“Death, Dying and Coma Work”

Interview with Mark O’Connell, England, 2000

MARK: Gary in your forthcoming book, “Leap into Living: Moving Beyond Fear to Freedom”, you talk about the anxiety around death and illness, which appears to be stronger in Western Cultures than in other parts of the world. Why do you think this anxiety is stronger?

GARY: Well one of the things in more Eastern cultures and more tribal cultures is that there is much more of a spirituality involved with dying: there are whole myths and stories around dying, and practices to prepare for dying. And death is something which is really talked about and that you are preparing for your whole life. In the West it is still one of the most forbidden topics to talk about openly. So that hidden-ness makes for a lot of anxiety.

MARK: People may hear chickens in the background, we are currently in an orchard, surrounded by birds and chickens and flies, in the heart of nature. So it’s do with the mythology and… (laughter)

GARY: … Are the chickens drinking your tea? (laughs)

MARK: Yes. (more laughter)

GARY: That should be part of the tape…. Laughter and detachment is a big part of it, the more you work on death and dying. A lot of Zen masters just talk about laughing at the moment of death, and it doesn’t mean that it’s also not something serious and scary, but in other cultures it is more meaningful, whereas in the West it is often seen as something not meaningful and a sign of failure.

MARK: Right. Do you think the experience of anxiety around death and dying has an effect on how Western Medical systems approach working with people who are dying?

GARY: Totally. There’s a whole chapter in my book about it, and I start with a quote by a physician who talks about how he was trained to see death as meaning he had failed. So if you have that attitude about death of course it is something you are not going to want to get close to. And I think it affects a lot of how modern medicine, especially, treats people with so called terminal diagnoses and things like that.

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MARK: So if the idea of health is that someone has to not die, for example, that might be behind that anxiety?

GARY: And then that if someone is dying you are failing. Well most of us don’t like to really get near our failures. And it’s hard, like I think of how many coma patients just sit in coma wards, lying there, nobody really interacts with them much, because, one of the reasons is that you often don’t get big results with coma work, you get little results. But if you are trained to think of results as progress and as not results as dying or failure, then it’s sort of a losing game as a health professional since people are all going to die.

MARK: That leads me on to think how in your book you talk very personally of your own experiences of anxiety. And I am wondering how, as a therapist, your anxiety has influenced your working with people who are dying, and how working on that yourself has changed maybe your approach?

GARY: Well two things. One is that the whole book is around death and life, and especially transitions; that many, many times we go through death-like transitions in life, all the big changes in life, like the adolescent years, the mid-life crisis, ageing crisis, all these different crises. And often people will dream at those times that they actually have died. And so I am interested a lot in helping people through those transitions.

MARK: And so you are saying that every transition in life is like a death, and you’ve experienced working on those transitions… and fear of death…

GARY: … a lot in my own life. I grew up in a family of doctors and people anxious about health, and so I have a lot more compassion I think. I have developed compassion for people who go through those anxieties: they can be very painful, and so working with them as transitions helps. I know some of the Zen masters talk about how eventually, that death is just the next moment, if you are living each moment in life fully, and then the next moment is death. And then there are moments after that. And so I try to help people through that.

And one of the other things I try to help people through, if they get a terminal diagnosis, is to try and help them to feel freer around that diagnosis. That they can take that as one perspective. Like I have had a lot of people with terminal diagnoses who are doing fine for many years. And also to help people when they are dying to really utilize their dying to grow rapidly, and to ride the dying as a wave that can really take you into incredible places in yourself. And when people feel their death is processed and meaningful, death is a very different business.

MARK: Right. What recommendations might you have for professionals working with death and dying? What do you feel is important if you are working with people who are dying?

GARY: I think it is to work on your own death a lot first. Lie down sometimes and imagine you are dying. And then see what happens next. And get familiar with death as a transition point in yourself, so that you are not against it. And also to really work on your own inner views of valuing only healing, and being so one-sided, as opposed to valuing each moment and each state.

MARK: Right, so you say lie down and imagine your own death. That might be scary for some people, to even think of doing that. Some people don’t even choose to think about death. What kind of experiences do people have when they do this kind of work?

GARY: They almost always have a huge sense of relief. That something which needs to die dies, and then the next thing comes, like maybe… say you are very anxious person, you lie down, and then maybe you find that what has died is your anxiety. And then maybe the next thing you find yourself is jumping up and down. I know I’ve done that exercise so many times that I’ve had wonderful experiences becoming rivers and stars. And it’s a way to find something bigger, the Big You, something that is beyond your ordinary identity.

