Let Your Pain Be a River: Vidyamala Burch on Living and Teaching With Chronic Pain

Based out of the UK, Vidyamala Burch is an award-winning teacher whose courses and work in the field of mindfulness and pain management have been recognized for the measurable ways they have served the common good. She recently launched a new program, HEALS, which offers a comprehensive, holistic approach for managing and living with chronic pain and illness.

As a writer who loves interviewing, I came to my conversation with Burch with my list of questions and a healthy dose of journalistic curiosity. I felt a little starstruck to get to meet her. 

If I’m honest, though, these weren’t the only things I brought, because this conversation also felt personal.

So many people I know, myself included, have had experiences living with chronic pain and illness. I was nearly 40 years old when I finally found healing from more than 20 years of recurring and increasingly debilitating low back issues. I have many friends, some just in their 30s or 40s, who deal with fibromyalgia, chronic fatigue syndrome, recurring migraines, and other adrenal and nervous-system challenges.

My mother survived polio as a young child and lived with relentless chronic conditions for her entire life as a result. She passed away suddenly a decade ago, at the young age of 67. Polio wasn’t technically the thing that killed her, but I knew from many conversations with her in her final years that the long slogging decades of complications, disability, and pain made her long for relief. I was with her when she took her last breath, and I felt the surrender in her body, finally.

To suffer ourselves, or to watch people we love suffer over long periods of time, often without real answers or effective treatments—the questions that bubble up aren’t academic. They sit close to the bone and the heart.

Why did this happen?
Why did it go on for so long?
Why does it feel so lonely?
Where do these ailments come from, and why are they often so mysterious and so intractable, even in the face of intense medical interventions?
Can practices like mindfulness really offer anything meaningful into this complicated, messy world of living with chronic illness and pain?

Yes, I wanted to talk to Vidyamala, the expert on mindfulness and pain management. But I also didn’t want to waste the opportunity to talk to Vidyamala, the human being who has traveled this long road herself, and who understands intimately that the clinical ways we think and talk about physical suffering can’t meet us fully where we need to be met.

 The clinical ways we think and talk about physical suffering can’t meet us fully where we need to be met.

Siri Myhrom: I’m curious about where the HEALS Program got its start for you. How do you see it as unique from and also working together with your other programs?

Vidyamala Burch: I developed Mindfulness for Health, which is our eight-week mindfulness program for people living with chronic pain and long-term health conditions. So the seeds for HEALS were way back in 2000, when I started running that [Mindfulness for Health] as an experimental course in 2001.

In my own experience as somebody who’s lived with chronic pain and disability for nearly 50 years now, mindfulness has been absolutely crucial to that journey because my life, my quality of life now, is really pretty good, notwithstanding my disability.

So mindfulness is foundational. And when I look at my own journey of reclaiming my quality of life, I realized that it was mindfulness-plus. So what I’ve done is I’ve worked on my nutrition. I’ve worked on how I move. I’ve looked at my sleep habits. I try to have time in nature. So if I looked at what’s worked for me, it was mindfulness plus these other dimensions. I felt that it would be really helpful to come up with an applied mindfulness program. 

This is my vision, that people come through either doorway. You might come through the HEALS doorway or you might come through the Mindfulness for Health doorway. I see them as definitely complementary and as two doorways into the same room.

SM: Mindfulness talks a lot about awareness, and I have a question around that that’s maybe more personal. The people I know who live with chronic pain would likely say, I’m already very aware of my pain. I’m curious how you understand that word awareness, especially within a mindful context, and how does that serve to alleviate the suffering, rather than creating a focus on it?

VB: That’s an excellent question because it’s very counterintuitive. People might think, I’m very, very aware of it. And I don’t want to be more aware of it. And maybe people might think, The last thing I want to do is become aware of my body. My body is my tormentor. I want to just split off from my body.

