A Lecture on the theme of Illness

Antiochus and Stratonice

I first came across this story from the vinaya (Vin i.301) and Sangharakshita's book A Guide to the Buddhist Path, and then later a fuller version in his talk: "A Case of Dysentery". I've always found it extremely moving. This is no allegory, and it is not ambiguous. Quite simply the Buddha requires that members of his community care for each other, most especially when they are ill. To not do so is a wrongdoing (dukkaṭa) - wrongdoing here is quite a literal translation. The text speaks for itself, so rather than saying much more, I'll simply give you my translation and add one or two comments at the end. 

The Pāli title of this passage is Gilāna-vatthu-kathā 'A lecture on the theme of illness', hence my title.

Lecture on the Theme of Illness

Once there was a monk who was afflicted with dysentery. He lay on the ground covered in his own shit and piss. The Lord was out on walkabout with Ānanda as his sidekick, when he approached the dwelling of that monk. He saw the monk lying in his own filth and went up to him.

"Monk", he asked, "what is wrong with you".

"I have dysentery Lord".

"Is there no one to care for you?"

"There is not Lord."

"But why not?"

"I don't do anything for the other monks, so they do not care for me," he told the Lord.

Then the Lord asked Ānanda to go and fetch some water so they could bathe the monk. Ānanda agreed and soon returned with water. The Lord sprinkled water over the monk, and Ānanda washed him. Then, with the Lord at his head and Ananda at his feet, they lifted him up and put him to bed.

Then the Lord called the monks together and questioned them.

"Monks", he asked, "is there a sick monk in that dwelling there?"

"There is Lord" they replied.

"And what illness does he suffer from?" asked the Lord.

"He has dysentery, Sir."

"Is there no want to care for him?"

"No, Sir."

"Why is that?"

"Well, he is useless, Sir. He does nothing for us, so we don't care for him", the monks explained.

"Monks," said the Lord, "you have no mother and no father to care for you. If you don't care for each other, then who will care for you? If you would care for me, then tend to the sick."

He went on to say: "If a preceptor is present then they should care for you until you are well, and remain with you until you are on your feet again. Or if an instructor is present; or a fellow practitioner; or a pupil; or someone with the same preceptor, or the same instructor, they should care for you until you are well and remain with you until you are on your feet again. If none of these are present then you should be cared for by the community. If you are not cared for it is an offence of wrongdoing."

My translation is a mix this time - at times I go for modern idiom, at times I'm more conservative. The Pāli is not very fancy, and only gives the bare bones. I've tried not to elaborate on it too much, though I think it could stand a dramatic retelling.

The passage continues on to describe the ideal kind of patient and the ideal kind of nurse. There is a full translation on the Access to Insight website. Bhikkhu Thanissaro his chosen to entitle the passage in Pāli Kucchivikara-vatthu (lit 'on the theme of dysentery') and in English 'The Monk with Dysentery'. In his reference to this text Ven. Thanissaro has "Mv [i.e. Mahāvagga] 8.26.1-8; PTS: Horner vol. 4, pp. 431-34" - normally the abbreviation PTS points to the Pali Text Society's Pāli version, but in this case it refers to the Miss Horner's English translation (which mixed up the order of the texts making Mv vol 4.). The correct citation should be: PTS Vin i.301.

One small point to make here is that though there is a clear ecclesiastical hierarchy in the milieu of the Vinaya, no one is exempted from caring by their status within that hierarchy. You may be a preceptor or an instructor, but you are no less responsible for caring for the members of the spiritual community than the juniors. Perhaps we may say that the preceptor or instructor has a greater responsibility, because not only must they participate in caring, they must set an example for the others. The great danger of more senior members of the spiritual community being seen not upholding the values and virtues of the community, is that it can be used as a rationalisation for laziness, or otherwise ignoble behaviour on the part of others. Of course there is no excuse for ignoble behaviour, but we are apt to find rationalisations.

Sangharakshita gave a talk on this passage in 1982 as part of a series on incidents from the Pāli Canon. It's available from freebuddhistaudio.com: A Case of Dysentry [sic]. There is also an edited transcript of the talk (with correctly spelt title). An extract from this talk forms the section entitled 'Unfailing Mutual Kindness' in Sangharakshita's excellent introduction to Buddhism: A Guide to the Buddhist Path, p.121f. Note that Sangharakshita relied on the translations from 'Some Sayings of the Buddha', translated by F.L. Woodward (Buddhist Society, London, 1973), which now seem very dated.

Pain & Suffering

When we talk about suffering in Buddhism we often make a distinction between various 'types' of suffering. In the Arrow Sutta* the Buddha makes an important distinction which I like to think of in terms of physical pain, and emotional (or mental) suffering. This text is fairly well-known, and there are already several translations of it available. The translations that I'm aware of all seem to suffer more or less from the phenomenon which Paul Griffiths has called "Buddhist Hybrid English", that is English which preserves the syntax of Pāli and therefore sounds peculiar. What I've tried to do is read the text in Pali in order to understand it, and then render it into contemporary English. I've retained the overall structure of the Pali text, including the verses at the end, though I've made no attempt to turn them into English poetry, not being a poet. I hope the result is both readable and informative.

The Arrow

The ordinary person feels pleasant feelings, unpleasant feelings, and vague feelings. Likewise the insightful person feels the same kinds of feelings. So what is the distinction, what is the difference between the two?

