Meditation and the Practice of Clinical Medicine

This is an interview that I did with Daniel Ingram, a meditator and former ER physician whose book, Mastering the Core Teachings of the Buddha, I first read in about 2010. I had wanted to talk to him for many years about a number of topics, and when I reached out to him, he graciously agreed to talk to me for a couple of hours. What we ended up with is a combination of fanboy interview and back and forth discussion about a wide range of topics, centering around the relationships between the practice of clinical medicine and the practice of meditation, including some side journeys into talking about trigger points. You can listen to it as is, or you can read a little more below to get some background on some of the more technical terms we use when we are talking about meditation.

One last thing before we get started: Daniel wanted me to make sure I gave a disclaimer to anyone listening. So I will simply quote one of the last things he says in the interview:

“Just make sure you give an appropriate qualifier that you need to practice within the scope of your own license and take responsibility for your own decisions. Some dude on the web, or whatever, like, is just some guy, but you need to maintain proper professional standards and take everything I said with an appropriate grain of salt.”

One more last thing . . . if you are not familiar with the technical terminology used in Theravada Buddhism to describe the stages of meditative practice, you might want to read the brief description of some of them down below before getting too far in the interview.

One of the topics we discuss in some detail is the fact that when people start training in meditation (or in any form of attention training, and sometimes just spontaneously), they tend to go through fairly predictable stages of experience, regardless of the tradition they are in. Daniel has spent many years talking about the map of these stages as they are described in the Theravada Buddhist tradition, which is the main tradition that he trained in. The topic is somewhat controversial in modern meditation circles, as there are quite a few different maps, depending on the tradition, and there are quite a number of teachers who feel that talking about the various map theories of meditative experience is a bad idea.  

We go straight into the discussion about maps without much preparation, so I thought it would be helpful to define a few technical terms used to describe the stages of meditation for the benefit of those of you who don’t have any formal training in Buddhist terminology. The following terms are ones that come up in the conversation, and they describe some of the first few stages of progress in meditation in the Theravada Buddhist tradition:

1.       Mind and Body – a generally pleasant state where you first learn to differentiate physical sensations from mental sensations and thoughts. This is what most people mean when they use the term “mindfulness meditation.”

2.       Cause and Effect – the difference between mental and physical phenomena become more clear, as does their relationship (such as between intentions to act, and the actions themselves), on a number of levels. As this stage develops, the relationship between phenomena can seem to become more mechanical or jerky.

3.       The Three Characteristics – in this stage, meditators start to notice the three aspects of phenomena that define our experience in Buddhist philosophy: nothing lasts, nothing will ever provide a lasting sense of satisfaction (alternately, everything will eventually be the cause of suffering), and nothing has any inherent, independent existence (or “self”). This can be a physically and emotionally unpleasant stage with varying degrees of bodily and psychological tensions and pains.

4.       The Arising and Passing Away (aka “The A & P”): in this stage, meditative practice kicks into high gear, and people often have various very impressive physical or spiritual experiences and increased perceptual abilities, often involving explosions or bright lights. This stage doesn’t last, and is followed by a series of challenging stages named for what people experience as they go through them: Dissolution, Fear, Misery, and Disgust. These more challenging stages are what Daniel refers to as the “Dark Night” stages of spiritual practice.

There are more stages after this, leading up to various experiences of spiritual awakening, followed by more repetitions of the whole cycle, but these first four stages are the ones we refer to in the interview.

Official bio:

Dr. Daniel M. Ingram, MD MSPH is a board certified emergency medicine physician who practiced clinically and taught medicine for 12 years, mostly in large emergency departments.

 Daniel has been having meditation-related experiences since he was a child, and started formally meditating and going on retreats in 1994.

 He is the author of Mastering the Core Teachings of the Buddha, available for free at www.mctb.org, and co-author with Shannon Stein of The Fire Kasina. He runs a website dedicated to open discussions of meditative experiences, techniques and theory at www.dharmaoverground.org, and co-runs www.firekasina.org. His personal website is www.integrateddaniel.info.

 He is interested in the deep end of meditation practice, the maps of meditative terrain, phenomenology, researching the positive, negative, and unusual effects of meditation, and living a useful life.