The spiritual life calls out to me. But is it self-indulgent?
Your Mileage May Vary is an advice column offering you a unique framework for thinking through your moral dilemmas. To submit a question, fill out this anonymous form or email sigal.samuel@vox.com. Here's this week's question from a reader, condensed and edited for clarity:
I graduate college soon, and like everyone around me, I'm working hard to find a job. But unlike those around me, I have a sense for how inactivity enlivens me — I get lots of joy from silence, reflection, and complete agency over my mind. I've quit most social media, and I got into meditation a while ago and never looked back. This awareness makes me tilt towards a life that optimizes for this. But I also have very altruistic leanings, which could become serious scruples if I don't do good in the world.
Should I be trying to balance the pursuit of two seemingly opposed life goals — pursuing true happiness through inactivity and contemplation (as hypothesized by thinkers like Aristotle and Byung-Chul Han) and striving to do good in the world through robust goal-oriented action? The first is indifferent to which ends (if any) one's life contributes to, as long as it is blanketed in leisurely contemplation and true inactivity. The second invites and rewards behaviors that are constantly opposed to prolonged inactivity (working efficiently, constantly learning, etc). So I really don't know how to handle this.
Dear Contemplative and Caring,
Matthieu Ricard is known as the 'world's happiest man.' When he lay down in an MRI scanner so scientists could look at his brain, they saw that the regions associated with happiness were exploding with activity, while those associated with negative emotions were nearly silent. The scientists were stunned. How did his brain get that way?
The answer: 60,000 hours of meditation. See, Ricard grew up in France, earned a PhD in genetics, and then, at age 26, abandoned a bright scientific career in favor of going to Tibet. He became a Buddhist monk and spent nearly three decades training his mind in love and compassion. The result was that one stupendously joyous brain.
But what if he'd instead spent 60,000 hours bringing joy to other people?
Philosopher Peter Singer once put this question to Ricard, basically asking if it was self-indulgent to spend so much time in a hermitage when there are problems in the world that urgently need fixing. Ricard gave a complex answer, and I think looking at all three components of it will be helpful to you.
Have a question you want me to answer in the next Your Mileage May Vary column?
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For one thing, Ricard pointed out that there are many different values in life. Helping other people is absolutely a wonderful value. But there are others, too: art, for instance. He noted that we don't go around scolding Yo-Yo Ma for the thousands of hours he spent perfecting the cello; instead, we appreciate the beauty of his music. Spiritual growth through contemplation or meditation is like that, Ricard suggested. It's another value intrinsically worth pursuing.
Ricard also emphasized, though, that helping others is something he values very deeply. Just like you, he prizes both contemplation and altruism. But he doesn't necessarily see a conflict between them. Instead, he's convinced that contemplative training actually helps you act altruistically in the world. If you don't have a calm and steady mind, it's hard to be present at someone's bedside and comfort them while they're dying. If you haven't learned to relinquish your grip on the self, it's hard to lead a nonprofit without falling prey to a clash of egos.
Still, Ricard admitted that he is not without regret about his lifestyle. His regret, he said, was 'not to have put compassion into action' for so many years. In his 50s, he decided to address this by setting up a foundation doing humanitarian work in Tibet, Nepal, and India. But the fact that he'd neglected to concretely help humanity for half a century seemed to weigh on him.
What can we learn from Ricard's example?
For someone like you, who values both contemplation and altruism, it's important to realize that each one can actually bolster the other. We've already seen Ricard make the point that contemplation can improve altruistic action. But another famous Buddhist talked about how action in the wider world can improve contemplation, too.
That Buddhist was Thich Nhat Hanh, the Zen teacher and peace activist who in the 1950s developed Engaged Buddhism, which urges followers to actively work on the social, political, and environmental issues of the day. Asked about the idea that people need to choose between engaging in social change or working on spiritual growth, the teacher said:
I think that view is rather dualistic. The [meditation] practice should address suffering: the suffering within yourself and the suffering around you. They are linked to each other. When you go to the mountain and practice alone, you don't have the chance to recognize the anger, jealousy, and despair that's in you. That's why it's good that you encounter people — so you know these emotions. So that you can recognize them and try to look into their nature. If you don't know the roots of these afflictions, you cannot see the path leading to their cessation. That's why suffering is very important for our practice.
