Do You Understand Bladder Cancer?

Do You Understand Bladder Cancer?

Welcome to an informative journey where we unravel the mysteries surrounding bladder cancer. This article aims to deepen your understanding of this widely misunderstood condition.

Bladder cancer is a complex disease that affects millions of people worldwide. It is characterised by the abnormal growth of cells in the bladder lining, leading to various symptoms and potential complications. We will cover everything from the causes and risk factors to the available treatment options.

Our brand voice will compassionately and knowledgeablely explain every aspect of bladder cancer, offering insights and guidance for patients, caregivers, and anyone seeking a comprehensive understanding of this condition.

Throughout this article, we will also address common misconceptions and bust myths about bladder cancer, ensuring you have accurate and up-to-date information at your fingertips.

So, whether you are personally affected by bladder cancer or simply curious to expand your knowledge, join us as we dive into the world of bladder cancer and shed light on this often misunderstood topic.

Types of Bladder Cancer

Bladder cancer can be classified into several types, each with its own characteristics and treatment approaches. The most common types include:

  1. Transitional Cell Carcinoma (TCC) is the most prevalent type of bladder cancer, accounting for approximately 90% of all cases. It originates in the urothelial cells lining the bladder and can also affect other parts of the urinary tract.
  2. Squamous Cell Carcinoma: Squamous cell carcinoma typically develops due to long-term irritation or infection in the bladder. It accounts for around 4% of bladder cancer cases and is more common in specific geographic regions with high rates of chronic bladder inflammation.
  3. Adenocarcinoma: Adenocarcinoma of the bladder is a rare form, accounting for only 1-2% of bladder cancer cases. It originates in the cells that produce mucus in the bladder lining and is often associated with chronic bladder inflammation or a history of bladder diverticula.

Understanding the different types of bladder cancer is crucial as it can impact the treatment options and overall prognosis for patients. Now, let’s delve deeper into this disease’s causes and risk factors.

Causes and Risk Factors of Bladder Cancer

Bladder cancer can arise from a combination of genetic and environmental factors. While the exact causes are unclear, certain risk factors have been identified. Here are some of the key contributors to bladder cancer:

  1. Tobacco Smoke: Smoking is the most significant risk factor for bladder cancer, with smokers being up to four times more likely to develop the disease compared to non-smokers. The harmful chemicals in tobacco smoke can accumulate in the urine and damage the bladder lining over time.
  2. Exposure to Chemicals: Occupational exposure to certain chemicals, such as aromatic amines found in dyes, rubber, and plastics, is a known risk factor for bladder cancer. Individuals working in manufacturing, painting, and truck driving may face increased exposure to these harmful substances.
  3. Age and Gender: Bladder cancer is more common in older individuals, with the majority of cases occurring after the age of 55. Additionally, men are about three times more likely to develop bladder cancer than women, although the reasons for this gender disparity are still being studied.
  4. Chronic Bladder Inflammation: Frequent urinary tract infections, bladder stones, and other conditions that cause chronic inflammation can increase the risk of bladder cancer. These inflammatory processes can lead to genetic mutations and cellular changes in the bladder lining, potentially leading to cancerous growth.

These are just a few of the factors that can contribute to bladder cancer’s development. While these risk factors increase the likelihood of developing the disease, not everyone exposed to them will develop bladder cancer. Now, let’s explore the symptoms and early detection methods for bladder cancer.

Symptoms and Early Detection of Bladder Cancer

Early detection of bladder cancer is crucial for successful treatment outcomes. Being aware of the common symptoms can help individuals seek prompt medical attention. Here are some of the signs and symptoms often associated with bladder cancer:

  1. Blood in the Urine (Hematuria): The most common and noticeable symptom of bladder cancer is blood in the urine, which may appear pink, red, or dark brown. Hematuria is typically painless and intermittent, meaning it may come and go.
  2. Frequent Urination: Bladder cancer can cause an increased frequency of urination, even when there is minimal urine in the bladder. This symptom is often mistaken for a urinary tract infection or an overactive bladder.
  3. Pain or Burning Sensation: Some individuals with bladder cancer may experience pain or a burning sensation during urination, similar to the symptoms of a urinary tract infection. However, these symptoms are not always present, especially in the early stages of the disease.
  4. Pelvic Pain: As bladder cancer progresses, it may cause pain in the pelvic area. This pain can be dull, persistent, or intermittent and may worsen over time.
  5. Back Pain: In advanced cases, bladder cancer can spread to the surrounding tissues and organs, including the lower back. A healthcare professional should evaluate back pain unrelated to physical exertion or injury.

