I recently came across a book review of Saints to Lean On and wanted to interview the author, Sister Janice McCrane.

Sister McGrane was diagnosed at age 25 with rheumatoid arthritis (RA), a form of arthritis which is painful and which also creates deformities in the joints. She shares some of her wisdom below.

How to Cope with Pain:  Can you tell us a little about yourself?

Sister McGrane: I was diagnosed with rheumatoid arthritis at age 25, and unfortunately it’s severe. I have so many joint replacements and fusions that my friends refer to me as the Bionic Nun. I entered the Sisters of Saint Joseph in 1983, and my primary ministry has been with disabled persons. Presently I’m chair of the board at Liberty Resources, the disability advocacy organization for Southeastern Pennsylvania. And I’ve just begun working on a sequel to Saints to Lean On, which is selling quite well.

HtCwP: Can you tell us a bit about your own experiences with pain?

SM: Yes, I’ve had times of significant pain, mainly because RA wears away the cartilage in joints, resulting in bone rubbing against bone. Before I had the major joint replacements, I remember contemplating, Should I keep standing in pain, or sit down and have the pain of getting up again? A few months ago I fell, resulting in a severe hip contusion (thankfully, not a break). It was so painful I had to use a wheelchair for three weeks. I’m fortunate, however, that since the major joint replacements, pain does not rule my life.

HtCwP: Your first book is Saints to Lean On: Spiritual Companions for Illness and Disability. Can you tell us what the book is about, and what your inspiration for writing it was?

SM: From my own experience, and ministering with people with disabilities and illnesses of all kinds, I recognized a need for us (actually, all people) to turn to someone among the Communion of Saints who has experienced illness, disability, or pain. I hope to encourage people to recognize that, along with their genuine holiness, saints also lived with physical and mental ills. I attempted to invite people to turn to someone among the Saints to whom they feel drawn. I relied on Sister Elizabeth Johnson’s scholarship in Friends of God & Prophets, which reclaims the early church model of saints as companions, as well as intercessors and role models.

HtCwP: Can you give us an example of one of the saints whom you write about?

SM: Probably the best example of someone with excruciating pain is Therese of Lisieux, the Little Flower. She was in agony as her lungs deteriorated from tuberculosis. In addition, her superior denied her any relief from morphine, deeming it not appropriate for a nun. The treatments were ineffective and awful, for example, puncturing her chest with burning needles. Therese was honest about the fact that she was in great pain. Her death is quite well documented.

HtCwP: Illness, pain, and other challenges can sometimes test our relationship with God. Did you ever experience that?

SM: Definitely. For years I struggled with, Why me? Of course I’ve been angry with God, too. As my level of disability is quite visible, I also go through periods of struggling with how I walk, people gawking at my hands, etc.

HtCwP: On the other hand, great wisdom and growth can come out of adversity. Do you believe there were silver linings for you in your experience of illness, related to your spirituality or otherwise?

SM: I don’t just believe, I KNOW that human struggles of whatever nature have the potential to bring us closer to God, assuming we’re open to the grace. In my case, I have united my pain with Jesus time and time again. I believe as Caryll Houselander articulated so well in her work, that suffering is redemptive, that it heals the Body of Christ, in whatever mysterious way that occurs.

As for silver linings, I stopped driving years ago, which is difficult. However, several of my friendships have deepened through many a car talk that would never have happened if I were still driving myself. I’m convinced God will bring good out of even the worst situations.

Thanks so much to Sister Janice McGrane for sharing some of her story.

What do doctors want from patients?  What helps doctors give you the best care?

But first, 2 precautions, so this article isn’t taken the wrong way…

1. Don’t worry about needing to be a perfect patient.

2. These suggestions aren’t so your doctor’s life is better, but so you can help your doctor be able to give you the best treatment.

How to be a “good” patient

1. Be organized and focused

Both at your initial visit with a doctor, and at follow-up appointments, communicating important information about your health is crucial. Have your medical history outlined, know what medications and procedures you’ve tried and the results. Keep your focus on your health issues.

2. Relate a clear story, without too much unnecessary detail

Time is at a premium in health visits today. Ask yourself, Is this story or detail going to help my doctor help me? If not, leave it out. For example, instead of telling a long, rambling story to illustrate the point that your pain effects your ability to work, just say that directly. Your doctor may ask for an example, in which case you can elaborate.