MARK: So we are in a sense needing to die in order to live

GARY: That’s really right, so that to live more fully you have to die, and learn to die to each moment. And learn that at certain times of your life big processes are dying; for example, in the mid-life crisis a lot of old identities from the family you come from, and all your old patterns – like maybe you consider yourself a victim of this or that. All those old patterns start to want to fall away like the skin on a snake. And people often feel like they are dying, and they are. One part is dying, not the physical body, but a certain form of your identity. So that’s a different form of life, viewing life as a constant shedding of skins, at different times of your life, and then you’re reborn again. It can have great effects on your physical body and on your energy levels

MARK: Do you know of particular people who have worked really effectively with their own dying process? You have worked with dying people and you’ve met shamans from different cultures. I am curious about what your observations are around how people have dealt with their own death.

GARY: I think of some of the people I have worked with who have made huge leaps in their personal history cleaning things up, and also huge leaps into their spirituality. Like I am thinking of one woman who had almost no psychology, and she was on dialysis, she had kidney failure, and eventually she chose to not get anymore dialysis. But in the times just before she died she cleared up all the relationship stuff with her family, she even cleared up the relationship stuff with her pastor who had made her feel really bad about things. She had an incredible death; she became more and more lucid and clear, and spiritual and loving.

And the last thing that happened was that I called her from another town where I was teaching. And they said she had been in a coma for six days. And I asked them to put the phone up to her head, and let’s say she was called Sally. I said “Sally, how are you doing it’s Gary?”, and she said “GARY! I’m doing good”. I said, “I thought you were supposed to be in a coma?” She said “Yeah!” And I said, “What’s happening”. She said, “All life is beautiful, everything is clear, and I love everybody, and I am in a state of love. I am ready to travel and I am free.” And I said, “Sally have a great time, I love you a lot”. And she said, “Oh I love you a lot. See you later.” And when I got back to town I discovered that about 12 minutes later she had died. So that’s a woman with very little pre-psychological training who used her death to, in a way, become enlightened. In my view she died something like an enlightened being.

MARK: Are there people who this work of going through a dying process is not appropriate for? Do you sometimes find that there are people who just wouldn’t want to work that way?

GARY: Occasionally, but I think that the really strange thing is that whether or not you are into being psychological or spiritual in much of your life beforehand, when people get near their death they seem to almost always get more interested in their personal death. Because altered states happen to you as you get nearer dying, having worked with those before is great, and having someone who can assist you through them. People are usually very receptive. I would never press it on anybody, but it’s usually the opposite, that people actually want some help in those states.

MARK: It strikes me also that maybe not only on an individual level, but maybe in relationships and cultures there may also be a dying process on that different level? What do you think of the idea that cultures may be dying?

GARY: I think so. You could say that certain trends; like for example in the States we have been in an age of incredible materialism and yet it looks like that is beginning to die, and in the background is this increasing interest in personal growth and in spirituality and stuff like that. So it may be that that whole thing, not that we won’t need material life, but the sort of over-materialism may be dying. And you see that all over the place, like in science and in medicine and things like that, the interest in theoretical physics and in quantum physics and mysticism is really growing.

MARK: It’s interesting to think of death as a multi-leveled phenomenon.

GARY: And again the real emphasis in all these spiritual traditions that really have you work on your death, is on really living fully, and living as a dead person. Meaning learning to live with some detachment, overview and some bigger perspective. It’s one of the reasons I think process work as a psychology is so popular, because it emphasizes the meaningfulness of life, and so you could say that it has a death perspective from the beginning. That life is bigger and that you are bigger than you are.

MARK: I know for myself that I came to process work through a death anxiety, or a death type of experience, over the period of ten years I actually thought I was dying. However real physically that was or not, it was a very real sense of dying. And it was only when I actually finally got to the point of admitting to myself that I might die, and really went through that, that I came to process work.

GARY: Yes I think shamanism, process work, Tibetan Buddhism, mystical and religious traditions address those issues. And there is such a hunger, because in the average western culture you have very little connection with a kind of spirituality that connects you directly to your dying process and your living process in the moment, and to something very eternal. I mean we may have ideas of heaven and stuff like that, but really giving people a momentary experience of that is really unique, I think, to more mystical traditions. And I call process work in a way a mystical tradition because it works so much with the unknown.