So those are all very reasonable things to think about. What we do is right up front in both Mindfulness for Health and HEALS, we talk about how by using awareness, you can investigate this experience that you label pain. Investigate that and realize that it’s got two components. One component is your basic unpleasant sensations.

The other component is all things that you do to create extra suffering when you resist those basic unpleasant sensations. What most people call pain would be that whole set of sensations, plus resistance, plus depression, plus anxiety, plus secondary tension, plus breath holding, plus poor sleep.

Most people think that’s what their pain is. But actually, the only thing that’s a given in any moment are the unpleasant sensations. Everything else is added through our reactions. So you’re learning to accept the unpleasant sensations with kindliness, tenderness, to soften the resistance, and a lot of that secondary stuff can fall away. You’re just left with unpleasant sensations. People find that a very optimistic message.

We put that right up front in all our programs. Week one, we talk about primary and secondary suffering. The other thing about awareness that we really strongly emphasize— again, in week one—is that it’s awareness that gives us agency. If we’re aware, we have choices. If you’ve got no choices, you know, you’re just swept along by this thing that’s ruining your life as if it’s a kind of enemy.

Awareness doesn’t make it pleasant. I think this is one of the ways people misunderstand this: that if I’m mindful, I’m aware, then suddenly I’m going to love my pain. You probably aren’t, because your pain is unpleasant, but you’re going to learn to relate to the unpleasantness with much more spaciousness, much more kindliness, more acceptance. 

One of the things I say is by coming closer and examining this experience, you realize it’s a process, not a thing. One of the ways I talk about that is to experience it as a river rather than a rock, because everything is changing all the time. Most people relate to their pain as a solid lump, like it’s a big boulder that’s kind of taken up residence. But it’s amazing to be able to experience it as a river rather than a rock. Just let it flow through the moments and then have this less-reactive mindset. That’s very liberating. 

SM: Do you attract people who already have experience with mindfulness, or is it a mix of people?

VB: I iteratively develop my programs with potential audiences. The first one was a six-week program with people who know about mindfulness, who have a health condition and have worked with us before. I really wanted them to have a sense of co-creation. They gave me lots of feedback. Out of that, I made it longer, 10 weeks. 

My second cohort was with people who didn’t know anything about mindfulness, but did have a health condition. It was people who were recruited from a cancer charity and a fibromyalgia charity, and that was very interesting as another test case. It went down very well with both those audiences. 

Then the third pilot was with physicians from a primary care medical center. A lot of them didn’t know anything about meditation, didn’t have a health condition, but were trying it out for themselves, thinking about their patients. Again, very positive feedback. So I feel confident now that you don’t need to know anything about mindfulness to do this program. 

SM: Where does HEALS fit into general medical care?

VB: I don’t know what it’s like in the States, but certainly over here there’s a crisis in our healthcare system—not enough money, aging population, multiple chronic health conditions. 

Western medicine is particularly good with acute care. But with multiple chronic conditions all happening at the same time, Western healthcare isn’t brilliant. There’s more of a move towards a recognition that lifestyle has an enormous impact on our health and well-being, particularly with people being sedentary, eating a poor diet, scrolling on their phones late at night, not being able to sleep, all these kinds of things. There’s a whole field emerging of what’s called lifestyle medicine over here, which is called integrative care in the States. So we’re very well placed to be able to offer this program. 

What’s unique about our program is that it’s got mindfulness as the foundation. I think a lot of people know what they should be doing for their health and well-being. They’ve got the information, but they don’t know how to make it stick. So my thesis is that mindful awareness is really crucial to that, because you have to know what you’re experiencing to have some facility and agency, instead of just being swept away by habitual behaviors. These people in general practice who tested the program said, “You’re absolutely on the right track. You’re ahead of the field. Keep going.”

SM: I notice, again relating to other people I’ve known with chronic conditions, that there’s an emphasis on tiny steps. Why is that effective?

