This new blog aims to bring together those who have experience and/or knowledge of psychosis and who practice, follow or are simply interested in the teachings of the Buddha.
It will also be of interest to those who facilitate/practice mindfulness based therapies in relation to psychosis and mental health issues.
This blog is inspired by positive feedback on an article (Aldridge, M.A. (2011) 'Psychosis and the Three Refuges' The Middle Way: Journal of the Buddhist Society, Vol. 86 No.3). This article can be seen below.
Authors and those interested in contributing comments are warmly invited to offer their views, knowledge and experiences...
Psychosis and the Three Refuges
Psychosis sounds scary. It is
the name of a 2010 horror film based on a serial killer who “unleashes his
blood lust”. The first thing people often ask, when I tell them I work with
people who have psychosis is: “aren’t you scared?” So what can psychosis have
to do with the Three Refuges (the Buddha, Dharma and Sangha)?
Psychosis
In
psychiatry psychosis is sometimes used as a synonym for ‘severe mental disorder’
and according to
the mental health charity, Mind, there is actually more chance of being killed
by lightning than by someone with a mental illness. Most narrowly
defined, psychosis is simply the presence of delusions and/or hallucinations.
Delusions, as understood in psychiatry, are beliefs
that are clearly false and that indicate an abnormality in the affected
person's content of thought. Hallucinations
in psychosis are often auditory, hearing voices is a well known example. They can
also be visual, and some people with psychosis experience strong smells or have
sensations on or under the skin when nothing is actually there as far as other people are concerned.
Whilst some of us may have a greater predisposition, all of us
can potentially experience psychosis. The British
Psychological Society (2000) has estimated that around 10-15% of the general
population experience what could be described as psychotic phenomena, and most
are neither distressed, nor seek help. Studies have shown
that all sorts of beliefs Western psychiatry might see as delusions (including
beliefs in magic, aliens, telepathy and spiritualist beliefs) are actually
extremely common in the general population (Peters et al. 1999).
Psychosis
may be triggered by many things including stress, traumatic life events, drug
use or even Buddhist practice. Buddhism traditionally recognizes that such experiences
can arise in the practice of zazen.
The Japanese term makyo, roughly
“diabolic phenomenon” from “ma” (akuma), “devil” and kyo, “phenomenon, objective world” is used to describe such
hallucinatory or delusional experiences in this practice. VanderKoor
(1997) describes the example of Sara, who on a Buddhist meditation retreat had
intense makyo. Following the retreat
she was hospitalized and received antipsychotic medication.
Although
I have a specific qualification in interventions for psychosis and around 7 years
experience in working with others with these experiences, my most direct understanding
comes not from training, work or study, but from personal first-hand experience
of psychosis both within and without the mental health system.
My
first experience of psychosis, when eighteen, was thought by psychiatrists to
have been a reaction to stress and bereavement. In 1996 I began reading books
on religion and Zen and believed that I was making a 'breakthrough'. My presentation
quickly led to a psychiatric hospital admission. The following are extracts
from my personal health records of the time:
“...he is acutely psychotic, with paranoid delusions...
hospital treatment is the only option...”
Record of receipt
of medical recommendation(s) and formal admission to hospital
“...it became
necessary... for police to handcuff him and force him into the ambulance where
he was strapped to a stretcher..." Mental Health Act 1983 Social Circumstances Report
In
hospital I was further restrained and heavily medicated with antipsychotic
injections by force. Fortunately the admission was brief and once discharged I
stopped all medication after about 6 weeks. Since then over a number of years,
at times of stress, I experienced brief psychotic symptoms. I chose not to disclose these symptoms to medical
professionals at the time and navigated my way through, getting on with my life
without subsequent compulsory psychiatric hospitalisations or forced injections.
During
1999-2000, whilst at university, I had a period of experiencing what a nurse
described as “anxiety attacks”. The nurse recommended abdominal breathing. This
worked for me and reminded me of the Zen books I had read over the previous few
years, so I decided to try the practice of zazen
(seated meditation). Later in 2002 I formally became a lay Buddhist at a Jukai ceremony and now consider the
Three Refuges as vital to my personal recovery.