It’s important to note that various non-cancerous conditions can also cause these symptoms. However, if you experience any of these symptoms, it’s crucial to consult a healthcare provider for further evaluation. Now, let’s explore the diagnostic tests used to detect bladder cancer.

Diagnostic Tests for Bladder Cancer

When bladder cancer is suspected, healthcare providers use various diagnostic tests to confirm the diagnosis and determine the extent of the disease. Here are some of the standard tests used for the detection and evaluation of bladder cancer:

  1. Urinalysis: A simple urine test, known as urinalysis, can detect the presence of blood or abnormal cells in the urine. This initial screening test helps identify individuals who may require further evaluation for bladder cancer.
  2. Cystoscopy: Cystoscopy is a procedure that involves inserting a thin, flexible tube with a camera (cystoscope) into the bladder through the urethra. This allows the healthcare provider to examine the bladder lining for any abnormalities visually.
  3. Biopsy: If abnormal areas are detected during cystoscopy, a biopsy may be performed. A small tissue sample is removed from the bladder during a biopsy for laboratory analysis. This helps determine if the abnormal cells are cancerous and the type and grade of the cancer.
  4. Imaging Tests: Imaging tests, such as CT scans, MRIs, and ultrasounds, may be used to evaluate the extent of the cancer and identify any spread to nearby lymph nodes or other organs. These tests provide valuable information for staging the disease and planning appropriate treatment.

These diagnostic tests, along with a thorough medical history and physical examination, help healthcare providers accurately diagnose bladder cancer and develop an individualised treatment plan. Now, let’s explore the stages and prognosis of bladder cancer.

Stages and Prognosis of Bladder Cancer

The staging of bladder cancer is crucial for determining the appropriate treatment options and predicting the prognosis. Bladder cancer is staged based on the extent of the disease, which includes factors such as tumour size, invasion into surrounding tissues, and the presence of lymph nodes or distant organ involvement. The stages of bladder cancer are as follows:

  1. Stage 0 (Non-Invasive): At this stage, the cancer is confined to the innermost layer of the bladder lining and has not invaded the more profound layers or spread to nearby lymph nodes or organs.
  2. Stage I: Cancer cells have invaded the connective tissue layer beneath the bladder lining but have not reached the muscle layer or spread to lymph nodes or distant sites.
  3. Stage II: The cancer has invaded the muscle layer of the bladder but has not spread beyond the bladder or to nearby lymph nodes or distant organs.
  4. Stage III: Cancer cells have spread beyond the bladder to nearby tissues, such as the prostate, uterus, or vagina in females or the prostate or seminal vesicles in males. Lymph node involvement may also be present.
  5. Stage IV (Advanced): The cancer has spread to neighboring organs or distant sites, such as the liver, lungs, bones, or lymph nodes distant from the bladder. This stage is further divided into IVA and IVB based on the extent and location of the metastasis.

The prognosis for bladder cancer varies depending on the stage at diagnosis, the grade of the tumour, and other individual factors such as age and overall health. Early-stage bladder cancer has a higher chance of successful treatment and long-term survival compared to advanced-stage disease. Now, let’s explore the available treatment options for bladder cancer.

Treatment Options for Bladder Cancer

The treatment approach for bladder cancer depends on several factors, including the stage and grade of the tumour, overall health, and individual preferences. Here are some of the standard treatment options for bladder cancer:

  1. Surgery: Surgery is often the primary treatment for bladder cancer. The type of surgery performed depends on the stage and extent of the disease. Surgical options may include transurethral resection of the bladder tumour (TURBT), partial or radical cystectomy, or urinary diversion procedures.
  2. Intravesical Therapy: In some cases, after surgery or as a primary treatment for non-invasive bladder cancer, medications can be delivered directly into the bladder through a catheter. This approach, known as intravesical therapy, helps destroy any remaining cancer cells and reduces the risk of disease recurrence.
  3. Chemotherapy: Chemotherapy drugs can destroy cancer cells and shrink tumours before surgery (neoadjuvant chemotherapy), after surgery (adjuvant chemotherapy), or as the primary treatment for advanced bladder cancer. Chemotherapy can be administered intravenously or directly into the bladder.
  4. Radiation Therapy: Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. It can be used as the primary treatment for individuals not candidates for surgery or in combination with surgery or chemotherapy to improve treatment outcomes.
  5. Immunotherapy: Immunotherapy drugs help stimulate the body’s immune system to recognise and attack cancer cells. These medications are often used for advanced bladder cancer that has spread or recurred after initial treatment.