VB: This has come out of my experience, and what I’ve observed is that a lot of people think you need to make big changes all at once—get another job, change your diet, change the way you exercise. When you do these big changes all at once, you don’t sustain any of them. You don’t know what’s affecting what because you’ve changed too many variables all at once. Very often you just need to change a tiny thing. In the program, I use a model called Tiny Habits, which is developed by B.J. Fogg. It’s a lovely model where you have a prompt, a behavior, and a celebration.  

For example, for me to do a little bit more strengthening in my arms outside my office, I’ve got some straps. Every time I go in and out my office door, that’s the trigger. I go to my straps. It might be three to five movements, just a few. That’s the behavior. Then the congratulations, and you get a little dopamine hit, and then you’re going to want to do it again.

One of the things I’ve really learned from my own life, and this is a very important point, I think, is that you can bring about major transformation through tiny little nudges across a broad front for a long time. I always say to people that we won’t do any of these things perfectly, but if you’re doing all of them adequately, you’re going to experience change. 

SM: It looks like the most recent cohort for HEALS is October 25th? Is that right?

VB: Yes, the first course booked out in 24 hours. That seems to be going very well. One of the things we’re doing in this program is using buddy groups testing. We divide into groups of four or five people based on geography. They decide for themselves how they want to keep in touch. Most of them are using WhatsApp. The idea is that they will contact each other daily, ideally so they can let people know how they’re getting on.

SM: Is the buddy system partly addressing the sense of isolation that can come with being in pain?

VB: Yes, I think so. Also, with these online programs, it helps to have something that’s more intimate, a daily reminder so that people are really forming connections. I think that’s very helpful in this tiny-habits method for behavior change.

SM: If someone came to you looking for help, but they were feeling skeptical, how would you describe this work in a way that would open up the possibility for them? 

VB: We’ve used validated questionnaires in our three pilots and we’ve got hard data. Doing this work has measurable results. It makes people catastrophize about their pain less. It makes people able to function better in daily life. They’re less depressed, less anxious. 

For people who live with chronic pain or health conditions, I say just try it and see what you think. You can have your pain and your illness and be miserable and have a very difficult life. Or you can have your pain and illness and be happier and have a more fulfilling life. So which one would you rather have? 

By doing these very simple, evidence-based approaches, we know that it can help you reclaim your life. It doesn’t take long, 10-15 minutes a day, with a very supportive group for 11 weeks. We know that people are experiencing quite a strong improvement in quality of life. So it doesn’t seem like a big risk. It’s training and getting your mind working with you rather than against you. Most people don’t even realize that their mind is working against them. In the untrained mind, 75% of our thoughts are negative. It’s staggering. 95% of our thoughts, we’ve had before. We’ve got the same old undermining rubbish, just going around and around like the spin cycle on a washing machine, and you can do something about that. You can do something about it through these small changes across a broad front. 

Would that be convincing to you if you were skeptical? 

SM: Well, I dealt with chronic low back pain for about 25 years. I went to all kinds of different doctors. I tried all sorts of different modalities, and it was not an uncommon experience to go to an allopathic doctor and kind of feel like they don’t quite believe you. Especially in the US, there’s a tendency to prescribe opiates or recommend surgery, which I knew had a very low success rate. 

For me, finding contemplative practice really did make a difference. But I think being able to speak to the exhaustion is important, because a lot of people who have been dealing with chronic issues, especially for a long time, it’s not that they want to give up. It’s that they’ve already tried 10 or 15 different things that haven’t worked.

VB: Yes, absolutely. Something we do at Breathworks is we believe people first, because I’m not interested in your diagnosis. I’m interested in your experience. With chronic health conditions, it’s sometimes hard to get a diagnosis. People are often not believed, and it’s awful. If someone says they’re suffering, I believe them. I think it’s really important that it’s an experience orientation rather than a diagnostic orientation.

We all have our habits of sort of resisting and fighting our experience. We can all learn to be more at peace with whatever’s happening. In my own case, you know, I’ve still got disability, I’ve still had all the surgeries, I’ve still got pain, but my overall pain has massively improved. 