3. Prioritize which symptoms/problems need to be focused on at each visit

For both new evaluations or follow-up visits, have 2-3 goals for a visit and write these down. Presenting these at the outset gets you and your doctor on the same page as far as what to address. Be realistic on what can be accomplished during 1 visit – there’s not usually time for more than a few issues.

4. Keep a log of how you respond to each treatment

Pain logs are helpful to figure out what’s making things worse and what’s helping. If you’re having many flare-ups, review your logs before the visit, so you can discuss what might be going on. If you’re trying a new medication, pain management technique, or PT, be able to present what worked, what didn’t, and what questions you have about the new treatment.

5. Follow through on taking medication, practicing pain management techniques, etc.

Your doctor can make treatment suggestions, but it’s up to you to put them into practice. Take your medication as directed. If there’s something that gets in the way of that – you don’t understand the directions, you’re having side effects, the medication’s too expensive – speak up about this. If you’re to do relaxation exercises each day, do them. If you’re to practice exercises at home between PT visits, do this. Treatments will only work if you use them!

6. Don’t be overly dramatic

Your doctor needs to know if your pain is severe, or if you’re having a hard time coping with pain. But use language that can help your doctor help you. Give a 1-to-10 rating of your usual daily pain, your worst daily pain, and how much your pain levels fluctuate. Briefly describe what you can and can’t do when you have pain – this gives your doctor an indication of your functioning.

If you’re depressed or anxious, get a referral to a pain management therapist. Many pain medicine doctors, for example neurologists and anesthesiologists, don’t have either the time or expertise to discuss your emotional state or help you cope better. However, coping with pain is so important! So get a referral to an appropriate person who can help you.

Phrases to avoid:

• “my pain is 10/10 all day, every day”
• “nothing helps”
• “narcotics are the only thing that help”

7. Don’t expect a miracle

It’s hard to continue to experience pain as your treatment unfolds. However, for most people, that’s the reality of chronic pain treatment. For some, full pain relief will come. For many, unfortunately, their pain won’t be completely relieved. But for most, treatment can get you to a better place, both decreasing pain and coping better with pain. Try to be patient – if there were a faster, easier, or better way, your doctor would already be prescribing it.

Thanks for listening!  🙂

This post is part of a series on how Hinduism views pain and suffering. Today we’ll look at What Do Researchers Find When They Put Acceptance To The Test As A Way To Cope With Pain?

Acceptance of chronic pain is defined by pain researcher Lance McCracken as living with pain without reaction, disapproval, or attempts to reduce or avoid it. Importantly, acceptance involves a disengagement from struggling with pain, a realistic approach to pain and pain-related circumstances, and an engagement in positive everyday activities. This idea is similar to the Hindu goals of equanimity and detachment.

Mindfulness meditation is related to acceptance in that it focuses on your current state (including pain) and neutrally accepts that state. What do researchers find when they study how these concepts help people cope with pain? Here are 3 studies…

Study 1:
90 patients with pain went through a 10-week program of mindfulness treatment. They showed significant improvements in pain, body image, activity, mood, and medication consumption. These positive results were still there 15 months later.

Study 2:
This study looked at how acceptance helps with experimental pain. Group 1 was taught an acceptance-based strategy, while Group 2 was taught a cognitive control-based strategy for coping with experimentally-induced shocks.

The acceptance-based strategy participants showed significantly higher tolerance to pain, and a majority of subjects continued the experiment when they experienced a “very much pain” rating. In contrast, the cognitive control-based strategy produced a greater reduction in their ratings of pain for individual shocks. However, when they experienced more pain, they tolerated this less well, and more of this group stopped the experiment when they reached a “very much pain” rating.

The researchers concluded that avoiding and trying to control pain (cognitive control-based strategies) are not effective when attempting to manage intense or longer-lasting pain.

Study 3:
This study was the most interesting in my view. It again looked at an acceptance strategy compared with a control strategy. To create pain, subjects put their hands in cold water. (Just as McDonalds now has to warn that the coffee is hot, please don’t put your hand on ice at home – it’s cold!)

Subjects in the acceptance group were instructed to notice their thoughts and feelings, but not allow these to control their actions. For example, a thought such as, I can’t stand this pain, might occur, but subjects were instructed to only observe their thoughts and not act on them, for example, by removing their hands from the cold water.