The Three
Refuges are the Buddha (meaning both the
historical Buddha and the Eternal Buddha Nature), the Dharma (the teaching of
the Buddha and of our own Buddha Nature), and the Sangha (those who follow the
Buddha and those who seek, long for and know the Eternal) (Schomberg, 1996)
The Three Refuges
The Buddha
Mindfulness was originally integrated into
Western healthcare in the late 1970s by Kabat-Zinn (Baer, 2006); he describes
mindfulness as: “paying attention in a particular way: on purpose, in the
present moment and non-judgementally” (Kabat-Zinn, 1994 p.4). In healthcare
the importance of presenting mindfulness as secular and distinct from Buddhism
is frequently emphasised; psychologists now often present mindfulness as
something from psychology or something that Kabat-Zinn ‘came up with’. In fact
he was a student of Zen Master Seung Sahn (Streitfeld, 1991) and recent
healthcare treatments such as Dialectical Behaviour Therapy (DBT; Linehan et
al., 1991; Linehan et al., 1993) and Mindfulness-Based Cognitive Therapy (MBCT;
Segal et al, 2002) also have a basis in adaptations of Buddhist teachings
(Welch et al., 2006; Gilpin, 2006). The Dalai Lama has stated: “...what we
are trying to do here is to see, among the age old meditative practices,
aspects which can be adapted into the domain of health...” (The Dalai Lama,
2005).
Studies are now
beginning to support the use of Mindfulness practices drawn from Buddhism in
the clinical treatment of psychosis (Abba, et al, 2006; Bach and Hayes, 2002; Chadwick, 2006; Gaudiano and Herbert, 2006). Paul Chadwick
(2005; 2006), for example, is a clinical psychologist who has drawn on the
teachings of Ajahn Sumedho (1992) and now advocates relating mindfully to
unpleasant psychotic sensations; with a clear, open and gentle awareness of
whatever is present.
Daishin Morgan,
Abbot of Throssel Hole Buddhist Abbey in England, sees the therapeutic and
enlightenment aims of meditation as on one continuum. He reminds us that whilst
it is good to see some of the benefits of Buddhist practice made available to
those who might not otherwise find them, the fundamental aim of Buddhist
practice goes much further (Morgan, 2004).
Koshin Schomberg
(1996a), Abbot of North Cascades Buddhist Priory in the USA, teaches that, in
Buddhist training, difficulty in accepting the full religious implications of
meditation can be an obstacle: Buddhism is a religion, and requires us to have
real faith. This faith is not a matter of professed creed or belief. It is the
faith that there is That which is a
true Refuge and that we can find this Refuge through meditation and training.
In my own life,
this practice is more than just a technique for changing my relationship to
unpleasant experiences; zazen is
directly taking Refuge in the Buddha.
The Dharma
Whilst I was in
hospital with psychosis, I was convinced that the world and all that relates to
it had ceased to exist – nothing was real. All that remained was an illusion, placed there by the devil to keep
me bonded to false reality and ultimately in hell. I also believed that various
people including my family were in fact this devil in disguise attempting to
keep me in bondage.
After
looking at a landscape painting on the hospital wall for some time, I had a
sudden belief that it was a window into the true reality beyond the devil’s illusion
– a window into heaven. In order to show trust in God, I stood upright and
allowed myself to fall backwards hoping to land in the heavenly reality shown
in the painting. As I allowed myself to fall backwards my head hit the edge of
a table. I lay on the floor, my head now bleeding. “Look at the blood” said the nursing staff around me, “What blood?” I answered, defying what I
believed were the devil’s attempts to bind me.
Knowing
what is real and what is not can be especially difficult when experiencing
psychosis. For me, taking Refuge in the Dharma, the Buddhist teachings (which reject both extremes of eternalism and nihilism), provides a source of stability and confidence. In particular the teaching
of the Buddhist precepts; beginning with “Cease from evil”, provides an anchor
in the midst of the changing conditions of daily life, and an essential guide
to action no matter what may happen (or appear to happen). Even within psychosis
the Dharma, and in particular the teaching of the precepts, provides an anchor.