Treatment choice depends on several factors, and healthcare providers work closely with patients to develop individualised treatment plans that offer the best chance of successful outcomes. In addition to medical treatments, specific lifestyle changes can also help prevent bladder cancer.

Lifestyle Changes and Prevention of Bladder Cancer

While preventing bladder cancer is not always possible, specific lifestyle changes can help reduce the risk. Here are some strategies that may help lower the risk of developing bladder cancer:

  1. Quit Smoking: If you smoke, quitting is the most critical step you can take to reduce your risk of bladder cancer. The harmful chemicals in tobacco smoke can accumulate in the urine and damage the bladder lining, increasing the risk of cancer.
  2. Stay Hydrated: Drinking fluids, particularly water, can help dilute the concentration of harmful substances in the urine and reduce the risk of bladder cancer. Aim to drink at least 8 cups (64 ounces) of water daily.
  3. Eat a Healthy Diet: A well-balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help support overall health and reduce the risk of various cancers, including bladder cancer. Limit the consumption of processed foods, red meat, and sugary beverages.
  4. Protect Against Occupational Exposures: If you work in an industry that involves exposure to chemicals linked to bladder cancer, take appropriate precautions. Follow safety guidelines, wear protective equipment, and attend regular health screenings.
  5. Practice Safe Hygiene: Avoid urinary tract infections by practising good hygiene. Wipe from front to back after using the toilet, drink plenty of fluids, and urinate regularly to flush out any bacteria that may be present.

While these lifestyle changes can help reduce the risk of bladder cancer, it’s important to remember that they cannot guarantee complete prevention. Regular check-ups and screenings are essential for early detection and prompt treatment, especially for high-risk individuals. Now, let’s explore the support and resources available for bladder cancer patients.

Support and Resources for Bladder Cancer Patients

Being diagnosed with bladder cancer can be overwhelming, but there are numerous support networks and resources available to help patients navigate their journey. Here are some of the support options and resources for bladder cancer patients:

  1. Patient Support Groups: Joining a support group can provide emotional support and the opportunity to connect with others facing similar challenges. These groups offer a safe space for sharing experiences, asking questions, and finding comfort.
  2. Online Communities: Online platforms and forums dedicated to bladder cancer provide a virtual space for individuals to connect, seek advice, and share information. These communities offer a sense of belonging and can be a valuable resource for patients and caregivers.
  3. Cancer Centers and Hospitals: Many cancer centres and hospitals have specialised bladder cancer clinics or departments offering comprehensive patient care and support. These centres often have dedicated healthcare professionals who specialise in bladder cancer treatment and can guide the treatment process.
  4. Educational Resources: Numerous organisations and websites provide valuable information about bladder cancer. These resources cover various aspects of the disease, including treatment options, coping strategies, and tips for managing side effects.
  5. Financial Assistance Programs: Some organisations and foundations offer financial assistance programs to help bladder cancer patients with the costs associated with treatment, medications, and supportive care services. These programs can alleviate some financial burdens and ensure access to necessary care.

Remember, no one should face bladder cancer alone. Reach out to these support networks and resources for your help and guidance. Now, let’s conclude our informative journey through the world of bladder cancer.

Conclusion

In this comprehensive article, we have explored the various aspects of bladder cancer, from its types and causes to the available treatment options and support resources. Bladder cancer is a complex disease that requires a multidisciplinary approach for successful management. By deepening our understanding of this condition and raising awareness, we can work towards earlier detection, improved treatment outcomes, and, ultimately, a better quality of life for individuals affected by bladder cancer.

Remember, if you or someone you know is experiencing symptoms or has been diagnosed with bladder cancer, it’s crucial to.

 
Liz McCaughey & AM Team

MsC., MoC. Member of: ACA, BACP

Further Articles like this:

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Removing the Mask

Removing the Mask

I arrived at my gym for an appointment with my trainer.  “Are you going to Lan Kwai Fong tonight?” he asked enthusiastically.  As a busy (and middle-aged) professional who’d been up since 5 am and still had several work obligations after this gym session, I figured the probability of hanging out in LKF on a school night was pretty low.  “Why on Earth would I do that?” I asked.  He responded, “Everyone’s going there at midnight to burn all their masks!  Can’t wait to see the bonfire!”.  While the thought of such a sight was pretty attractive after 945 days of mask-wearing, I immediately thought of the toxic fumes that would soon travel through central Hong Kong – fumes we could avoid breathing through a mask.  The irony was not lost on me.