I would add that contact with the world improves contemplation not only because it teaches us about suffering, but also because it gives us access to joyful insights. For example, Thich Nhat Hanh taught that one of the most important spiritual insights is 'interbeing' — the notion that all things are mutually dependent on all other things. A great way to access that would be through a moment of wonder in a complex natural ecosystem, or through the experience of pregnancy, when cells from one individual integrate into the body of another seemingly separate self!
At this point, you might have a question for these Buddhists: Okay, it's all well and good for you guys to talk about spiritual growth and social engagement going hand-in-hand, but you had the luxury of doing years of spiritual growth uninterrupted first! How am I supposed to train my mind while staying constantly engaged with a modern world that's designed to fragment my attention?
Part of the answer, Buddhist teachers say, is to practice both 'on and off the cushion.' When we think about meditation, we often picture ourselves sitting on a cushion with our eyes closed. But it doesn't have to look that way. It can also be a state of mind with which we do whatever else it is we're doing: volunteering, commuting to work, drinking a cup of tea, washing the dishes. Thich Nhat Hanh was fond of saying, 'Washing the dishes is like bathing a baby Buddha. The profane is the sacred. Everyday mind is Buddha's mind.'
But I think it's really hard to do that in any kind of consistent way unless you've already had concerted periods of practice. And that's the reason why retreats exist.
Buddhist monks commonly do this — sometimes for three years, or for three months, depending on their tradition — but you don't have to be a monk or even a Buddhist to do it. Anyone can go on a retreat. I've found that even short, weekend-long retreats, where you're supported by the silent company of other practitioners and the guidance of teachers, can provide a helpful container for intensive meditation and catalyze your growth. It's a lot like language immersion: Sure, you can learn Italian by studying a few words on Duolingo alone each night, but you'll probably learn a whole lot faster if you spend a chunk of time living in a Tuscan villa.
So here's what I'd suggest to you: Pursue a career that includes actively doing good in the world — but be intentional about building in substantial blocks of time for contemplation, too. That could mean a year (or two or three) of meditative training before you go on the job market, to give you a stable base to launch off from. But it could also mean scheduling regular retreats for yourself — anywhere from three days to three months — in between your work commitments.
More broadly, though, I want you to remember that the ideas about the good life that you're thinking through didn't emerge in a vacuum. They're conditioned by history.
As the 20th-century thinker Hannah Arendt points out, vita contemplativa (the contemplative life) has been deemed superior to vita activa (the life of activity) by most pre-modern Western thinkers, from the Ancient Greeks to the medieval Christians. But why? Aristotle, whom you mentioned, put contemplation on a pedestal because he believed it was what free men did, whereas men who labored were coerced by the necessity to stay alive, and were thus living as if they were enslaved whether they were literally enslaved or not.
In our modern world, Arendt notes, the hierarchy has been flipped upside down. Capitalist society valorizes the vita activa and downgrades the vita contemplativa. But this reversal still keeps the relationship between the two modes stable: It keeps them positioned in a hierarchical order. Arendt thinks that's silly. Rather than placing one above the other, she encourages us to consider the distinct values of both.
I think she's right. Not only does contemplation need action to survive (even philosophers have to eat), but contemplation without action is impoverished. If Aristotle had had an open-minded encounter with enslaved people, maybe he would have been a better philosopher, one who challenged hierarchies rather than reinforcing them.
It can be perfectly okay, and potentially very beneficial, to spend some stretch of time in pure contemplation like Aristotle — or like the Buddhist monk Ricard. But if you do it forever, chances are you'll end up with the same regret as the monk: the regret of not putting compassion into action.
Bonus: What I'm reading
Not only does modern life make it hard to think deeply and contemplatively — with the advent of AI, it also risks homogenizing our thoughts. The New Yorker's Kyle Chayka examines the growing body of evidence suggesting that chatbots are degrading our capacity for creative thought.
This week, I learned that rich Europeans in the 18th century actually paid men to live in their gardens as…' ornamental hermits '? Apparently it was trendy to have an isolated man in a goat's hair robe wandering around in contemplative silence! Some scholars think the trend took off because philosopher Jean-Jacques Rousseau had just argued that people living in a 'state of nature' are morally superior to those corrupted by modern society.