In contrast, subjects in the control-based section were told that various techniques to control their thoughts and feelings could help them cope with pain. These techniques included positive self-talk, controlled breathing, positive imagery, and body focusing. For example, the subjects were told that focusing on a pleasant scene could be used when experiencing pain.

Results showed that subjects in the acceptance group demonstrated greater tolerance of pain, being able to keep their hands in cold water longer. And this wasn’t because the acceptance group found the experience less unpleasant – both groups rated the experience equally unpleasant. The acceptance strategy helped them not be controlled by pain.

So what do these studies mean to you? Acceptance is a worthwhile attitude to cultivate. Certainly, it takes a lot of practice, but it may help you feel less controlled by pain, and better able to live fully, despite pain. I don’t believe that it’s necessary to throw out other strategies, such as breathing, positive imagery, etc. These are good, too, and I certainly teach them to my patients. However, when pain levels remain high, acceptance, instead of fighting and panic, may help you more.

This article is part of a series about how Hinduism views pain and suffering. Today we’ll look at What published studies tell us about acceptance as a coping skill.

In pain medicine journals, an excellent researcher Lance McCracken defines acceptance of chronic pain as living with pain without reaction, disapproval, or attempts to reduce or avoid it. Acceptance of chronic pain is, of course, more than a mental exercise and not simply a decision or a belief. Importantly, acceptance involves a disengagement from struggling with pain, a realistic approach to pain and pain-related circumstances, and an engagement in positive everyday activities. These words echo the Hindu goals of equanimity and detachment.

Dr. I. Viane et al describe the danger of a sole focus on trying to find ways to decrease pain, especially when this meets with little success. These strategies can actually increase your focus on pain, i.e. How much pain do I have? How about now? And now? … How much pain does this activity cause me? It’s also a problem to avoid activities that increase pain, but that are positive in other ways. This can decrease functioning through avoidance of work, relationships, and leisure.

As McCracken summarizes, it may be difficult for a person with chronic pain to devote their efforts equally to pain control and to valued aspects of their life at the same time. If efforts to control pain dominate, quality of living may be sacrificed. In contrast, acceptance of some degree of pain can free you to focus your energy on living a positive life despite pain.

What’s very interesting is that McCracken found that greater acceptance of pain was associated with reports of less pain, less pain-related anxiety and avoidance, less depression and disability, and better work status. Lots of good stuff! The positive correlation between acceptance and measures of functioning was independent of pain intensity. This means that it’s not just those who have lower pain scores who can accept their pain.

Scores of acceptance of pain can successfully predict which patients are classified as functioning well, compared with those who are dysfunctional, again, even after influences of pain severity, depression, and pain-related anxiety are taken into account. Acceptance is superior to other coping techniques in explaining adjustment to chronic pain.

Mirror, mirror on the wall
Can you help my pain, after all?

Well, that’ a version of the rhyme that never made it into Snow White! But if you’re looking for pain relief (instead of finding out who’s the fairest of them all :), mirror boxes might offer an answer. Mirror image therapy is an exciting treatment for many pain syndromes. Today we’ll look at Complex Regional Pain Syndrome (CRPS), also called RSD. CRPS is a neurological pain disorder with symptoms which include:

• pain out of proportion to any injury
• movement problems, e.g. muscle spasm, clumsiness
• temperature control problems, e.g. the affected area becomes cold or hot out of the blue, excessive sweating, pain increases with exposure to cold

There’s a lot that’s unknown about CRPS, but we do know that the changes that occur in CRPS affect not only the area where there’s pain, commonly a hand, foot, arm or leg. The changes also involve the spinal cord and brain. The body map hypothesis may apply to CRPS. This hypothesis says that there’s an internal representation of your body in your brain. This picture helps you know where your body is in space, even with your eyes shut. It also helps you perform movements, without having to think about each little part of a complex movement.

In CRPS, the brain’s map of the area where there’s pain may become distorted. It’s not clear if this distortion is a cause or a result of pain, but correcting this distortion can help. In CRPS, movement often hurts and can make pain worse. But lack of movement means fewer normal sensations coming into the brain. This allows pain signals to get too much play in your brain, creating a sort of spiraling feedback loop…

pain, which causes you to move less, which causes fewer normal movement sensations going to your brain, which causes pain signals have less to compete with to get your brain’s attention, which causes PAIN, and we’re back to the beginning

So where do mirror boxes come in? Let’s say your right hand is affected by CRPS. You can put your right hand in the box so it’s not visible. You then move your left hand, and your brain sees the reflection as if your right hand is moving. And because your left unaffected hand is moving, the movements are easy and fluid. So it looks to your brain like you’re right hand’s moving comfortably and easily. It may be that tricking your brain into seeing that everything’s ok, lets pain begin to slowly decrease.

