Skillful Ways, Skillful Means
About two years ago I was diagnosed with the blood cancer multiple myeloma (MM). At the moment no one knows what causes it, nor how long you’ll be able to live a quality life should you be diagnosed, and receive timely and adequate treatment. There’s no cure. I was diagnosed when it was at an advanced stage. Today, I am on maintenance medications, with no trace of the cancer detectable in my blood. That’s really cool. And I’m truly grateful.
Part of my recovery came from learning about the disease, and alternative approaches to overcoming the cancer, along with the standard infusion and chemo therapies. I discovered MM impacts American Black people like me who get the disease more often, and we get the worst treatment with the poorest outcomes. That also holds true for other cancers as well. In this article in PART I, I’m going to talk a tiny bit about history but quickly move on to PART II and discuss ways that will be beneficial for American Blacks and others who might face this situation. To be clear, I’m not a medical professional. What I have to say here is based on my experience and meant to show how to change mindsets in order to help live a quality of life through Buddhist practices.
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Cancer Infusion Center, photo courtesy Carla Stalling WalterI’m suggesting here that we can utilize the Buddhist Noble Eightfold Path before and after diagnoses to help us through the entwined histories and consequences we find in our lives today.
The Noble Eightfold Path includes:
right view - drawing from the Four Noble Truths in understanding the nature of suffering
right thinking - creating wholesome intentions and points of view
right speech - speaking kindly, being honest, from a place of loving kindness
right action - engaging in ethical and non-harmful actions
right livelihood - being in a job or profession that doesn’t harm anyone
right effort - making a conscious effort to remove unwholesome thoughts, words, and actions
right mindfulness - taking time to understand our lives as they are
right concentration and meditation - keeping on the path so that your mind can be clear and calm
As you can imagine, each of these views can apply to multiple circumstances simultaneously. So first I’ll give a brief overview of how the impact of unavailable medical care has hurt certain people and then I’ll weave in five skillful actions we can take, that I have taken and continue to, that rely on the Noble Eightfold Path to provide a kind of added ancillary but critical medicine. My hope here is to help reflect upon ways to bring agency to health care with our bodies and minds. You might apply them in your own way or see more than one way. There are of course no guarantees of any outcome due to impermanence, yet we can take responsibility for our health by following simple steps to develop, follow, or stay on a path.
PART I
American Blacks and Cancer
In 2022, about 224,000 people died from cancer and about a third of them were American Black people. According to the American Cancer Society1 we have the highest mortality and the lowest survival rates when it comes to cancer. And for sure, the rate of MM diagnoses is on the rise for our population. Multiple myeloma occurs twice as often for us, and comprises 20% of all myeloma cases. Being overrepresented here means that the onset exceeds the percentage of American Blacks in the US population by about seven percent. We’re contracting the disease at younger ages on average, experiencing disparities in care, including delays in diagnosis and limited availability of cutting-edge treatments. American Blacks have more cancers and have greater barriers to cancer prevention, detection, treatment, and survival, due to policy issues and lack of health insurance, resulting from historical and current antiblack racism. American Black people have the highest death rate and shortest survival of any racial/ethnic group for most cancers in the US. American Blacks and people of color are many more times as likely than whites to get the disease and die more frequently.2
Why is this? Let’s Recall a Bit of History
Some folks in the medical system believe we’re inferior so we get worse care.3 Historically, American Blacks, people of color, and those that are poverty stricken have often received less than the best, or timely, medical treatments if any. That’s still going on these days too, through laws and policies that allocate resources in ways that harm members of certain groups.4 American Black women, men, and children are the most negatively impacted and those in LGBTQIAP+ groups even more so.
What are the health care systems that rely on policies and laws in administering care? Hospitals, emergency rooms, urgent care, nursing homes, addiction recovery centers, doctors’ offices, skilled nursing facilities or rehabilitation centers, physical and mental therapy clinics, cancer centers, infirmaries, surgical centers, and so on.
Unfortunately good medical care and medicines in the US are generally only available for those with adequate health insurance or with enough money, or with “friends and family who are doctors they can call,” or who can pay the price. Sure, certain organizations provide support for some of the costs of treatment, such as grants or pharmaceutical set-asides, or children’s hospitals. You have to apply for these. However, adequate health insurance that just provides it without having to jump through application hoops, includes coverage for not only chronic and acute illnesses like cancers, but also includes annual wellness evaluations, prevention, education, addiction treatment and mental health attention, for everyone on one’s insurance.
Photo by Ozkan Guner on UnsplashWe have to Change Views
One problem: a lot of people, especially American Blacks, don’t trust the medical or pharmaceutical industries. This stems from historic mistreatment, neglect, denial of American Blacks’ entrance to medical or nursing schools, and perceptions of inferiority created by and residing in a psyche of people suffering from antiblack racism. While these causes and conditions and collective karmic scars aren’t to be forgotten or ignored, it’s important to work with seeing our mindsets, our egos and unskillful thoughts, that may prevent us from getting the care, or giving it, that’s available. Many people in healthcare from various backgrounds, including my MM oncologist, general practice physicians, and other medical professionals, are aware of this history and reality and work against it, work to eliminate it and bring equity to it. But we must take the skillful path and apply the right effort to seek them out, avail ourselves of what they offer, to get the help we need. This could be considered a “right view.”