The ordinary person touched by pain is upset and miserable, they are aggrieved and confused. They have two experiences: one physical (kāyika), and one emotional (cetasika). It is like someone being pierced by an arrow, and then immediately pierced by a second arrow, and feeling the pain of both. When they experience pain they immediately feel aversion, because they have an underlying predisposition to aversion in relation to pain. Coming into contact with painful sensations they seek out pleasure, because they don't know any other response to pain. They don't understand the reality of the origin and passing away; the sweetness and the bitterness; the outcome of those experiences because of a predisposition to ignorance.

Feeling a pleasurable or a painful sensation they are caught up in it. Or if there is vagueness about sensations they are caught up in that. The ordinary person is caught up in birth, old-age, death; in grief, crying, misery, dejection, and trouble.

By contrast the insightful person touched by pain is not upset and miserable, they are not aggrieved and confused. They feel only one sensation: the physical; not the mental. They are not pierced by the second arrow, and so feel only one feeling.

Coming into contact with painful sensations there is no aversion, because they do not have an underlying tendency to aversion in relation to pain. They do not seek out pleasure because they know another response to pain. Not having a predisposition to ignorance they understand the reality of the origin and passing away; the sweetness and the bitterness; the outcome of those experiences.

When they have a pleasurable or a painful sensation, they are detached from it. When there is vagueness, they are not caught up in that. So the insightful person is not caught up in birth, old-age, death; in grief, crying, misery, dejection, and trouble.

This is the distinction, this is the difference between the ordinary person and the insightful person.

The big difference between
The insightful and the ordinary.
Is that on feeling pleasure or pain,
The wise-one is not reactive.

For the well-versed examiner of mental processes,
Seeing through this world and beyond.
Objects of desire do not disturb their mind
And the undesired is not resented.

For them satisfied and obstructed desires,
Are scattered and destroyed.
Having known the faultless sorrowless state,
They understand perfectly, and transcend, becoming.

Comments

I need to say one or two things about my translation. The phrase that I have translated as 'ordinary person' is assutavā puthujjano. Assutavant means 'one who has not heard' (suta) with an implied reference to the Buddha's teachings. The word puthujjana is translated in different ways, 'worlding' is common; while puthu means 'separated, individual; numerous', and while jana means 'people or person'; so the overall sense is of the majority, the crowd, especially those people who are not interested in religion. Compare puthujjana with the Greek word 'idiotēs' which referred to an individual who could not, or would not, participate in public life (from which we get the word 'idiot'. Juxtaposed with this is the sutavant ariyasāvako - the learned disciple of the noble one which I have translated as 'insightful person'. The phrase is something of a tautology because suta and sāvaka come from the same root √śru 'to hear', and mean 'heard' and 'one who hears'. Saying of someone 'they have heard much' is equivalent to contemporary English 'learned' because an ancient India one did one's learning by listening.

I've translated cetasika as 'emotional' in this case. A more typical translation might have been 'mental', but the context clearly shows that what is intended here is our emotional reactions to pain. In the Buddha's time there was no clear distinction between mental and emotional. Interestingly neuroscience has showed us that physiologically there is often very little to distinguish between emotional states. We have states of arousal or excitation which are similar across a great range of what we usually think of as different emotions, such as e.g. fear and anger, and what really distinguishes between these is the thoughts that go with them.

The phrase 'caught up in that' translates saññyutto naṃ. Saññyutta (also spelt saṃyutta) may be familiar as the name of the Nikāyas in which we find this text and means 'yoked together': yutta 'joined' being a past-participle of √yuj 'to join' (from which also yoga); and saṃ- suggesting togetherness or completion. It has the sense of 'yoked to', or 'bound together' - so the ordinary person is bound to be caught up in their emotional responses.

Newcomers to Buddhism, and sophists, like to ask questions such as 'did the Buddha feel pain?' This sutta is one of many which make it clear that anyone with a human body feels pain. However not everyone feels the anguish, the aversion that goes with it. As the verse at the end of the sutta says the big difference (mahā viseso) between someone who is insightful and someone who is not, is that the insightful person is not reactive towards feelings pleasure or pain. It is possible to feel physical pain and yet not to experience that as suffering. This does not mean that it is not painful. In another sutta the Buddha's foot is pierced by a stone sliver and it is excruciating, but again he is not caught up in that pain, he never loses his mindfulness or composure.**

I've repeatedly emphasised that the Buddha's teaching is mainly to do with the mind. I take the Salla Sutta to be a confirmation of this. Yes, we do have physical sensations. However we share these with the enlightened ones. What distinguishes an insightful person from us, is the mental and emotional side of the equation. Buddhist practice does not make us invulnerable to pain, but it does help us to bear that pain. This is where I find it useful to make a distinction between pain on the one hand, and suffering on the other. From this point of view enlightenment is the lack of reactivity towards vedanā or sensations arising from contact between us as subject, and objects of the senses (whatever they might be).


Notes

* Salla Sutta. SN 36.6, PTS iv.207 (aka Sallatha Sutta). Not to be confused with another Salla Sutta in the Sutta-Nipāta, Sn 574ff. See also Access to Insight.
** Sakalika Sutta. SN 1.3, PTS: S i 27.

image: Painting by Il Sodoma (c. 1525) depicting the martyrdom of St. Sebastian. Wikipedia.