Now for the “be careful” section…

1. It gets trickier to use a mirror if…
   – both your right and left side are affected, i.e. there’s no pain-free part
   – an area like your chest, back, or stomach is affected, where there’s not an obvious mirror image part
2. It’s controversial if you can just start out using a mirror, or you need to build up to this kind of work, by graded motor therapy.
3. It’s also controversial if you need to move the hand or foot that’s in the mirror box, i.e. the affected limb that’s hidden from view.

So, if you’re interested in mirror therapy, take a look at the NOI website. Read some more on the treatment to educate yourself. And, most importantly, get some guidance from a medical practitioner – MD, physical therapist, etc. – who’s informed about this treatment. It’s a very exciting option – and one I want to make sure you use safely. You can learn more as well as purchase a mirror with instructions for use:

NOI Group

This post is part of a series about how Hinduism views pain and suffering. Today we’ll look at acceptance strategies to cope with pain.

Of the Hindu concepts we’ve talked about, acceptance, from a nonreligious perspective, has been studied in pain research. Although acceptance isn’t unique to Hinduism, it’s certainly central to the religion, and includes at least 2 aspects.

1. Hindu traditions view acceptance as a logical attitude towards what one’s life presents, including pain and suffering, because all is seen as the just working of karma (karma = the principle that determines the unfolding of events, based on how a person has lived).
2. The practice of acceptance is also a means to a greater end, detachment.

The process of accepting one’s life lessens one’s desire for things to be different than they are. As desires fall away, detachment is achieved.

Related to pain, both painful and pain-free states would be accepted equally. Detachment from this world, to be focused on God/The Ultimate, is a primary goal in Hinduism.

As ways to cope with pain, acceptance-based strategies can be contrasted to control-based strategies. In control-based strategies, the goal is to decrease problematic thoughts, feelings, or experiences. It’s believed that these need to be reduced for improvement to occur. For example, relaxation treatment is a control-based strategy for anxiety, in which relaxation exercises are used to decrease the thoughts and feelings described as anxiety. The treatment goal would be a reduction or elimination of anxiety.

In contrast, acceptance approaches attempt to teach clients to feel emotions and bodily sensations more fully and without avoidance, and to notice fully the presence of thoughts without following, resisting, believing, or disbelieving them. However, uncomfortable thoughts and feelings are delinked from behavior. Thus, problematic thoughts, feelings, or experiences don’t have to be reduced for improvements in behavioral endpoints to occur. Patients can focus on making desired behavior choices regardless of their feelings or thoughts.

In treating chronic pain, the goal of treatment wouldn’t be to decrease pain. As well, patients would be taught to not have their pain level determine their activity level, thus decoupling uncomfortable feelings from behavior.

Reflect (ha-ha) for a moment, how nice it would be, if something as simple as looking in a mirror could help lessen your pain. Well, you might like what you see!!

Mirror image therapy is an exciting treatment for an increasing number of pain conditions. Today we’ll look at an uncommon pain disorder, phantom pain, but one that started us down the path of using mirror image therapy for pain.

Phantom pain is pain in a part of the body that’s no longer there, e.g. from an accident, surgery, etc. This pain is most common in limbs, but can also occur in other body parts, e.g. a breast after mastectomy. It’s more likely to occur if pain was present before removal of the body part.

The exact causes of phantom pain are uncertain, but ideas include:

• a brain memory of pain, if there was pain before an amputation
• re-wiring of nerve circuits in the brain as the brain experiences a change in incoming sensations from the body part that’s now missing
• abnormal re-growth in the cut nerve endings

The most interesting possible explanation for phantom limb pain involves the brain’s body map. A newer idea, this hypothesis says that there’s an internal representation of your body in your brain. It helps us know where our bodies are in space, even with our eyes shut. It also helps us perform movements, without having to think about each little part of a complex movement.

When there’s a mis-match between the brain’s internal image and the sensations that register as being from the missing body part, the brain may interpret these as pain.