The Sangha
Buddhism is more
than mindfulness with bells, gongs and incense, but it is no cure for
psychosis. At the completion of my final exams at university I had been practicing zazen
for a while, but nevertheless became psychotic again, believing that I was
being spied on by government agents:
When
I was out I noticed that someone looked at me and touched their ear. This was a
message that they had an ear piece and were listening to me. In a pub,
believing I was being listened to by government agents, I began reading from my
passport; hoping this would help give me protection: “Her Britannic Majesty’s Secretary of State requests and requires in
the name of Her Majesty all those whom it may concern to allow the bearer to
pass freely without let or hindrance, and to afford the bearer such assistance
and protection as may be necessary”. As I read this I looked across the pub
and could see that a woman was touching her ear looking at me and smiling. I
then knew that she could hear me through an ear piece and was a spy. There was
also a television on in the pub, the news was on and I could see that there was
a riot in another part of the country. This riot was connected to the things
that were happening to me and it became clear that I was now on a secret government
mission. The woman’s smile was a signal that I would indeed have assistance and
protection as necessary on this mission...
Around
this time I had a number of other unusual experiences and then decided that it
may be beneficial to practice zazen
(something I had not done for a while). So I sat down in my room, but
attempting to practice whilst in this
psychotic state was like getting hit by a mental tsunami. For a moment I saw
just how incredibly unsettled my mind was and this was very disturbing. This
disturbance inspired me to check out my recent experiences, with a Buddhist
Monk in a local Zen temple. My intention was to ask the Monk what his opinion
was of these beliefs and experiences. On my way to the temple I had various
further experiences such as receiving messages from inanimate objects. I also
felt elated and believed that this could be a spiritual experience. I intended
to share all this with the monk in the temple.
When
I entered the temple I was invited to join meditation. We first read a
scripture together but when it was time to move I stayed put. I was then told that
meditation was over and was offered a cup of tea.
Responding
to my unusual perceptions and experiences, I began to act in a chaotic way in
the temple, and was eventually asked to leave. On my way out I explained that I
had come to find out if the monk thought I should see a psychiatrist and he
said that he thought I should. Being advised by
the monk to see a psychiatrist challenged my psychotic beliefs and helped to
bring me back down to earth. Fortunately
this challenge gave me enough insight to move in the direction of recovery
without actually seeking medication or hospitalisation at the time. In the next
few weeks, having completed my exams, I attended my graduation ceremony and
returned to my parents’ home for a while.
For many, in the
face of an unsatisfactory mental health system, it can be tempting to seek
alternatives in Buddhism. Taking Refuge in
the Sangha means trusting in and seeking the advice of those who follow the
Buddha. Over 2000
years before Florence Nightingale, who is seen as the founder of the nursing
profession, Buddhist teachings set forth the qualities of a good nurse in the Anguttara
Nikaya (De Silva, 1994). The Buddha stated: "Whoever, O monks,
would nurse me, he should nurse the sick" (Zysk, 1991 p.41) and
Buddhism has begun to enrich contemporary Western nursing.
Even so, Buddhist centres
which are not set up as treatment clinics or hospitals cannot be expected to
function as such and in relation to psychosis the
most essential role of the Sangha may indeed be to continue pointing those in
need in the direction of professional healthcare providers.
Psychosis and the Three Refuges
In reality, unlike
the movies, psychosis is not about “unleashing blood lust”, in fact sometimes
it is not scary at all, but it can be deeply disturbing for both those who directly
experience it and their families. One does not need to be a Buddhist to
practice mindfulness, and it may be helpful to people in getting grounded and
letting go of disturbing sensations or thoughts;
however, Buddhism goes much deeper and I believe that
not only mindfulness, but the Buddha, Dharma and Sangha have been essential to
my staying well after psychosis.
Finally, the Three
Refuges do not offer a miracle cure for psychosis which can be rolled out
through the healthcare system in a secularised form. There are perhaps as many
routes to recovery as there are people.
Note: You may also be interested in Manasa Ayurveda - a traditional Buddhist Ayurvedic approach to mental health and wellbeing, now being introduced in the West...
Note: You may also be interested in Manasa Ayurveda - a traditional Buddhist Ayurvedic approach to mental health and wellbeing, now being introduced in the West...
Comments and views welcome!
ReplyDeleteI was hospitalized twice for schizophrenia. My initial diagnosis was weed induced psychosis. I had delusions and hallucinations. I strongly believed that I had developed telepathy because I was hearing voices. I believed that there was a sex cult called Thelema recruiting young people. I believed I was being spied on through satellites and had vivid dreams including one of a monk asking if I needed help. I woke up after he asked and said yes. Now, two years later I’m on medication and feeling much better :)
ReplyDeleteThank you for this article, good read!