MARK: Also we are going to talk today about coma work. And one of thing that often comes up around coma, which is a big ethical issue, is about when to let someone die or when to keep someone alive on a life support system. And I wondered whether you could talk a bit about that issue in terms of process work and your work with people in comas?

GARY: I think Arny Mindell said it so well: he called it the ‘Thanatos Ethic’. And what he means by that is that you don’t just take any one state of consciousness in any part of your life to make a huge life decision. In other words, let’s say you are deciding to stay in a relationship, then you don’t just make a list of the pluses and minuses of the person and add them up and make a decision. You ask another level of consciousness, like you ask for a dream or something like that. And so that is really what you do with coma patients. Let’s say that someone signs a living will. That’s one level but that was the pre-coma level of awareness. And what we do is to ask them in the coma, through signals, to indicate to us, their position now on dying.

One of the big reasons for that is that a number of people who we have asked, who have come out of coma, who had living wills and yet because of the coma work weren’t disconnected from the plug, have said that in the coma state itself they were in a different place and didn’t want to die. So you have to ask both states, and you have to ask many, many times of someone in a coma. And it’s amazing to me that people show in coma states, when you do coma work, that they can make really clear choices in those states. Like somebody may stop breathing or something like that, and they choose in that way to die. Or you’ll see them go in a certain direction.

On the other hand, people who I have been told have no chance of living, where the hospital wants to unplug the person, we have had experiences of those people getting up and walking and talking. So the ethic is to ask the person and not to impose a medical or legal view on the person.

MARK: A comatose state as I understand it is a state of a very different type of consciousness, so what do you mean when you say asking someone or communicating?

GARY: Well there are two major ways I do it. One is that I look at the trends. Like if you try a lot of interventions with somebody and you get no minimal feedback at all, there’s no verbal sounds and no movement, the person is not interested in anything. Then I look at the trends, and if the person has been going further and further away from consciousness that’s a strong signal for me. And then another way of doing it, though, is to create a binary signal hook-up, which means you find a way of asking the person ‘yes’ or ‘no’, where they clearly signal you back and you test that signal over and over again. Like I’ve used a bunch of them. One is somebody taking a deep breath meaning ‘yes’; another is often working with someone putting their finger or their thumb up.

MARK: So you can actually get a yes or no answer? So there is some sort of definite consciousness, and a communication loop happening between you and the person in coma?

GARY: That’s right. And I will also ask them many times about dying, but I will also ask them many other questions about how they are doing, what their experience is like. And I may ask them if they would like to come out of the coma. And if they have a sense, I may ask them times, like “Do you imagine coming out in a month? ..or in two months? ..or six months? Or..”

MARK: That must be an incredible experience for a family. I presume that a lot of the families you are working with, people whose relative is in a coma, are not familiar with the chance of communicating with them from the start?

GARY: Well I think that is the most relieving thing. I think it’s very important when you do coma work with a family, to let them know you are coming from a slightly different place than a western approach. Because in a western approach they hire you and you are supposed to bring the person out of the coma. But the clear thing for me is that my job is to follow nature. Which means I am not against death. And so I am there to follow the person and to ease them into dying if that is their process. Or just to clarify the process, if it’s to come back or if it’s to take a long time. And every family I have ever worked with has said that the main benefit they found, whether or not the person “gets better” is that the communication improves greatly. And families love being able to communicate with the person.

MARK: So do people pick up those skills while you are working and they start to interact in the same way?

GARY: If people are interested I almost always try to train the family in how to do at least do the basics of it, which is the communication style, and maybe making a binary hook-up, and following some of the movement processes and stuff like that.

MARK: We are talking about families. What happens in a family around coma? I know process work has some ideas around the importance of family work around people with comas, and I’m curious about what kind of dynamics are happening?

GARY: Well there are so many important things to address in a family! One is the idea that it is possible that the family itself mirrors what is going on a lot in the person in the coma. That they are like receivers for the signal. So one thing I look at is, in terms of the recovery of the person, how much energy there is in the family. And you find a huge diversity, from people who say “We are ready to let go of the person,” to people who have huge extended families organized, and they are working on the person almost around the clock, and you have to tell them to give the person a rest. And so one possibility is the family is a reflection of it.