For example, if I want to pick up a cup, my brain needs to figure out things like:

• where my hand is now
• where my  hand is each time my muscles move it, to make interim adjustments
• what force I need to create to pick something up, etc.

My brain also gets sensations as I’m performing this task:

• what position my hand is in to start
• what position my hand is in as my muscles move it
• what force I’m exerting on the cup, etc.

When there are problems with these outgoing and incoming sensations, pain can occur. For example, when my brain sends a message to my hand to open, but nothing happens, problems can start. Likewise, when my brain sends that message to open my hand, but there are no sensations coming back of my hand opening, problems can start.

2 excellent websites where you can learn more, as well as purchase a mirror with instructions for use:

Mirror Box Therapy

Noi Group

This post is part of a series about how Hinduism views pain and suffering.  Today, we’ll look at When Religion Becomes A Hindrance, Rather than A Help:

Although religion can be a positive resource for some, there are times when religious coping can be ineffective. For Hindus, a first potential challenge may be the feeling of passivity or fatalism that may arise because of karma (karma = the principle that determines the unfolding of events, based on how a person has lived). A patient can feel hopeless or unable to change things because he feels that things are fixed by karma.

Hindu traditions counter this by saying that a person can start in the present moment and go forward, living his life in a positive way by following dharma (dharma = sacred duty). If a patient currently experiences pain, change can occur by attending to present appropriate action. If one’s present state is a consequence of what has gone before, the urgency of responsible and appropriate action becomes greater, not less.

Acceptance can be misunderstood as passivity. Hindu traditions do advise a focus on appropriate action, rather than outcome, but this doesn’t mean inaction, “avoid attachment to inaction.” People with pain can be encouraged to actively manage their pain and continue to seek improvement, but become detached from the outcome of these efforts.

Lastly, there can be a risk of feeling that one is failing the test of pain and suffering, that one isn’t succeeding in achieving an even disposition. However, the religious practices of Hindus teach trying one’s best. Detachment can even be sought from the degree one achieves detachment; that is, a person can attempt to be less concerned about his success or failure to be detached. The process of trying is important, rather than a focus on a final goal of being detached. Patience with oneself is encouraged. Patients can also try to learn as much as possible from their current situation, including their apparent failures.

It would be important to note that any one Hindu may be at any stage of spiritual growth with respect to viewing her physical pain and suffering as Hindu traditions teach. A person may or may not even be using his religious resources for support to cope with pain.

The level of religious coping may change across time, for example, as aspects of a person’s illness change, including severity of pain, and as the availability of other resources changes. As in any religion, there would probably be only a small minority of Hindus who wouldn’t struggle with some aspect of their experience of pain or for whom acceptance is easy and unchanging; however, many strive to be faithful to their own religious tradition.

Today we’re looking at how mindfulness relates to our experiences of chronic pain. I’ve asked my pain management colleague Dr. David Kannerstein to say more about this connection.

Dr. Kannerstein: “Mindfulness can be understood in different ways. Fundamentally, it means focusing your attention on what you’re experiencing in the present moment, without judging it. This may seem simple, but it’s in fact a radical departure from our normal experience where we live much of the time in our heads, thinking about what’s going on rather than experiencing it in the moment.

In various Buddhist traditions, mindfulness is a form of meditation that’s used as part of one’s spiritual development, with the goal of reaching enlightenment, as Thubten Chodron discussed. In recent years, mindfulness has become widely used to help in treating those with chronic pain, as well as those suffering from emotional disorders such as depression.

How can focusing on what’s happening in the moment help the person suffering with chronic pain? Isn’t the goal to NOT notice what you’re feeling? As a psychologist who’s used it in my work with individuals with pain, I’ve found that it can be incredibly powerful as a tool to ease suffering.

I’ll ask an patient to focus attention on her breath (or something else if breathing is painful), to be aware of each inhalation and exhalation, and to notice whenever she’s distracted. Whenever she notices she’s distracted, she’s to notice what she was distracted by – thoughts, emotions, sensations such as pain – and then to refocus on her breathing.

This approach was pioneered in helping those with pain by Jon Kabat-Zinn. You may also allow your attention to float over the whole range of your experience – sensations, thoughts, emotions – without becoming absorbed in any one aspect of things.

If my patient is so immersed in her pain that she’s unable to focus on anything else, I’ll use an approach I learned from the writings and recordings of Shinzen Young, an American who trained as a Buddhist monk in Japan, and who’s been a major force in using meditation for pain. I’ll suggest that the patient focus on the pain – its location, qualities, intensity – and just observe it with as much detachment as possible.