Twentieth-century Trappist monk Thomas Merton was a great lover of stillness. His poem ' In Silence' is mainly an ode to the contemplative life. But he ends the poem with these cryptic lines: 'How can a man be still or listen to all things burning? How can he dare to sit with them when all their silence is on fire?'
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Get our best explainers on everything from money to entertainment to what everyone is talking about online. Email (required) Sign Up By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. The reality is more complicated. Many patients felt they were lied to by their doctors whose only option for pain management was over-the-counter painkillers. Studies analyzing social media posts about IUD insertion found that almost all of them mentioned pain and discussed how this pain was minimized. Part warning, part public service announcement, these viral videos not only helped bring to light the real suffering patients were experiencing, but also shaped professional guidance regarding what pain management doctors should offer them. Within the past year, the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists (ACOG) released updated recommendations for pain management during IUD placement. Both suggest clinicians offer local anesthetics like lidocaine spray, lidocaine-prilocaine cream, and paracervical block — an injection of anesthetic around the cervix. Other providers are going further, offering anti-anxiety medications or general anesthesia. The most effective way to address pain is perhaps the most straightforward, and the most novel: talking to patients and hearing their concerns. While the ACOG guidance found insufficient evidence to support nitrous oxide use, Ni remembers her doctor telling her how it helped other patients. She had a similarly positive review; she says she'll request it again when she needs to replace her IUD. 'Unless there's some other medication then,' she says. 'But I feel like the laughing gas will suffice.' Over 6 million people in the United States currently use IUDs as contraception, and the evolving pain management standards around them show the medical establishment has moved to address women's pain — and how much more work is left to be done. Aside from having a slate of pain management options on offer, the most effective way to address pain is perhaps the most straightforward, and the most novel: talking to patients and hearing their concerns. The shifting standards around IUD procedures point to the ways doctors are only beginning to see patients as experts of their own bodies, and to take women's concerns seriously. 'This fits right into a movement that has really picked up steam, but I doubt is the norm across medical disciplines,' says Eve Espey, a professor and chair of the department of OB-GYN and family planning at the University of New Mexico. 'But if you approach patient care in that way — in thinking about what a patient might experience with a painful outpatient procedure — [it] would dovetail very nicely into that much more patient-centered approach.' A history of pain in gynecology Intrauterine devices are a form of long-acting birth control that have grown in popularity over the last 30 years, especially among those between the ages of 25 and 34. There are two categories of IUDs: copper and hormonal, both of which prevent sperm from fertilizing eggs. Part of the allure of IUDs is that, unlike the pill, which must be taken daily, an IUD is effective for anywhere from three to 10 years, depending on type. No upkeep, no prescription refills. Some users report less cramping and bleeding during periods and less endometrial pain; others stop getting their periods altogether. 'There's also some literature that says if you tell people that something's going to hurt, that it hurts more, which is true.' Although the insertion itself only takes a few minutes, there are multiple points of pain throughout the procedure. First, the medical professional inserts the speculum, an instrument that opens the vaginal walls, which can be painful for some patients. Then, using a device called the tenaculum, the provider will grasp the cervix to straighten and hold it in place. The depth of the uterus is then measured, which can cause cramping, and finally, the IUD itself is inserted. Espey has placed countless IUDs during her 37-year career as an OB-GYN. For a while, she'd outline the risks and benefits and answer any patient questions. But she wouldn't necessarily emphasize the potential for pain in order to avoid scaring patients. 'We just assumed that if somebody came in for an IUD, that they wanted it,' Espey says. 'It's not that we wouldn't describe the fact that it was painful — I did — but it's also a little tough, because there's also some literature out there that says if you tell people that something's going to hurt, that it hurts more, which is true.' The concern was IUDs would be too difficult and painful to place for anyone else. 'On average,' Epsey says, 'women who have had vaginal births, particularly recent vaginal births, have far less pain with IUD placement than women who have not or who have only had C-sections.' Birth control pills were the go-to contraceptive method for decades, Espey says. But as more evidence emerged about the safety and efficacy of IUDs for people of all ages with uteruses, guidance about who should get an IUD began to change in the 2010s. But even as more people — particularly those who had never given birth — began to get them, the perception that the procedure was only mildly uncomfortable persisted. 