A second thing, which is important to address, is the well being of the people you are working with, also. Because a lot of times the family itself burns out and other people start having a lot of physical symptoms. And it’s a huge thing when somebody is identified as the sick one, or especially in an extreme situation like a coma, that the other people who may have physical problems and symptoms feel free to bring those up. I talk to families a lot about “How are you taking care of yourselves?”

One more thing also, is that helping people process the trauma, the shock and the stress of a loved one being in that state is incredible. Families have to also go through huge transitions. I’ve had families that go so far, that even if the person doesn’t come out (of coma) .. I remember two women telling me that the best relationship times they have ever had with their partner was when the person was in a coma. You are helping the family make a shift in consciousness, also, and it’s very difficult. I remember one of the first doctors I encountered who I asked “What do you consider progress?”, and he said “When Sadie can sit up and play cards again, then I consider that progress”. Families can get very depressed with that view. And a lot of your job as a coma worker is to help them shift their minds and their perspective to value what’s happening in the person, and to value the coma state as an important state of consciousness in itself.

MARK: Do you have an idea of what percentage of people in coma it is possible to work with? I am curious whether you feel there are some situations where it is just not possible?

GARY: I can only talk about my own experience. I would say that in 100% of the cases that I’ve worked with did I get feedback. And in a couple of those cases, after a while the person seemed disinterested or died or whatever.

But you know it’s sort of like saying “Who could use therapy?” “Everybody.” “Who could use coma work?” “Everybody.”

It’s amazing that I don’t think I ever worked with anyone where there wasn’t some kind of strong interaction which occurred. And this is back to the ethics idea, that leaving people alone in long-term extreme states may not be the most ethical thing. You can imagine if you were in a really extreme state, maybe one of the most challenging states of your life, and nobody called you, they just left you alone hiding in a corner or something. So one of the ethics is not leaving the person alone. And that means not only sitting around the bed. It also means really knowing how to go in there and find where they are and be with them.

MARK: Does that mean that there is therefore an unethical dimension in not even believing in people’s states there?

GARY: Well I have had that discussion sometimes with hospital directors you know. I think I have a different view. There are different views in neurology right now around coma. There are some views which are getting very interested in working with people. But other people’s views have said that their only job is to take care of the physical body, which some hospitals do an incredible job of. And we need that, because without that there is no such thing as coma work right?

But I would disagree with people like that. I would say, “I agree with you that is the best we have had so far, but now there is a whole other thing we can do with those patients besides. And it may also help their physical recovery a lot if we help them process the altered states which they experience. People come out and say they were at the bottom of the ocean. They have all sorts of wild scenes in coma, it’s very deep deep dreaming and people need help with that.

MARK: I could give you a scenario or type of situation which someone has mentioned to me, and lets’ see if you can give an idea of how you might approach this kind of situation. Imagine you were working with a person in a coma, where the hospital says the patient only has a few days left to live. The family is summoned from all around the country, but nobody is saying goodbye or talking about death or coma. There is a silence in the family. But also the patient is squeezing hands and giving feedback. How would you approach the whole dynamic of that family and the person in the coma? Just some ideas maybe.

GARY: Well I was thinking of a family actually that I went down to for just one day so that somebody could deal with an elderly parent. And we just talked openly about it. And he said goodbye to her and made peace with her. He had had a bad or difficult relationship with his mother. And my addressing it directly with him, and his directly addressing it with her, and getting her feedback was really incredible.

I was just training in the work at the time, and I remembered talking to Arnold Mindell then, and he said, “I think that woman may make a change in 9 days”, and on the 9th day she stopped breathing. The hospital resuscitated her against the wishes of the family and they had to sort of straighten that out. So maybe she wasn’t quite finished, it wasn’t just the hospital. But it was really clear to me that something was done, and that the family needed to say goodbye. She was really elderly, she had been in a coma from a stroke for many years, and I think was sort of trapped.

So I think there is a lot of ethic, and in the case you give I would bring that up. I am not opposed to bringing up unspoken things in families. I call those ‘ghost roles’; the role or action which is not addressed but everyone knows about. I would also ask, “how is everybody feeling about that, that the hospital says Sadie might be dying in a few days?”

MARK: So you address all parts of the field or the group that is there?

GARY: Yes, I am very cautious about supporting the hypnotic power of death sentences. And what I mean by that is that sometimes social workers, therapists, doctors or nurses will say to somebody “You have 3 months to live.” And then the person goes into such a deep depression that it is sort of self-fulfilling. In fact I have helped a lot of people who have said “I don’t want to die in 3 months. That doesn’t feel my process, I actually feel really good”. And people are then free to live out that. But I have also had patients who have almost committed suicide after being told that they were going to die in a short period of time. So it is a very delicate balance between not denying death but also not making a program out of it, and just following the person’s process around their dying.