Along with getting the valuable medical support we need, some other “right actions” should be considered. These apply across all ethnic and social groups. Namely, how do we live before a cancer diagnosis? There’re several actions we can take to try to lessen the likelihood of getting sick, reduce suffering, and carry these forward into and beyond a cancer diagnosis (or other life limiting diagnoses) and treatment. A short list includes reducing negative chronic stress, embodying compassion, using mantras, meditating and dancing, and finding moderation in consuming. Many others can be added in concert with those, such as exercise, engaging with fulfilling social interactions, gaining feelings of belonging, laughter and play. Those are good topics for another article.
Five Ways of Supporting Your Health with the Noble Eightfold Path
1. Limiting or reducing chronic stress, the stress that arises from “reasons like adversity, depression, anxiety, or loneliness/social isolation can endanger human health.” Chronic stress is stress that is ongoing and hurts the body and mind. That stress is a very big deal in cancer, and there’s evidence of it being linked to some types of cancers. “Recent studies have shown that chronic stress can induce tumorigenesis and promote cancer development….”5
Many American Blacks and other people of color face over the top chronic stress during their childhoods and on through their lifetimes. It’s really important to address the fact that chronic stress can make life more difficult, can put you in unhealthy mental states which no one needs but particularly not after a cancer diagnosis. Chronic stress management is very critical in being proactive with your health.
Work is a stress producer, no doubt. The society we live in valorizes hard work for rewards, yet we know that in many cases, it’s a myth especially for American Blacks, people of color, and some in poverty. Finding “right livelihood” and time for rest and sleep within each day can support your wellbeing, and doing so can lower the risk of many diseases, including cancer.
Take short breaks during the day to let your mind and body rest. During those periods, be still and silent if you can and refrain from talking or thinking about your problems. Try to set up a sleep schedule so you go to bed and get up around the same time each day. Prepare your sleeping area so you can have peace and quiet. Stop using devices at least an hour or more before you lay down to sleep. Thich Nhat Hanh6 advised that we turn off all media all the time, stop watching violent and sexually abusive programs, and reduce our talking topics to those which are wholesome. Read up on why getting enough rest and sleep are important.
Yes, it’s true that we may feel we can’t stop working too much because “we got bills,” or fear of losing the job we have. How do we rest and sleep when this is the case? The answers will be different for everyone, however, they require changing thinking, letting go of certain cultural beliefs, setting healthy boundaries, and reevaluating needs and priorities. These open us to a different awareness, and are examples of taking “right action.”
2. If you can, hold the focus of being compassionate with yourself and others as a perfect gratitude and “right thinking.” Be grateful for calmness that comes from managing stress, and getting enough rest and sleep. Celebrate any good news you receive or tiny wins you have (like, I took a five minute break today, or I tried something different today). Focus on developing and offering a soft heart, kindness, and generosity especially when you feel agitated. I’m not saying ignore feelings or what not; appropriate responses are needed and important. I’m saying tune into the habit of holding compassion for yourself and others.
3. When you find your mind drifting to fear of the future or thinking of negative thoughts of the past, focus on a mantra. This could be a type of “right mindfulness.” This shift of focus can take some practice, since the mind likes to travel down well worn familiar, making us feel bad sometimes, paths! Take some time to get a few mantras memorized. They don’t have to be long, just a few words. Some people call them affirmations, but whatever you call them, get in a new habit: when those negative thoughts arise, be aware of them, and then shift to your mantra. At first it’s not easy but soon with practice you’ll find the mind is staying present, which is a great way to reduce stress. A list of mantras can be found here; if these don’t serve, write your own!
Cosmic Mudra, photo courtesy Carla Stalling Walter
4. Practicing Zazen and Dance Dharma are important to get the body moving and the mind engaged with it in the here and now, to be in “right meditation.” Zazen is sitting quietly, focusing on your inhale and exhale, not trying to get, do, or be anything. Sit with your eyes open, facing a blank wall, in the crosslegged position or in a chair or lying down, back straight, and hands in the Cosmic Mudra for a time.
You can start out slowly with a few minutes and then increase as you feel comfortable. Set up a daily schedule preferably before leaving the house to start your day. When Zazen has concluded, remain present and attentive as you connect movement to your daily activities.
Dance Dharma comes in many forms such as sacred dance or kinhin and allows you to continue to maintain the space which helps to connect you to Buddha Nature, and stay present. For example, if you reach for a glass of water, or brush your teeth, remember that you're dancing, present, and moving in space and time. Feel the space that you move in, and even though you might not see it, may not understand time, just acknowledge they’re there. Like the space between your eyes and this that you are reading. Do you see it? Mostly we just look through it, not acknowledging its being. But it’s definitely there, right? Do you see the space? Do you feel it on your eyeballs? Your skin?