I do not know if the LKF mask-burning event occurred, but the sentiment resonated.  It also prompted me to wonder how the people of Hong Kong would feel as they prepared for this change.  No doubt everyone considered what it meant for them and their loved ones.  And as I’ve been listening to friends and colleagues over the last 48 hours, I’ve come to the view that regardless of whether removing the mask mandate is “good” or ‘bad”,  it allows for personal choice, which empowers us all.

Let’s consider kids, for example.  As of Wednesday, millions of five-to-eight-year-olds will (strangely, after showing a negative RAT test to attend school in the first place) be seeing their teachers’ full faces, perhaps for the first time.  Children three years old or under do not know the world without masks.  It will be interesting to see how they interact with their friends now that they can see their whole faces.  It’s difficult enough as an adult to recognize people when they see them without a mask for the first time.  How we look at people and recognize their faces is different with masks on than with masks off.  Also, these little children have learned to read people’s emotions just by looking at their eyes.  What will it be like for them to see a full facial expression?  How will they interpret what they see? Ongoing research at places like the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London links facial expression to healthy social interactions. Within a social context decoding facial expressions is an essential foundation for stable emotional relationships. It is a skill that helps to reduce anxiety.

And just as kids are not used to seeing their teachers’ full faces, the same is valid for teachers with their students.  One teacher shared a story of playing “guess the child” with her peers:  When the kids took their masks off to eat, the teachers tried to figure out who they were.  It wasn’t easy to recognize them, as the teachers had a mental image of the children’s faces, which was inaccurate.  They almost had to re-learn who Nancy, Tom, Millie, or James were, as they were unrecognizable without the masks.  Imagine the child who bounds up to her teacher with a big “HELLO!” and the teacher isn’t sure who she is.  This experience could result in children losing identity or sense of place, as the teachers they’ve become comfortable with don’t seem to know who they are anymore. How disempowering would that appear to the child that a person who is essential in their lives fails to recognize them?

And what about vulnerable people or those in hospital environments?  Most medical clinics allow their staff to choose whether or not to wear masks at work.  Patients with respiratory illness symptoms are still requested to wear masks. 

The mask mandate may have been removed, but does this mean we should no longer consider the needs of others?  A diverse city of 7.6 million people like ours does not thrive without the goodwill and tolerance of its people.  It’s worth remembering that Hong Kong people commonly wore masks when sick – well before any mandate and well before the rest of the world – out of consideration for others.  Perhaps there’s no need to burn all our masks, and we might instead choose to keep a few around for the greater good. As mentioned earlier, it is a choice, and being able to make choices is positive for our mental health.

Today, I also heard another example of two brothers – the younger one thrilled to see his friends’ faces, and the older one worried about his facial acne.   Female colleagues are talking about needing to spend money on makeup now that their whole faces are “on display” again.  Jokes about teeth whitening products selling like hotcakes and dentists being completely booked out.  For the last three years, the beauty ‘playing field’ was somewhat even, and the eyes were all that mattered.  Now our whole faces are back in the limelight. Face masks eased the anxiety of people with body dysmorphia or those anxious about their appearance. This anxiety will have to be dealt with by many people.

And another friend told me she was thrilled to see the mandate go for the simple reason that she’d be able toread lips again – a helpful skill when seeking assistance at various customer service counters around the city.  It was hard enough before trying to understand what the customer service agent was saying behind the plate glass window with tiny holes and poor quality intercom – add mask-wearing into the equation. This friend has said, “sorry, can you please repeat that?” about 17,000 times over the last three years. These are six words that she’s delighted to remove from her vocabulary.

There are so many stories about the effect of mask-wearing, but that is enough for now. Hong Kong is finally free from HAVING to wear a mask, now is the time for people to appreciate they have choices, and it is up to them what they choose to do.

Perhaps the take-home point is that we in HK must celebrate our adaptability and resilience – we kept masks on for 945 days, the most extended period of mask-wearing in the world.   Now they are no longer mandatory, and we can decide for ourselves.  I can choose to wear it or not, just as I can decide to go to Lan Kwai Fong on a Tuesday at midnight or go home to bed.  Free will and choice are empowering, and as you read this, make a choice for yourself and be empowered in the process of having that choice.