MARK: So you are talking about how there are also different belief systems within systems, hospitals say, the medical system, around what determines if someone is dying. You are saying in a sense that a message can kill someone.

GARY: I am not sure I am saying a message can kill someone, but if someone is teetering… like I don’t think if they say something to someone in great health they are going to keel over. But let’s say they are fighting something. Like I am thinking of a man I worked with who was fighting, he wanted to stay alive for awhile, and he had cancer throughout much of his body. And he had a great physician who told him “Just keep working on yourself.” And another time he went to a different physician, and the guy said “Why are you working on yourself? You are going to die anyway, it’s a waste of time”.MARK: So that’s a belief system that there’s limited time.

GARY: There’s limited time, there’s no hope, and whatever the medical model says goes. If the medical model says you are going to die you have to go. So he almost committed suicide, and I had to work a lot with him on that. And he stayed around quite a while, and his death was an awesome death, by his own timing. He called a funeral for himself while he was alive, and he had an incredible ceremony, and he was a transformed human being. He died after lighting some candles with a smile on his face.

And I have worked with a lot of people where that has been the case. So I say it is better to let the person follow their own process around dying rather than proscribe something. You may say “The medical model, or one view of this says you may die within 3 months; now let’s see what your process is. Let’s see what your body wants to do.” I am working with one woman who was given a death sentence a little while ago. We’ve been working about 2 or 3 months intensively on this, plus she was given some chemotherapy, but still she wasn’t supposed to live and was supposed to have about 18 months of chemotherapy to give her another year or two. After about 3 months her cancer count is normal. And they are thinking now of stopping the chemotherapy. So how do you explain that? And if she hadn’t had the personal power to fight that prescription of death, it may have pushed her into a depression. You know there is also a lot of research about psycho-immunology, that says that how we feel has a lot to do with our own immune system.

MARK: I am hearing in what you are saying that a lot of people are working through some kind of process in themselves in the coma. Process work is concerned with integration and individuation of the whole person? So is a comatose person in an individuation process would you say?

GARY: Absolutely. That is why I liked when Arny Mindell’s book ‘Coma – Key to Awakening’ or Amy Mindell’s book ‘Coma – A Healing Journey’ came out. That’s the way I see it, and that is also terrifying. I did a phone consultation with a mom the other day, and she said her son had been in a severe accident with little hope of recovery. Not everyone recovers, but this was a lucky story, I hear he has recovered. And she said, “Do you think this will change him?” and I said ‘Yes’, and that was terrifying for her. She couldn’t hear it almost. And it took me along time to explain that yes he’ll change, but for the better, that coma is a rapid path to growing. And I have never seen anybody who went into coma who didn’t make a life shift.

MARK: Right. And will the family sometimes hold back a person who is in a coma?

GARY: I think families hold back people all the time. Not all families. But they can hold back your development at any stage. And sometimes it looks like the coma is related to that, like somebody who really wants to be themselves. Like young people I’ve worked with in coma especially, who are maybe in the 20s or something, who want to have one life, and their parents want a different life for them. Part of the coma looks like maybe a partial dialogue around that. And also a lot of people seem better able to be themselves in a coma than out of one. And one of the issues that I address with them there, is that if they come out of the coma, that is only the beginning of the work. Then we have to help them work with their family and their culture to be themselves out of the coma.

MARK: That brings me on to this next question, which is about whether you feel there are particular kinds of life processes which go along with a comatose state? Do certain kinds of experiences in people lead them onto comas?

GARY: I can’t generalize too much, but I can say some situations I have seen. But people need to know that this is not causal, that if you have these symptoms you are going to have a coma, because everybody has all of these symptoms. But sometimes before a coma you see some kinds of major depressing things which come up, and which aren’t processed. This might be something you see sometimes.

Other things I’ve seen sometimes, and particularly in older people, are people who could never rest much or go into deep more feeling states. So a lot of the time, out of the coma you will see people come out with a lot of emotional state, people who weren’t so emotional. I remember working with some people who worked like 90 hours per week and hadn’t taken a vacation for 10 years, and you could look at them in coma and actually guess what their life was like by looking at the posture of their body. I worked with one family where, when I went in, I said, “It looks like mom is on vacation”. And they said mom was a farmer and she had never been on vacation, and she was just about to retire, and then she got in this coma. She was so much on vacation that I had to work with her in the most relaxed way.

