How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers by Toni Bernhard and Sylvia Boorstein, Wisdom Publications (September 14, 2010), 216 pp. ISBN-10: 0861716264. The book is available in paperback and Kindle edition.

Toni Bernhard is a practicing Buddhist and an author with a background in teaching. Ms. Bernhard was a law professor at the University of California-Davis for almost twenty years and served as the dean of students for six years before she had to retire due to illness.

The purpose of this book is to reassure other people who have become ill that despite their illness that they can optimize the life they have.

The book is organized in five main sections.

How everything changed

In the first section, How Everything Changed, Toni Bernhard writes about how she became ill and about when she realized that she was not going to recover. Faced by this challenge, she turned to the teachings of the Buddha to help her learn how to be sick; she had begun her study of Buddhism in the early 1990s. She became ill while on long-awaited trip to Paris in 2001 and before long, she was besieged by gamut of diagnoses: CFS, CFIDS, ME, PVS, VICD, OI, and POTS (acronyms which are readily recognized by our patient community). While the author uses her experiences, insights, and knowledge of Buddhism for coping with illness and associated losses or limits, she states her book is intended to help all of us find peace and well-being despite our circumstances. This book could have been just as easily called "How to Live Life More Fully."

Accepting pain

To better understand how Buddhism helped Ms. Bernhard cope with illness, it is worth taking a quick look at the primary teachings relating to the "three marks of existence" which form the basis of many other practices. These are described as suffering, impermanence, and no-self, which the author discusses in the next section, Accepting Pain.

Suffering is an aspect of our existence and is experienced by all beings. Suffering also applies to circumstances that are unsatisfactory or unpleasant, those that may cause anguish or stress, or result in change or illness. The author describes suffering as bearing life up from underneath (meaning that much of our suffering comes from our inner responses to our life situations) and explains how it is possible to change one's view and approach, which in turn, may ease one's misery. She also points out how someone's relentless quest to avoid suffering may actually generate more suffering.

Impermanence is a concept that regards everything as being transient or in a state of flux. Impermanence is a necessary part of life in order for all living things to grow and develop. Time passes on no matter what happens. The author sums up this concept by saying, "Anything can happen at any time." One of the comparisons given by the author for this teaching is the weather. In life, many situations may arise and then pass by; it is important for people to learn how to take comfort in the calm or brighter moments after the storm.

No-self is a complicated concept that departs from the traditional notion of an individual being a permanent self or soul, with a limited identity, and staying the same throughout their life. In Buddhism, an individual is viewed as the collective result of his or her feelings, perceptions, awareness, and other aspects which continue to change with each experience. The author remarks that, "Experiencing no-self lifts a burden and brings a sense of spaciousness and freedom to everyday life."

Finding joy and love

Ms. Bernhard devotes the segment, Finding Joy and Love, to the principles of "sublime states" which have to do with loving-kindness, compassion, sympathetic joy, and equanimity. When people are able to wish both themselves and others well; reach out to those who are suffering, including themselves; feel joy in the joy of others; and keep a peaceful mind in all circumstances, then their lives become more enriched. The author admits these practices may be very challenging, but over time, people may view their lives more positively and develop a more wholesome attitude. This in turn may help to ease their suffering by the compassion they cultivate for themselves and others. She acknowledges that it is very difficult to maintain composure when dealing with insensitivity, uncertainty, and instability, especially by those with chronic illness. People have a tendency to want to have their desires fulfilled and they often attach themselves to the outcome. If people's happiness depends on their desires, they are much more likely to set themselves up for suffering. When people learn to let go, be more accepting of life as it comes without blaming anything or anyone, and find things to be grateful for, they may cope better with the losses and erratic nature of the illness.

Turnarounds and transformations

The next six chapters, Turnarounds and Transformations, describe strategies which can promote positive change and improvement. Examples of these strategies include becoming more mindful about one's reaction to unpleasant sensations; approaching one's pain and suffering and that of others as a path to compassion; examining thoughts that could cause suffering; living in present moments; avoiding extremes and seeking the middle ground; and exploring Zen.

From isolation to solitude

The last section, From Isolation to Solitude, draws attention to how to communicate wisely and better deal with isolation. The final chapter consists of the author's reflection about her life—that it is perfect, just as it is.

Toni Bernhard effectively communicates her experience of chronic illness on her life—the suffering, many losses and limits and her use of Buddhism as a way to cope with illness and accept her life. Her main message is that people will do better by accepting their illness and develop strategies to live with it rather than deny it. The majority of ME/CFS patients might find it difficult to grasp and follow the many practices and teachings described in the book, depending on the severity of their illness. One advantage the author has is her familiarity with Buddhism which she studied more than nine years prior to the onset of her illness. She also had the good fortune of enjoying a good career and lifestyle prior to becoming ill, which may place her in a more advantageous position than many ME/CFS patients who often live in survival mode, alone and on a fixed income. In these ways, this book is the story of Ms. Bernhard's life and her experience with illness with the knowledge and options available to her.

In conclusion, How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers may encourage patients to rethink their lives and learn ways not to become entrenched in a "sick person" identity. A few recurring concepts in the book such as a person's ability to live, let go and accept shortcomings in his or her life without regret or blame and maintain a peaceful mind at all times may illustrate the potential of the teachings and techniques of Buddhism over a period of time.

Some readers may find the philosophy of Buddhism contradictory to their existing beliefs and traditions and might find it difficult to really connect with the teachings. How easy and helpful this book will be across-the-board may greatly vary among patients, but it's worth exploring to best of one's abilities.