By the Team at AMindset

If you would like to speak with a counsellor about how we can support you, please contact us.

Other Articles by AMindset Counsellors:

The Mental Health Impact of Hong Kong’s Mask-Free Policy on Children, Anoush Davies

Re-entering the Outside World, Kelly Hutchison

Christmas Alone, Elise Phillipson 

Talking About Eating Disorders, Megan Chang 

The Mental Health Impact of Hong Kong’s Mask-Free Policy on Children

The Mental Health Impact of Hong Kong’s Mask-Free Policy on Children

After months of waiting, Hong Kong is now mask free from the 1st March. This is good news for the citizens of Hong Kong and children in particular, who have been living with mandatory masks for over three years. With the lifting of this policy, children can now see their friends’ faces for the first time in years—and that has both positive and negative implications on their mental health. Let’s explore how this will affect them. 

The Positive Effects of Going Mask-Free

The most obvious benefit to children being able to go mask free is the joy of seeing their classmates’ faces after such a long time. Seeing familiar faces and being able to interact with them can help boost children’s moods, build relationships, and create a sense of comfort and security in the classroom  . Additionally, going mask-free can help reduce stress levels that have likely been heightened by having to wear masks every day for over three years. Knowing they are no longer required to do so can bring an immense sense of relief to many students—especially those who may have struggled with wearing masks due to sensory issues or allergies. 

The Negative Effects of Going Mask-Free 

On the other hand, there could also be some negative effects associated with the lifting of this policy as well. For example, some students may struggle with feeling overwhelmed when faced with direct eye contact or conversations after so long without it. They may also feel anxious or self-conscious about speaking up or engaging in class if they’ve grown accustomed to hiding behind a mask for so long. In addition, kids may need extra support if they find themselves struggling with feelings of guilt or shame due to a perceived lack of effort during pandemic times compared to their peers who were able to socialize more freely while wearing masks was mandatory everywhere else but at school. 

Overall, while it’s certainly wonderful news that Hong Kong is going mask-free from now onwards and children will finally get to see their friends’ faces again after so long apart, parents and teachers need to remain cognizant of potential mental health issues related to this transition period and be prepared to provide additional support if needed. By keeping an open dialogue and modeling positive behaviors in the classroom environment, we can ensure our kids not only adjust but thrive in these new circumstances!

Anoush Davies

MSc

If you would like to speak with a counsellor about how we can support you, please contact us.

The Power of Silence

The Power of Silence

The Power of Silence

Modern humans have lost touch with their inner ‘true self’ says Steve Taylor Ph.D  a lecturer in psychology at Leed University, UK. In his article below, Steve says that: “Silence and stillness are a means to recovering happiness and contentment. In the modern world silence has practically ceased to exist.” which few of us can deny when we reflect on our daily busyness.  The Power of Silence

The human race has stamped its authority over the planet Earth not just by covering its surface with concrete and destroying its plant and animal life, but also by burying the natural sounds of the Earth beneath a cacophony of man-made noise. We live our lives against the background of this cacophony, with the jagged mechanical sounds of urban-industrial society continually assaulting our ears: the roar of trucks, aeroplanes and trains, the clanging and thudding of machinery, the noise of building and renovating, the chatter of radios and TVs in other people’s cars and houses, and pop music blaring from every conceivable place.

But nothing, of course, has done more to obliterate silence than the car. In the modern world it’s very difficult to go anywhere where there’s no possibility of being disturbed by the sound of passing cars, and the only chance that city or town dwellers get to experience something of the quietness which existed everywhere in the pre-car world is sometimes on Sundays, when the mad rushing to and fro of modern life slows down. This quietness seems so foreign now that it seems difficult to believe that a hundred years ago and before it was everywhere all the time. Back then this quietness would even have filled the busiest city centres, which would have probably had a noise level equivalent to that of a modern small village.

There’s also more noise than ever before inside our houses. It’s unusual to go into a house nowadays where there isn’t at least one television set chattering away somewhere, even if the residents aren’t actually watching it, and other forms of home entertainment compete against TV to produce the most noise: radios, CD players, computer and video games etc. In fact the only sound which is largely absent from people’s houses nowadays is the voices of their occupants actually talking to one another.