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The 'father of modern gynecology,' James Marion Sims, developed gynecological practices by experimenting on enslaved women without anesthesia based on the false stereotype that Black people have higher pain thresholds. Amid the eugenics movement of the 1900s, those with low incomes, people of color, and people with disabilities underwent forced sterilizations. Even as late as the 1990s, contraceptive implants were marketed toward low-income Black communities as a means of controlling reproduction of those deemed unfit or unworthy of parenthood. 'I'm an OB-GYN,' says Ashley Jeanlus, a board-certified OB-GYN in Washington, DC, 'but I'm also not very naive that historically and to modern times, how we take care of patients isn't always patient-centered.' The recent CDC and ACOG pain management guidelines are a welcome change, Jeanlus says. 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Both the ACOG and CDC guidelines are just that: recommendations for practitioners. They urge doctors to better understand what pain management options are available and supported by research, and to inform their patients of these options, risks, and benefits. CDC guidelines simply mention topical lidocaine 'might be useful for reducing patient pain.' ACOG goes a step further, saying pain management options 'should be discussed with and offered to all patients seeking in-office gynecologic procedures.' But whether doctors follow the guidelines is completely voluntary. Getting an IUD? Here's how to advocate for yourself. Learn about the different options for pain management. What might be best for you? Discuss your concerns, fears, and preferences with your doctor ahead of time. Don't wait until the day of your appointment to ask about anesthetics or anti-anxiety medication. Ask as many questions as you want until you feel comfortable. Make sure your doctor explains all of your options, which may include referring you to another clinic with more resources. Develop a plan. What medications will you take pre-appointment? What form of anesthetic will your provider use during the procedure? If your doctor isn't taking your concerns seriously or doesn't offer pain management that you want, find a new one. Ask if your doctor has a referral list. Or you could reach out to a hospital affiliated with a university. There might be a higher chance of finding a provider that offers additional pain management there, Jeanlus notes. You can also try searching for a provider who is fellowship trained in complex family planning , which means they have received additional training in abortion and contraceptive care. Pain is complex and subjective, which makes studying it difficult. Patients who have a history of sexual abuse and trauma or prior negative gynecological experiences can also experience greater pain during IUD placement. The number of different pain medicines — injected lidocaine, sprays and gel-based lidocaine anesthetics, over-the-counter painkillers — and the various combinations in which researchers use them in studies make it difficult to reach conclusive results, Riley says. Danielle Tsevat, an OB-GYN at the University of North Carolina at Chapel Hill who studies gynecological pain, says the most conclusive evidence for pain relief during IUD insertion points to a lidocaine paracervical block, especially among patients who have never given birth. During her medical residency a few years ago, Tsevat had a mentor who utilized the anesthetic during IUD placements. She'd seen it used for other procedures, like abortion or miscarriage evacuations, but the shot wasn't commonly used for IUD placements. Other studies have found topical lidocaine gel or creams to be effective at minimizing pain from the tenaculum (the device that holds the cervix in place during the procedure), Tsevat says. Other methods aren't as definitive. Ibuprofen hasn't been shown to help during the insertion, but can ease cramping afterward. Some clinicians will offer anti-anxiety medications since anxiety can put a patient at higher risk for pain, Tsevat says. 'They report improved outcomes after that too,' she says. 'That one also doesn't really have much evidence behind it yet…but it's something that we've seen offered.' Nitrous oxide, what Ana Ni used during her procedure, has also shown promise in studies, Espey says. Meanwhile, misoprostol, one of the pills used in medical abortions, was found by ACOG to cause more abdominal pain during IUD placement. No one option provides a panacea because there is no one source of pain during IUD placement, and the pain itself is relatively short-lived, lasting all but a few seconds. Additionally, a shot itself can be uncomfortable. Perhaps the paracervical block — administered after the speculum is inserted — would be more effective if clinicians waited a few minutes after giving the shot. 'But that also prolongs the procedure too,' Tsevat says. 