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An anthropologist once questioned a native Alaskan shaman about his tribe’s belief system. After putting up with the anthropologist’s questions for a while, the shaman finally told him: “Look. We don’t believe. We fear.”

In a similar way, Buddhism starts, not with a belief, but with a fear of very present dangers. As the Buddha himself reported, his initial impetus for leaving home and seeking awakening was his comprehension of the great dangers that inevitably follow on birth: aging, illness, death, and separation. The awakening he sought was one that would lead him to a happiness not subject to these things. After finding that happiness, and in attempting to show others how to find it for themselves, he frequently referred to the themes of aging, illness, death, and separation as useful objects for contemplation. Because of this, his teaching has often been called pessimistic, but this emphasis is actually like that of a doctor focusing on the symptoms and causes of disease as part of an effort to bring about a cure. The Buddha is not afraid to dwell on these topics, because the awakening he teaches brings about a total release from them.

This study guide provides an introduction to the Buddha’s teachings on aging, illness, death, and separation. The passages included here—all taken from the Pali Canon—are arranged in five sections.

(1) The first section presents medical metaphors for the teaching, showing how the Buddha was like a doctor and how his teaching is like a course of therapy offering a cure for the great dangers in life.

(2) The second section diagnoses the problems of aging, illness, death, and separation. This section touches briefly on the Buddha’s central teaching, the four noble truths. For more information on this subject, see The Path to Freedom and the study guide, The Four Noble Truths. See also the articles, The Weight of Mountains, Five Piles of Bricks, and Untangling the Present.

(3) The third section contains passages that use aging, illness, death, and separation, as reminders for heedfulness and diligence in the practice. The central passage here is a set of five recollections, in which recollection of aging, illness, death, and separation forms a background for a fifth recollection: the power of one’s actions to shape one’s experience. In other words, the first four recollections present the dangers of life; the fifth indicates the way in which those dangers may be overcome, through developing skill in one’s own thoughts, words, and deeds. Useful articles to read in conjunction with this section are Affirming the Truths of the Heart, Karma, The Road to Nirvana is Paved with Skillful Intentions, Faith in Awakening, and The Practice in a Word.

(4) The fourth section contains passages that give specific advice on how to deal with problems of aging, etc. The Buddha’s teachings on kamma provide an important underpinning for how problems of pain and illness are approached in this section. Given the fact that the experience of the present moment is shaped both by past and by present intentions, it is possible that—if an illness is the result of present intentions—a change of mind can effect a cure in the illness; but if the illness is the result of past intentions, a change of mind may have no effect on the illness but can at least protect the mind from being adversely affected by it. Thus some of the passages focus how practicing the Dhamma can cure a person of illness, whereas others focus on how the Dhamma can ensure that, even though a person may die from an illness, the illness will make no inroads on the mind. A useful article to read in conjunction with this section is Educating Compassion.

(5) The fifth section gives examples of how the Buddha and his disciples skillfully negotiated the problems of aging, illness, death, and separation.

The Buddha as Doctor, the Dhamma as Medicine

  • 1. This was said by the Blessed One, said by the Arahant, so I have heard: “I am a brahman, responsive to requests, open-handed, bearing my last body, an unsurpassed doctor & surgeon. You are my children, my sons, born from my mouth, born of the Dhamma, created by the Dhamma, heirs to the Dhamma, not heirs in material things.

—Iti 100

  • 2. “Both formerly & now, it is only stress that I describe, and the cessation of stress.”

—SN 22:86

  • 3. Once the Blessed One was staying at Kosambi in the simsapa forest. Then, picking up a few simsapa leaves with his hand, he asked the monks, “How do you construe this, monks: Which are more numerous, the few simsapa leaves in my hand or those overhead in the simsapa forest?”

‘The leaves in the hand of the Blessed One are few in number, lord. Those overhead in the forest are far more numerous.”

“In the same way, monks, those things that I have known with direct knowledge but have not taught are far more numerous [than what I have taught]. And why haven’t I taught them? Because they are not connected with the goal, do not relate to the rudiments of the holy life, and do not lead to disenchantment, to dispassion, to cessation, to calm, to direct knowledge, to self awakening, to unbinding. That is why I have not taught them.

“And what have I taught? ‘This is stress … This is the origination of stress …

This is the cessation of stress … This is the path of practice leading to the cessation of stress’: This is what I have taught. And why have I taught these things? Because they are connected with the goal, relate to the rudiments of the holy life, and lead to disenchantment, to dispassion, to cessation, to calm, to direct knowledge, to self-awakening, to unbinding. This is why I have taught them.

“Therefore your duty is the contemplation, ‘This is stress … This is the origination of stress … This is the cessation of stress.’ Your duty is the contemplation, ‘This is the path of practice leading to the cessation of stress.’”

—SN 56:31

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