Living in the midst of all this noise is bound to have a bad effect on us. All man-made noise is fundamentally disturbing. We find the sound of birds singing or of wind rushing through trees pleasing, but mechanical noise always jars and grates. And since we live our lives against a background of mechanical noise it follows that there’s always an undercurrent of agitation inside us, produced by the noise. This noise is certainly one of the reasons why modern life is so stressful as well. In modern life our senses are bombarded with massive amounts of external stimuli. Our fields of vision are always crowded with different (and constantly shifting) things, and our ears are bombarded with a bewildering variety of sounds — all of which clamour for our attention. Our senses have to absorb and process all this material, which takes up a lot of energy, and means that we’re liable to become drained of energy or ‘run down’ easily.

We can get out of this state by removing ourselves from all external stimuli and letting our energy-batteries naturally recharge themselves i.e., by relaxing. But there’s so much external stimuli around in the modern world and people are so unaccustomed to the absence of it that we may never be able relax properly, which could mean living in a permanently ‘run down’ state.

This lack of quietness has also meant is that people are no longer used to silence, and have even, as a result, become afraid of it. Along with inactivity, silence has become something which most people are determined to avoid at all costs, and which, when they are confronted with it, unnerves them. People have become so used to the frantic pace and the ceaseless activity of modern life that they feel uneasy when they’re left at a loose end with nothing to occupy their attention even for a few moments, and they feel equally uneasy when the noise they live their lives against the background of subsides. Why else is it that they need to have their radios and televisions chattering away in the background even when they’re not paying attention to them?

In other words, in the modern world silence has become an enemy. And this is a terrible shame, because in reality silence is one of our greatest friends, and can if it’s allowed to reveal itself to us have a powerfully beneficial effect on us.

Inner Noise

It’s not just the noise outside us which causes us problems, though, but also the noise inside us.

In the same way that the natural quietness and stillness of the world around us is always covered over with man-made noise, the natural quietness of our minds is constantly disturbed by the chattering of our ego-selves. This chattering fills our minds from the moment we wake up in the morning till the moment we go to sleep at night an endless stream of daydreams, memories, deliberations, worries, plans etc. which we have no control over and which even continues (in the form of dreams) when we fall asleep. This ‘inner noise’ has as many bad effects as the mechanical noise outside us. It actually creates problems in our lives, when we mull over tiny inconveniences or uncertainties which seem to become important just because we’re giving so much attention to them, and when we imagine all kinds of possible scenarios about future events instead of just taking them as they come. It means that we don’t live in the present, because we’re always either planning for and anticipating the future or remembering the past, “wandering about in times that do not belong to us and never thinking of the one that does” as Blaise Pascal wrote. And this constant inner chattering also means that we can never give our full attention to our surroundings and to the activities of our lives. Our attention is always partly taken up by the thoughts in our minds, so that wherever we are and whatever we’re doing we’re never completely there.

It’s probably possible to say that there’s also more of this ‘inner noise’ inside human beings than there’s ever been before. The hectic pace and the constant activity of our lives, the massive amount of external stimuli we’re bombarded with, and the barrage of information which the mass media sends our way, have made our minds more restless and active. We’ve got to juggle dozens of different problems and concerns in our minds just to get by from day to day, and every new thing we see or every new piece of information which is sent our way is potentially the beginning of a whole new train of thought to occupy our minds.

The True Self

Ultimately, the most serious consequence of both this inner chattering and the noise and activity of the modern world is that they separate us from our true selves.

Our ‘true self’ might be called the ground, or the essence, of our beings. It’s the pure consciousness inside us, the consciousness-in-itself which remains when we’re not actually conscious of anything. It’s what remains when our the activity of our senses and the activity of our minds cease. The sense-impressions we absorb from the world and the thoughts which run through our minds are like the images on a cinema screen, but our ‘true self’ is the cinema screen itself, which is still there even when there aren’t any images being projected on to it.