I’ve also seen people in the midst of fights in comas, and you can see that in their body, that the whole coma is about something really aggressive. A lot of comas are also about the need for contact. I know one of the people who lets me talk about her, because now she comes to my classes. A big breakthrough for her was that I had her husband give her a big kiss on her lips because she was moving her lips a lot. And the next morning she came out of the coma.

So contact, the need for bringing out your aggression, the need to process different depressing issues, the need to process ‘can I be myself in this life?’; but the one thing is that almost anyone who has come back has much more determination and a sense of what their life is really about. It’s a strong intervention to say to someone “Can you be your whole self in this moment?”. I sometimes say this to people in coma. And a lot of the research into near-death experiences says that people often tend to come back with a renewed determination to living out what is really meaningful about life. And they have been asked about that and it has been about love; doing something for the world; living out their creativity; and being more in contact with the depths of life.

MARK: Are you talking about spirituality there?

GARY: Yes, a sense of spirituality and meaningfulness, and, depending on their age, it can also be a sense of ‘Lets get on with it!’. For people in their younger years it may be ‘Lets get on with our career or family life’. And for people in their senior years it is often more ‘Lets get to what’s really real’. I have worked with various successful business people in coma who, when they come out, seem much more interested in their emotional life and things like that. It’s a kind of stretch. I see coma as a big stretch. Wherever you need stretching, it stretches you.

MARK: I saw you working yesterday with someone who had been in a coma, and I noticed that you asked them if just before they went into coma had they had any particular experiences. And there was a particularly strong experience. So what is it that is happening just there at the point of entering coma? What are you relating to? Why do you go back to that point?

GARY: Because I wanted to know what was the ‘sentient’ or ‘core’ experience under the coma. And often those experiences are present before something becomes a symptom. Sentient means that it is ‘pre-manifest’. There are other ways of getting to that. One is to ask the person once they come out of the coma if they had a previous near death experience, and then work on that. You can also get to that core thing the person is working on.

MARK: So this ‘core’ experience; would you often find people living closer to that after a coma?

GARY: Yes, closer to that core experience. Yes. For example one man had a previous near-death experience where he was almost killed by a car accident, and during that time he had a ‘God’ experience. And then his later experiences around dying, all about 20 or 30 years later, were about picking up his spirituality.

MARK: It’s very interesting. I remember hearing about a chap who had very seriously become paralyzed through jumping on a children’s bouncy castle. It always struck me that here you are as an adult really letting go and playing, letting your joy and spirit come out, and then you’ve broken your neck and your body is paralyzed; what a huge contrast that is! So maybe there might have been something there like a sentient experience of playfulness and fun?

GARY: It’s possible, and also there must have been, before paralysis, something of the core experience of that before it becomes paralysis, that’s the theory. For example we were talking about the person who was fantasizing and planning her vacations, and so then some deep relaxation state is there way before the coma: it’s just marginalized. So you could say that coma is one way to get over huge edges and to get to parts of yourself that are hugely marginalized.

MARK: So those states may not be very easy at all for the person to access even though they are there?

GARY: That’s why doing something like sentient or core work is useful, because there may be such huge edges against the more outward expression of the state. Lets say, for example, there’s an edge towards retirement, so maybe working on retirement is too difficult for someone. But maybe the sentient essence of retirement is something like ‘letting go’. Maybe you can work with the person and get them to get into some kind of movement process around letting go. So it’s sometimes easier, where there are huge edges in life, to go down to the core sentient experiences of that.

MARK: So do you then think it might be possible that if you could get to those sentient experiences before someone went into coma, possibly it would stop the need or the necessity of going into coma?

GARY: I think so. I work with a lot of people who have hit their heads or have knocked themselves out a little bit. I know one person who told me after one of my classes that she had knocked herself out three or four times recently. So we talked briefly about what was trying to happen in those states. It’s preventative. For example, I was gardening recently and I stepped on a gardening tool and hit my head, and then I was gardening a few weeks later and I gave myself another knock, but already I was working on what was that about. I don’t need a bigger knock. Those knocks were enough.

MARK: I have a great interest in the environment, and I was wondering if you have ever done an intervention or brought a comatose person out into nature?