SM: Yes, being with people who can just be with you and see you—that in itself is humane and tender and can initiate healing.

VB: Absolutely. One of the things that we hear again and again at Breathworks is that there’s a quality of lightness. One woman who came back the second week said, “I feel I’m learning to laugh again.” 

She’d done awareness practice. She was in a lot of pain, had a difficult life, quite a lot of sadness, I think. It wasn’t like, Well, I’m becoming more aware. It was, I feel I’m ready to laugh. 

I thought, that is so good, because we have a big group of people, many of them with really difficult circumstances. If we can help them find a way to bring some lightness into how they deal with their heaviness, they’re getting a great gift. I think particularly when one lives with difficulty, it is healing to find a way to relate to it in a more light, but not trivial way.  

SM: In the process of discovering meditation and studying more deeply, did you have a moment where you thought, I really want to teach this to other people? Or did it happen in a more subtle way? 

VB: I always go back to when I was 25 in intensive care in hospital, and I had this really big experience about the present moment, which changed my life. I knew that my pain was only happening one moment at a time and that most of my torment was about the future or the past. 

That’s the very short version. I thought, I really, really want to figure out what it means to be present. How can I train in that, and how can I train my mind?

And interestingly that experience rose up out of hell. It was not an experience that happened in the bliss of a meditation retreat. No, it was an absolute existential kind of moment. 

I had a social worker who was wonderful. She got me some tapes in the library, sort of beginning to meditate. I became a Buddhist a couple of years later, moved to England to live in a retreat center, and I was finding as I wasn’t really getting much guidance on how to meditate in the painful body. There weren’t many people around who seemed to know how to do that. I was always having to figure it all out for myself. People were very kind and very helpful, but the specifics of, how do you meditate when your back is absolutely screaming? It was a really hard thing to do. 

Gradually I worked out how to do that with the help of Jon Kabat-Zinn. Actually, when I came across his book Full Catastrophe Living, that was massively helpful. I realized that I needed to learn to tend towards my experience and soften around it and release all this kind of extra suffering that I’m bringing through my evasion and my craving, really in my grasping for a different experience and my aversion to this experience. 

With those two things together, I figured something out here, painfully and slowly over decades. And there’s going to be lots of other people like that young woman in hospital in intensive care, not knowing what the hell to do. There wasn’t any medical solution for my spine at that point. It was just like, we’re going to have to learn to live with it. 

That’s why I wanted to teach, because I wanted to offer these to other people who were in  the situation I was in so they didn’t have to have this 15 years of long, lonely journey. I was surrounded by incredible friends, and people couldn’t have been more supportive—but the specifics of how to meditate with pain, I wasn’t getting much. 

When I started, I just wanted to help people. Now, 25 years later, I just want to help people. It’s a very, very simple motivation. And if I can help one person suffer less, that’s my journey. 

When I started, I just wanted to help people. Now, 25 years later, I just want to help people. It’s a very, very simple motivation. And if I can help one person suffer less, that’s my journey.

SM: And it seems like it’s working. The response is there.

VB: It’s just very meaningful. It reframes all my suffering. More importantly, it helps others. 

And what I really love about Breathworks and the HEALS program is, it’s not rocket science. It’s not some sort of advanced, metaphysical, complicated teaching. It’s: Be present. Know what’s happening. Let go of aversion and clinging. Release into the flow of love. Breathe and breathe out. And relax your bum. That’s my highest teaching now: Relax your bum. 

That’s the whole. That’s it. You don’t really need much more than that. It’s very practical, very pragmatic. You don’t meditate to have a good meditation. You meditate so that you can cope with the moments in your daily life with a little bit more ease and grace and kindness and connection with others. 

You don’t meditate to have a good meditation. You meditate so that you can cope with the moments in your daily life with a little bit more ease and grace and kindness and connection with others.

People quite rightly say, It saved my life, and I know it saved mine.