Cultivate the Four Immeasurables, Yet Let Nature Take Its Course

On a Saturday afternoon while strolling in Zizhuyuan (Purple Bamboo) Park, I came upon a young couple. The girl was utterly obedient to the boy, gentle, delicate, and considerate; every glance and gesture showed how she cared for her boyfriend. But the boy was shy; though immersed in the happiness of love, he was not as expressive as the girl. A fleeting trace of grievance would cross her face now and then, unnoticed by this obtuse boyfriend.

As I passed them, I struck up a few words with the boy under the pretext of asking for directions. Zizhuyuan Park is a place I know better than well; I have spent over twenty years in this park and the National Library next door. So far, more than half my life has been lived and worked around here, and I know every path in the park. I simply wanted to take this chance to offer the boy a few words of warning, telling him his girlfriend needs more care and affection, because she may be overly sensitive, easily hurt, and prone to mood swings.

The boy asked, a bit startled, how I knew his girlfriend was overly sensitive and moody. I told him I was a doctor, and advised him to go back and learn something about fearful-avoidant attachment and anxious attachment, so he could better help his girlfriend stabilize her emotions and ultimately heal her anxiety.

Reading has made me increasingly adept at recognizing human physical and mental illness. This girl belongs to Cluster B personality types; she may already have one of the Cluster B personality disorders, or may only show a tendency. But deep within her, where ordinary people cannot detect it, there is much anxiety, unease, and depressive pain. Her life must have involved some traumatic stress; her caregivers may not have given her much security, which is why she behaves so humbly and anxiously in intimate relationships.

Such people make up over 10% of the general population; the most severe among them, borderline personality disorder, has a prevalence of 1.9%-5.9%. On a weekend, Zizhuyuan Park holds several thousand visitors. At that prevalence, there are perhaps dozens to a hundred such patients in this park. The suicide rate among these patients is 400 times that of ordinary people, and 73% of them have attempted suicide multiple times.

Diagnosing and treating them is extremely difficult, and caring for them often exhausts their families. Many of them are impoverished and sick, with no money to see a doctor. In the United States, many medical experts are calling for such patients to be classified as psychiatrically disabled, with social welfare funds covering their costs.

Zizhuyuan Park is one of Beijing's largest free parks. In other corners of the park there are group after group of practitioners of Guo Lin Qigong; most are diagnosed cancer patients, fighting the disease through every means and snatching their lives back from death. There are also others not yet diagnosed but, in the eyes of us doctors long used to cancer, already not far from diagnosis. In first-tier cities about one-third of the population dies of cancer, so many people in this park either already have cancer or are walking the road toward it. They will eventually be tormented by this despairing disease.

If I calm down and observe the people around me, I can see many problems in their faces, complexions, and every movement. I especially want to switch off this professional faculty I have trained through study, because it often lets me see the deep suffering of others and makes me grieve for their misfortunes. The more one knows about human misfortune, the more easily one is affected by the suffering of others.

Fortunately, most of the time when I walk in the park I am in a state of contemplation and do not pay attention to the movements of those around me, only noticing occasionally. Were it otherwise, I think I might be affected by others' misfortunes every moment.

Disease is the most painful thing in this world. Psychological counselors and clinicians are more prone to vicarious trauma than ordinary people, because they witness far more suffering. In the counseling profession, therapists must have supervision hours; one major function of supervision is to relieve the negative emotions counselors themselves accumulate from work. Doctors too need regular similar processing, or the negative emotions built up at work find it hard to find an outlet.

Every day we deal with modern people with both physical and psychological problems, and this profession sharpens our intuition about disease. Away from work and back in life, we can still observe health problems in those around us at any time. The more learned the doctor, the greater his ability to recognize disease and the more opportunities he has to perceive others' pain. Without sufficient psychological resilience, this professional sensitivity is a disaster for us. We need to grow a thick callus on our hearts, to become somewhat numb to human suffering. At the same time we must develop our own hobbies and shift our attention, so we can live more happily.

Medicine is a humanitarian enterprise. Although some doctors have indeed violated the humanitarian spirit, many still follow it. Humanism advocates putting people first and respecting human dignity and rights. Humanitarians uphold the values of liberty, equality, and fraternity, and stand for equal personality and mutual respect. Humanitarians value respect and care for the individual, holding that everyone should be treated equally regardless of social status, race, gender, sexual orientation, and so on.

So whether it is psychological counselors and psychiatrists treating mental illness, or clinicians treating physical illness, in essence all should feel compassion for patients and treat patients and their families with an attitude of holding and containing. A qualified doctor, in dealing with patients, should be as gentle, generous, and tolerant as possible, should sympathize with, understand, and accept patients, and use his professional knowledge to help them.

I myself have in the past been angry at some patients' conduct, but after learning more psychiatry, I have found that most patients who displease us may, beyond the main disease they come to us to solve, also have comorbid psychiatric disorders. Their plight deserves sympathy; the ideal doctor should be able to understand them, forgive them, and help them escape all this suffering as far as possible, because the social mission of the medical profession is to relieve patient suffering.

But this ideal state is very hard to attain. Most doctors, myself included, are limited by their own character and knowledge and fall far short of the ideal, though that ideal remains the goal I pursue.

Doctors must cultivate their inner spirit. I believe a doctor can ultimately help patients without harming himself only when he has cultivated both the Four Immeasurables advocated by Buddhism (loving-kindness, compassion, sympathetic joy, equanimity) and the Daoist state of letting nature take its course. There is indeed too much suffering in this world, and disease is the foremost. Patients seek doctors when ill; sometimes doctors can solve their problems and sometimes cannot. But in any case we should offer help and comfort.

Yet we have only the ability to "cure sometimes, help often, comfort always," not the power to end the suffering of all beings. So while feeling compassion and tolerance for patients, we should also lay down the pressure that this compassion places on ourselves. We must accept all bad outcomes of medical care and regard the suffering of living beings as an unavoidable law of nature. Otherwise, a doctor's inner self will sooner or later collapse.