Experiencing this ‘consciousness-in-itself’ can have a massively therapeutic effect. It brings a sense of being firmly rooted in ourselves, of being truly who we are. We also have a sense of being truly where we are, realising that before we were only half-present, and everything we see around us seems intensely real and alive, as if our perceptions have become much more acute. But above all, we experience a profound sense of inner peace and natural happiness. As the Hindu and Buddhist traditions have always held, the nature of consciousness-in-itself (which means the consciousness inside us and the consciousness which pervades the whole universe) is bliss. Getting into contact with the pure consciousness inside us enables us, therefore, to experience this bliss. Indeed, it could be said that it’s only when we do this that we can experience true happiness. Usually what we think of as happiness is hedonistic or ego-based that is, based around pressing instinctive ‘pleasure buttons’ or around receiving attention and praise from others and increasing our self-esteem. But the kind of deep and rich happiness we experience when we’re in touch with the ground or essence of our beings is a natural, spiritual happiness, which doesn’t depend on anything external, and doesn’t vanish as soon as the thing which produced it is taken away. It’s a happiness which comes from experiencing the divine inside us and also the divine inside everything else, since the pure consciousness inside us is the same pure consciousness inside everything else, and the pure consciousness of the universe itself.

Making Contact with the True Self

Whether we’re in touch with this ‘true self’ or not depends on how much external stimuli our senses are taking in from the world around us, and on how much activity there is going on in our minds.

If there is a lot of noise, movement and activity taking place around us then we can’t help but give our attention to it; and in the same way, when there is a lot of ‘inner noise’ taking place we have to give our attention to that too. And when our attention is completely absorbed in this way either by external stimuli on their own, such as when we watch TV; by ‘inner noise’ on its own, such as when we daydream; or by both of them at the same time it’s impossible for us to be in contact with our ‘true self’ to any degree, in the same way that it’s impossible to see a cinema screen in itself when it’s full of dancing images. Being in contact with our ‘true self’ is a state of attentionless-ness, when our minds are completely empty.

What we have to do if we want to get into contact with this part of ourselves is, therefore, to withdraw our attention from these things. And this is, of course, what we do when we meditate: first of all, we remove ourselves from external stimuli, by sitting in a quiet room and closing our eyes. And then there’s only ‘inner noise’ standing between us and consciousness-in-itself, which we try to quieten by concentrating on a mantra or on our breathing. If we manage to stop the inner noise (and therefore stop our attention being absorbed in it) pure consciousness immerses us and we become our true selves.

And this brings us back to the most serious problem caused by the massive amount of external stimuli (including noise) which our senses are bombarded with in the modern world, and by the intensified ‘inner noise’ which modern life generates. It’s not just a question of completely closing yourself off to external stimuli and shutting down ‘inner noise’, so that you can experience a state of total immersion in pure consciousness. It’s possible to have a foot in both camps, so to speak; to live a normal life in the world, being exposed to external stimuli and experiencing inner noise, and at the same time still be rooted in your real self. That is, it’s possible to be partially immersed in consciousness-in-itself, and for your attention to be partially absorbed by external stimuli and inner talk. But this can only happen when there is just a moderate degree of both of the latter.

It would probably have been quite easy for our ancestors to live in this way, because they weren’t exposed to a great deal of external stimuli and because their lives were relatively slow-paced and stress-free, which would have meant that their attention needn’t have been completely absorbed by external stimuli and inner talk. Perhaps this even partly explains why native peoples seem to possess a natural contentment which modern city dwellers have lost because their more sedate lives mean that they’re able to be in touch with the ground of their being as they go about their lives, and that they can therefore continually experience something of the bliss of which is the nature of consciousness-in-itself.

For us, however, this has become very difficult. There’s always so much noise and activity both inside and outside us that our attention is always completely absorbed, so that we can’t be in contact with our real selves. We spend all our time living outside ourselves, lost in the external world of activity and stimuli or in the inner world of our own thoughts. We’re like a person who plans to go away for a few days but finds so much to occupy them in the place they go to that they never go home again, and never again experience the peace and contentment which lie there. This is certainly one of the reasons why so many people nowadays seem to live in a state of dissatisfaction — because they’ve lost touch with the natural happiness inside them. That natural happiness has been buried underneath a storm of external stimuli and what Meister Eckhart called ‘the storm of inward thought’.

As a result of this it’s essential for us, in the modern world, to go out of our way to cultivate silence ourselves. Circumstances may oblige us to live in cities, and our jobs may be stressful and demanding, but we’re still free to remove ourselves from external stimuli and to try to quieten our minds by meditating, going out into the countryside, or just by sitting quietly in our rooms. We don’t have to fill our free time with attention-absorbing distractions like TV and computer games, which take us even further away from ourselves. We should do the opposite: stop our attention being absorbed like this so that we can find ourselves again.

We need silence and stillness to become our true selves and to be truly happy. ‘Be still,’ said Jesus, ‘and know that I am God.’ But he might have added, ‘and know that you are God.’