'A lot of patients just say, 'I want to get this over with and done,' and not be in the speculum for that long.' Related How to get the sexual health care you deserve During her medical training, Fran Haydanek, a board-certified OB-GYN in Rochester, New York, says she was never taught about pain management during IUD placement. After hearing from her patients, and others' horror stories on social media, she began counseling patients on pain management options and offering paracervical blocks in 2021. She estimates 80 percent of her patients opt for the injection, and her practice eats the cost because insurance won't reimburse for the medication, she says. 'There's clear guidelines from medical organizations that are saying this [medication] should be offered,' Haydanek says. 'Doctors should be reimbursed for that.' However, across the board, few providers seem to be offering these medications. In a small recent study, only 28 percent of clinics offered lidocaine, including paracervical blocks, for pain management; 85 percent recommended ibuprofen. Another study that looked at pain medications for IUD placement within the Veterans Affairs Health Care System found that lidocaine was used only 0.2 percent of the time, while nonsteroidal anti-inflammatory drugs were used during 8 percent of IUD placements. Whose pain matters? Perhaps the most effective pain management option is IV sedation or general anesthesia, which ACOG notes requires additional research to determine risks, benefits, cost, and accessibility. It's an even more resource-intensive option. 'I would bet a million dollars that if we studied IV sedation and IUD pain that we would find that it significantly reduces pain,' Espey says. But clinics would need a pharmacy, nursing staff, advanced monitoring equipment, a recovery room — all of which could drive up costs for patients. The many years that passed before women's pain was taken seriously for IUD insertions, as well as the continued lack of research into the cost and accessibility of general anaesthesia, lead to a logical question: Whose pain does the medical establishment take seriously? Men have long been offered pain medication for below the belt treatments. Aside from medications, innovations to the devices used during IUD placement could make the procedure more comfortable. The tenaculum, for instance, the tool that grasps the cervix and is a major source of pain, dates back to the 1800s. A Swiss company, Aspivix, has developed an alternative tool, called Carevix, that uses suction to secure the cervix. The device is FDA-cleared in the US and is used in 21 health care centers worldwide, including at the Indiana University School of Medicine and Columbia University, according to the company's chief marketing officer, Ikram Guerd. Given the absence of a silver-bullet solution, the most consequential change when it comes to addressing pain is far more understated. 'The most important thing that we've done, ironically, is stressed how important it is to talk to your patient,' Espey says. Trauma-informed care — in which doctors take a patient's past into account — puts the patient at the center of treatment. When patients feel safe to discuss prior challenging IUD placements or past sexual assault, the provider can better individualize pain control. Giving survivors of sexual assault control over their medical appointments can help avoid retraumatizing them. But how much control, how much information, is appropriate to share with patients? Doctors walk the fine line between disclosing how much discomfort to expect from a procedure (and potentially causing increased anxiety) and downplaying their concerns. Research shows that the more people expect pain, the more painful the experience actually is. But to say IUD insertion is entirely pain-free might come across as gaslighting. 'Do you minimize pain to reduce that anticipatory anxiety at the expense of potentially looking like you're lying to your patient about something quite painful?' Espey says. For Espey, the sweet spot is offering patients plenty of options, from prescribing anti-anxiety medications prior to the procedure or rescheduling them at a clinic with more resources. 'Just giving patients options really helps people feel like they can make a decision,' she says. In a current study, Tsevat, the UNC OB-GYN, is surveying patients post-IUD placement. The feedback has been interesting, she says. Some patients report low pain, while others have compared the experience to razor blades in their uterus. Some were offered pain management, others were not. One participant, who was getting her IUD replaced after eight years, was delighted when her doctor explained the pain management options available. 'She said it was still painful,' Tsevat says, 'but she was just happy that she had gotten something and [it] helped her experience a little bit.' Most notably, patients hardly ever discussed their experience with their doctors afterward; it wasn't something they thought was appropriate to mention. When patients don't feel seen or taken seriously, it can have lasting impacts and may result in their avoiding future health care. While one aspect of women's pain in medicine is finally being discussed, others with painful periods or endometriosis may still feel dismissed. There's still room for more conversations, more transparency.
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