5. Find moderation in eating foods that are prepared well, at home if possible. I know this can be a challenge for some! Yes, it may “take a minute” before you’re fully able (willing?) to prepare food at home, take your food for lunch or dinner if you’re not going to be home, depending on your situation. But it’s worth the time to get to that point. You might get a plan and set some boundaries. Yes, people may laugh at you, even accuse you in so many ways of betraying them. They feel loved when you eat their food or eat like they do! Just let that go. Get a few cookbooks or recipes. There are plenty available online or at the library. Try out different ways of preparing foods. You won’t like everything but that’s okay. Make enough for lunch the next day. This will take “right effort” for sure.
Reduce and try to eliminate eating ultra processed and packaged foods, as well as eating fast food. The hamburger isn’t giving you a break and that other one don’t “got the meat” you need! Anyway, these and other fast foods are generally loaded with extra salt, flour, bad fat, sugar and preservatives. Taken together, these can be addictive. In many cases ultra processed, packaged, and fast foods cause chronic inflammation which is a stress trigger for the body. Eating them can cause heart disease, cancer, type two diabetes, obesity, and digestive problems. Focus on getting enough low cholesterol proteins, and high protein plant based foods, enough fiber, such as whole or sprouted grains, beans, fruits and vegetables. Reduce eating beef, white bread, and foods that cause chronic inflammation which are associated with cancer and other debilitating illnesses.
As you eat, remember that you are moving, dancing the move, not just taking the process for granted. Where does the food come from? How did it get to you? What about the waste that you accumulate from eating? Where does it go? Do you remember the empty space you’re consuming in? Slow down and focus on breathing and breath, engaging your calm mind. But when you do eat, just eat. Put away the devices and just eat. It’s a bonus if others who are practicing better eating are present, either physically in the room, or virtually. And remember to hydrate: avoid all sodas, energy drinks, and intoxicants. Water, healthy juices, certain teas, these are all very good for the body and mind.
We can definitely use right speech in each of these five areas to voice what we need in loving and compassionate ways, to ourselves and others. We can use our hearts to inform our speech so we remember that everyone is suffering in some form or another. Being kind and gentle with our circumstances, saying encouraging words to ourselves and others, with no expectations, these are ways to give priceless gifts.
Following One Continuous Path
Even though at present people don’t know what causes MM, and we have historical and current policies in health care that are often less than optimal, in some aspects dismal, we also have ways of being and thinking that can address our individual and collective outcomes. This rings true regardless of who you are. Applying the Noble Eightfold Path as we remember the Four Noble Truths in our daily lives, and taking a few small daily incremental steps to change our mindsets, practicing Zazen and Dance Dharma, provide approaches that reduce suffering, for ourselves and others. I have found them to be very supportive in my understanding of and approach to living a quality of life in this world with MM.
Carla Stalling Walter, PhD, MBA, Author
Dance Meditation and Zen for the Black Cancer Patient , 2025
Sacred Dance Meditations: 365 Globally Inspired Movement Practices Enhancing Awakening, Clarity, and Connection , 2020
1American Cancer Society, Cancer Facts & Figures for African Americans 2019-2021, Atlanta, American Cancer Society.
2Kanapuru, Bindu. Analysis of racial and ethnic disparities in multiple myeloma US FDA drug approval trials. Blood Adv. Mar 22; 6(6): 1684–169, 2022. doi: 10.1182/bloodadvances.2021005482
3Geiger, H. Jack. Racial and Ethnic Disparities in Diagnosis and Treatment: A Review of the Evidence and a Consideration of Causes. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, edited by B.D. Smedley, A.Y. Stith, and A.R. Nelson, Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, National Academies Press, 2003. www.ncbi.nlm.nih.gov/books/NBK220337/;
Derman, B.A., et al. Racial Differences in Treatment and Outcomes in Multiple Myeloma: A Multiple Myeloma Research Foundation Analysis, Blood Cancer Journal, vol. 10, no. 80, 2020, doi.org/10.1038/s41408-020-00347-6.;
Cho Beomyoung, et al. Evaluation of Racial/Ethnic Differences in Treatment and Mortality among Women with Triple-Negative Breast Cancer, JAMA Oncology, vol. 7, no. 7, 2021 pp. 1016–1023. doi:10.1001/jamaoncol.2021.1254.
4Yearby, Ruqaiijah, et al. Structural Racism In Historical And Modern US Health Care Policy, HEALTH AFFAIRS VOL. 41, NO. 2: RACISM & HEALTH February 2022 https://doi.org/10.1377/hlthaff.2021....
5Dai, S., et al. Chronic Stress Promotes Cancer Development. Frontiers in Oncology, 10, 1492, 2020. https://doi.org/10.3389/fonc.2020.01492
6Hanh, Thich Nhat. Anger: Wisdom for Cooling the Flames, Riverhead Books, 2002