GARY: Oh absolutely! For example, I have learned a lot through working on myself a lot to be in hospitals. As a younger person I never wanted to get near a hospital. They were too terrifying. But now I have actually learned to be in them, and sometimes to even enjoy them. But a lot of times we actually take people for a walk if there is a courtyard. And I purposefully put a person whenever I can underneath the trees if the birds are singing, and people look like they have really good feedback to that.

MARK: So they are already communicating or giving feedback to the environment around them?

GARY: Yes, and you can also use that. If somebody seems to respond to a bird you can use that in the work, or if they seem to hook up to the sunlight or something like that it maybe part of their process.

MARK: I think there has been some research done, I don’t know where I’ve heard this, into looking at the environments of hospitals and into whether, if the outside environment were more accessible to people, it may be of benefit to them in terms of their healing process?

GARY: I think so, and people always try to do this. Family members love to put people in chairs where they can wheel them outside. They love getting outside into the environment.

MARK: Gary, if someone wanted to practice process work or coma work, what could you recommend to someone who is starting out? You have done coma work around the world. I know you have worked with Arnold Mindell, and various people know about your work; but someone who is starting out to learn these skills, how do people get started? It’s not like starting a private practice where people will start coming along to you.

GARY: There are a couple of things in that, like first; how does someone train? I think there are a lot of people – myself, Arny and Amy Mindell, and some of the other process work teachers – teaching coma work. But I would definitely go to the trainings that mostly happen in Portland, Oregon where the main process work training center is. There may be some training in Zurich. I am not sure. I hope to do some work in England in 2001.

Then I think the most important thing to do is to get someone to supervise you, or to assist somebody. I had Arnold Mindell supervise me for a long time. The third thing is to get a lot of experience, I have probably had thousands of hours of working with different kinds of patients. I learn so much each time. Working with somebody who was deprived of his oxygen for example, was different from working with someone who had a stroke; somebody who has a head injury; working with people who have had heart attacks; there are so many different kinds of comas, and different ages. Get some training and supervision, and then when you get the basics down, go out and practice and work with as many people as you can in all kinds of situations.

MARK: In that training process do you find that different kinds of comas stir up different kinds of things in you as a practitioner? Are you brought to particular edges in yourself?

GARY: Well, the first thing I’m giggling about is that I would describe myself as a person who is open to altered states but who feels pretty grounded these days. And the first times I worked in coma, afterwards, I felt like somebody had drugged me. The states are so altered, that I thought to myself ‘How am I going to drive after working with somebody like this?’. That’s pretty wild, so I think I had an edge to really opening to how the coma work really altered me, and as I worked on that more, then I allowed myself to do things like just meditate with the client, and bring out the imagery and the dreaming things which I saw while I was meditating. Being more open myself.

Are there other edges? I think the most difficult thing for me is working in a family where there is a lot of pressure to bring somebody back. I have a lot of feeling for people and families who are suffering, and often I would like to be able to bring people back, and yet I think that’s up to nature. It’s hard.

MARK: So I noticed you didn’t particularly talk about death and the fear of death as one of the edges there. Is that also something that one might expect to come up?

GARY: I think for me it wasn’t the actual fear that somebody might die. But if people haven’t ever experienced that, like being around a dead body for example, then it can be real scary. And you have to work on your own mortality. I’m sure that has a lot to do with what I had to work on, and why I avoided hospitals was because I didn’t want to look at my own mortality. Working with coma patients makes you feel really close to that whole realm of mortality.

MARK: Gary, do you consider that there is a minimum of skills and experience needed before one begins to work with someone in coma.

GARY: Again a minimum of both skills and what I would call ‘metaskills’ or feeling attitudes. And metaskills may be even more important. The key metaskill for me would be openness to experience and also your sense of concern for somebody.

You could hurt somebody in a coma, physically, because you are using your hands on people and they are not able to give you verbal feedback. So I want somebody to have a lot of sensitivity in their being, around following feedback in not pushing someone too far, in not hurting them.

And then I want them to have specific training in the various aspects of coma work including: how to work with verbal issues; how to work with visual things; how to work with body feelings and sensations; how to work with movement; how to work with relationship; and how to work with family therapy. I would like a person to have some basic training in all those things.

But that doesn’t mean that if someone calls me from Portugal and says their person is in a coma and they would like someone to work with them, that I am not going to tell the family right away to start. I will, but as a practitioner, I want a practitioner to have some basic skills to know they are not going to hurt somebody.