I’ve found that both of these approaches – focusing away from the pain and focusing on the pain – can be incredibly effective. Patients generally become more relaxed, but that’s not the most important result. The relaxation is part of breaking the circle:

negative sensations (pain) …

triggering negative thoughts and beliefs …

leading to negative emotions (fear, sadness, anger) …

leading to more pain, and so on.

By attending mindfully to what they’re experiencing, patients become less afraid of it, less depressed by it, and less angry about it – and their suffering diminishes greatly. As Shinzen Young puts it, meditating on pain lessens the resistance to the pain which causes the suffering.

Those interested in learning more about mindfulness approaches to pain may wish to read Full Catastrophe Living by Jon Kabat-Zinn (New York: Delta Books, 1990) or Break Through Pain by Shinzen Young (Boulder CO: Sounds True, 2004).

Thanks so much to Dr. Kannerstein.

This post is in a series about Hinduism and Pain. Today, we’ll look at Attachment and Detachment to Things in this World.

Attachment and detachment are concepts that in Hindu traditions relate to one’s level of involvement in this world and to the power this world holds over one’s state of mind. Attachment signifies overinvolvement in this world, having desires for things that one does not have and clinging to things one has. Detachment is a positive state of objectivity toward this world, where relationships, objects, and circumstances hold no power over one’s state of mind.

Attachment is a primary stumbling block to achieving moksha (complete release from this world). Attachment perpetuates the terrible bondage that keeps a person in the cycles of samsara (rebirth). Only through recognition that the Self is not bound to this world of suffering can release be achieved.

Perfect detachment creates an even disposition in the face of either happiness or sorrow. When someone achieves perfect detachment, no problem or circumstance, including pain, can cause her to suffer. From The Bhagavad-Gita:

Contacts with matter make us feel
heat and cold, pleasure and pain.
Arjuna, you must learn to endure
fleeting things they come and go!

When these cannot torment a man,
When suffering and joy are equal
for him and he has courage,
he is fit for immortality.

What suggestions are made for achieving this detachment? It can’t be simply an intellectual understanding that the Self is part of God/The Ultimate. It isn’t escapist, pretending that suffering doesn’t exist.

One part of achieving detachment is to follow dharma (appropriate action), but to be unconcerned with the outcomes of these actions. In The Bhagavad-Gita, a seeker of wisdom Arjuna is told:

Be intent on action,
not on the fruits of action;
avoid attraction to the fruits
and attachment to inaction!

Perform actions, firm in discipline,
relinquishing attachment;
be impartial to failure and success-
this equanimity is called discipline.

We who have pain are not to be passive and give up, and can continue to attempt to lessen our suffering. The ultimate goal would be to become neutral in the face of whatever outcome occurs, to not desperately strive for pain relief. Most important, however, would be to refocus away from pain to dharma.

The guidance to seek detachment from outcomes would likewise apply to those who treat patients, though this may challenge the outcome-orientation of Western medicine. Lack of immediate success in treating patients can be frustrating; however, an approach based in Hindu traditions would suggest continuing to try one’s utmost to heal patients but not becoming upset by failure. The dharma for a pain practitioner would be to be the best practitioner possible, while accepting all outcomes.

To be clear, this wouldn’t suggest becoming indifferent to patients’ suffering. Hindu traditions would support still caring deeply for patients, but needing to recognize that physicians aren’t in control of outcomes, nor know what’s the appropriate outcome from the perspective of karma.

Specific tools for achieving detachment also include meditation and yoga. These tools teach the understanding and control of one’s mind, and seeing beyond one’s mind to God/The Ultimate. As the focus of one’s life should be on God/The Ultimate, priority is given to this inner journey, with less focus on the world. By becoming less attached to one’s circumstances, including being in pain, a person can focus his life on God/The Ultimate, not pain. Hindu traditions hold that all have a capacity to achieve this.

Spiritual assistance and support are also to be found in God/The Ultimate. One way to know God/The Ultimate is through devotion, the way of bhakti. Bhakti implies that God/The Ultimate is accessible and knowable, in personal terms. A practice of some Hindus is to pray to God/The Ultimate, to ask for support in facing problems, believing that their suffering will be relieved and support will be provided.