourselves than anyone else, whether it be blaming ourselves for not doing more, calling ourselves stupid when we forget something, feeling guilty about the effect our illness has on our loved ones. When we are gentle and forgiving of ourselves, our compassion for the rest of the world increases. Experiencing joy for others, especially when they are doing things we no longer can, is a huge challenge. Toni says that when she first tried this practice after becoming sick, the joy felt artificial because she so envied those who were healthy. But if you persist, in time you will find that the joy of others becomes your joy too.

A mind state essential to coping with chronic illness, or caring for one who is ill, is that of equanimity. That is the ability to be calm and even-tempered in the face of difficulty. Keeping the effects of stress to a minimum is a known health benefit. Most of us have good days and bad days in the course of our illness, and these ups and downs are not necessarily predictable. If we are to successfully navigate the frustrating avenues of the health care industry, we must develop patience and a calm assertiveness. We must endure thoughtless and even hurtful comments and attitudes of those around us. And we must figure out ways to thrive despite loss. Toni teaches us that sometimes we must cultivate equanimity in baby steps due to the overwhelming nature of illness, but if we can let go a little, then we can let go a little more, until we discover that we can survive just about anything.

The human mind is a chaotic place. We cannot stop ourselves from thinking, but we can stop ourselves from believing everything that crosses our mind. In Chapter 12, Toni introduces what she called "inquiry practice", in which we question disquieting thoughts upon which we have become fixated. Much of our catastrophic thinking is merely an exaggeration of reality, and if we can redirect ourselves to focus on the truth, we can unburden ourselves.

Another process that happens in the chaotic mind is when memories of the past and fears of the future crowd out our awareness and enjoyment of the now. Toni details a two-step exercise to guide us back to focusing on the present, which can be a source of great relief. How much wonder and beauty have we missed in the world because we were preoccupied with something that already happened or something that may never happen?

Toni Bernhard says that because those of us who are ill or care for someone who is ill have limited energy and mental resources, how we reach out to others matters. We can build bridges with our speech or we can isolate ourselves even further. Essentially, we are creating a world with what we write and say. Therefore, if we want to speak wisely, we will only say what is true, kind and helpful. Consider these three criteria before you make a comment on Facebook or hit "send" on an e-mail message. Sometimes this entails not inundating friends and family with every single detail about your illness, or saving certain topics for those who are like-minded. Be aware of idle chatter as it may devolve into hurtful speech.

A chapter which is particularly relevant is "The Struggle to Find Community in Isolation". For some of us, leaving the house with family and friends or even conversing with them on the phone is out of the question. Chronic illness can change us so much that our relationships are impacted, not always for the better. Our besties may simply drop away from our lives. Caregivers become more isolated too. But does the fact of being by yourself in the room necessarily mean you have to be lonely? Toni highlights the important differences between isolation and solitude.

The exercises outlined in "How to Be Sick", while numerous, are simple yet profound. They are something we can turn to over and over again when we are overwhelmed by illness and all it encompasses. At the end of the book is a segment entitled, "A Guide to Using the Practices to Help with Specific Challenges". I could see turning to this section after a disappointing experience with a doctor, when I feel I can't stand one more minute of pain, when my mind won't quit chattering and I can't relax.

"How to Be Sick" teaches us that we can become spiritually gentle yet strong if we are open to the process. While there may be very little about our illness that we can control, we do have some say in how we react. And that may make the difference between simply existing and thriving.


Title: How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers
Author: Toni Bernhard
Publisher: Wisdom Publications
IBSN: 0-86171-626-4