Post: The Case of the Suffocating Woman

Rocky Point, Klamath National Wildlife RefugeI’m reading “Embracing Mind”, a collection of some of the talks Kobun Chino Otogawa offered at retreats (sesshins) between 1974 and 1993. Kobun offers some interesting comments about
seated meditation, among them:

It’s impossible to teach the meaning of sitting. You won’t believe it. Not because I say something wrong, but until you experience it and confirm it by yourself, you cannot believe it. (1)

I came across an article a few days ago by the psychiatrist Scott Alexander, entitled “The Case of the Suffocating Woman”. Here’s the way Dr. Alexander described his case:

A 20-something year old woman comes into the emergency room complaining that she can’t breathe. The emergency doctors note that she’s breathing perfectly normally. She says okay, fine, she’s breathing normally now, but she’s certain she’s about to suffocate. She’s having constant panic attacks, gasping for breath, feels like she can’t get any air into her lungs, been awake 96 hours straight because she’s afraid she’ll stop breathing in her sleep. She accepts voluntary admission to the psychiatric unit with a diagnosis of panic disorder. (2)

Dr. Alexander did a little checking online, and discovered some research by a man named Klein:

Klein theorized that the brain has a “suffocation alarm”, which does some pretty complicated calculations to determine whether you’re suffocating or not. Its inputs are anything from blood CO2 level to very high-level cognitions like noticing that you’re in space and your spacesuit just ruptured. If, after considering all of this, and taking into account confounding factors like whether you’re exercising or voluntarily holding your breath, it decides that you’re suffocating, it activates your body’s natural suffocation response.

And the body’s natural suffocation response seems a lot like panic attacks. Increased heart rate? Check. Gasping for breath? Check. Feeling of impending doom? Check. Choking? Check. Chest pain? Check. Faintness? Check. (2)

Down on the comment thread, someone named Liz added the following remarks:

My husband is a spear fisherman and he can hold his breath underwater for almost four minutes. He was trained to do so in a manner similar to how they train Navy Seals. They are able to do relaxation techniques and override their body’s impulse to panic. I’m not sure if everyone can accomplish this or if they are outliers. But one important point that I think fits into the topic here. They have to be wary of something called shallow water blackout. They will hold their breath without the panic response literally until they pass out underwater, and drown (even if they are only sitting on the bottom of a pool with a foot or two of water above them). (3)

In one of his letters, the twelfth-century Chinese Zen teacher Yuanwu wrote:

… Be like a person who has died the great death: after your breath is cut off, then you come back to life. Only then do you realize that it is as open as empty space. Only then do you reach the point where your feet are walking on the ground of reality. (4)

To my mind, Yuanwu is describing something similar to the Navy Seal training: the abandonment of activity in connection with the movement of breath, through continued relaxation even in the midst of suffocation panic. On the other side of that panic, an acuity of the senses necessary to the movement of breath comes forward (including the senses connected with self-location–”it is as open as empty space”), an acuity that lends weight to the stretch and activity of the body (“you reach the point where your feet are walking on the ground of reality”).

Sitting allows for the total cessation of habitual activity in the movement of breath. The open secret of such experience has to do with suffering, as Kobun explained:

When we ask what it is which senses this suffering, we have to understand that the one who is breathing in and out, in and out, doesn’t suffer. But it does sense suffering. (1)

Kobun was right that no one is going to believe that “the one who is breathing in and out, in and out, doesn’t suffer” until they experience it for themselves, and that the meaning of zazen practice derives from such experience. Nevertheless, “The Case of the Suffocating Woman” sheds light on exactly where the difficulty is in having such experience, and that is in the relaxation of specific activity of the body that comes to mind right through the panic of sensing that the breath is cut off, so that the ability to feel throughout the body with no part left out remains present. The direction of mind can suddenly accede to the gravity of the self-location in the particular inhalation or exhalation, and the foreground of bodily activity and the background of autonomic respiration can change places in a kind of Gestalt.

To me, Kobun embodied “the one who …doesn’t suffer” in his actions.

Kobun died in Switzerland, when he went into a shallow landscape pool after his five-year-old daughter, Maya, who had somehow fallen in and was drowning. I spoke to the guy who
owned the property with the pool, and he shook his head in disbelief that Kobun had actually drowned, because the pool was only about three feet deep.

Kobun once ended a talk by saying, “You know, sometimes zazen gets up and walks around.” It’s my belief that it was in fact zazen that went into the pool after Maya, and that it was the one who does not suffer (but nevertheless senses suffering) that remained under the surface by her side.



1) “Embracing Mind”, edited by Cosgrove & Hall, pg 48
2) “The Case of the Suffocating Woman”, posted on Slate Star Codex April 5, 2017 by Scott Alexander;
3) Ibid, commenter “liz”, April 5, 2017 at 10:41 am
4) “Zen Letters: Teachings of Yuanwu”, translated by J.C. and Thomas Cleary, pg 84


A Natural Mindfulness–PDF