Buddhism and Psychiatric Practice

Charles Byrne is a psychiatrist at a hospital in the west of Ireland. He is also a Buddhist.

Buddhism and my Psychiatric Practice  

It has been said that the suffering caused by mental illness is worse than that caused by physical illness. People suffering from severe depression often view themselves, their surroundings and their future in a very negative and sometimes hopeless way. The challenge a doctor or therapist faces is to help the patient experience hope. This includes hope that they will recover from the disorder, and hope from the realization of the importance of their own life and hope in relation to their family and their work.

I work as a psychiatrist at a hospital in the west of Ireland. The types of disorders I see are the same as those seen by psychiatrists around the world. From Africa to China to America, mental illness is very similar. It is a global problem that afflicts all humanity. In some types of mental illness, a person can completely lose touch with reality as in cases of schizophrenia or bipolar disorder. In schizophrenia, a person may feel that he is being persecuted and become paranoid. Supportive therapy, medicine and rehabilitation are needed for recovery. Most disorders can be treated effectively, contrary to common assumptions.

Among the challenges faced by mental health professionals is to maintain compassion and respect for, and inspire hope in, every patient they treat. This can be quite daunting, especially if one is seeing many patients every day. My Buddhist practice and the humanistic philosophy of Nichiren Buddhism have been a tremendous help. I began practicing twenty-seven years ago after a doctor and coworker introduced me to this Buddhism. At that time, I had no religious belief nor life philosophy and my life had lost direction. After taking up the practice, I found that gradually my compassion for my patients increased. I realized that with my Buddhist practice, I was able to approach each day refreshed and more revitalized. It also helped me handle the stress and strain of the day. I was encouraged and supported by the local SGI members and the philosophy of Buddhism explained in SGI President Ikeda's writings and Nichiren's letters were very inspiring and relevant to my daily life. The practice gave me the courage and determination to take the many professional examinations that I needed to advance my psychiatric practice.

At first I was concerned there might be some contradiction between my Buddhist practice and my work in psychiatry. I later realised, however, that fundamentally my work involves helping people and therefore is fully compatible with Buddhism. I do not tell my patients about Buddhism. But its philosophy helps me in my work and I tell my friends in the profession about its humanistic ideals. Buddhist theory has influenced the way I do therapy. I encourage a "start from now" approach to problems rather than excessively looking back on or regretting the past. I encourage action based on common sense and wisdom rather than on emotion. These approaches are also in keeping with the principles of Cognitive Behavioral Therapy, which came from the psychiatrist Aaron Beck. Additionally, I encourage patients to adopt a compassionate and tolerant approach to problems with their families and others wherever possible. I also always stress the importance of hope--that both they and their situation can improve. Therapy is approached from the standpoint of respect for every individual.

As I read more about Buddhism, I came to understand that it represents a profound understanding of humanity and the human psyche on a level different from that found in academic psychiatry and psychology. Depression, anxiety and problems with anger are well described in psychiatry and are similar to the worlds of hell, animality and anger in the Buddhist doctrine of the ten worlds. There is nothing, however, in psychiatry that corresponds to the other seven worlds of hunger, humanity, rapture, learning, realization, bodhisattva and Buddhahood.

Also in psychiatry, there is no concept similar to that of the three poisons. According to Buddhism, we live in a deluded state with our perceptions clouded and distorted by the poisons of greed, anger and foolishness. Through the practice of Nichiren Buddhism, compassion, wisdom, courage and strong life force, the antidotes to these poisons, naturally emerge in our lives. The attributes of our innate Buddhahood surface imperceptibly as our practice progresses. Accompanying these is also hope, which is central to Buddhism. This hope derives from the confidence that we can fundamentally change for the better (human revolution) and contribute to the betterment of society and the world.

Depression and anxiety are the most common psychiatric disorders, with large numbers of people affected. It is estimated that 16% of the population will suffer from a very serious depression sometime in their life. The percentage of individuals suffering from significant anxiety is similar. It includes long term disabling anxiety and shorter episodes of intense anxiety referred to as panic attacks. The latter can be associated with fear of open or closed space. Some people can become housebound because of this fear.

Charles with his father Patrick and their dog Homer

One of the most frightening consequences of severe depression is the possibility of suicide. Suicide can also occur as a result of temporary intense depression that may be associated with a loss, for example a relationship break-up, or with alcohol or drug abuse. Alarmingly, suicide has reached epidemic proportions among young men in Europe. In my own country, Ireland, it is the most common form of death for men between the ages of fifteen and thirty-five. The rate has approximately tripled in the last thirty years. It is also the most common form of death in young men in many European countries. The cause of this increase is unknown, although there are theories that link it to rapid changes in society, the decline of religion and changes in the role and status of men. I agree that religion is a protective factor in relation to suicide and particularly Buddhism, which is a religion of hope.

Another epidemic, particularly among young people in Europe and other countries, is alcohol and drug abuse. The problems of suicide and substance abuse in young people point to a generation in which many feel lost and hopeless. Psychoanalyst Carl Jung used the phrase "modern man in search of a soul." He believed that religion is a protective agent for people and encouraged his patients to have a spiritual aspect to their lives. He had a deep interest in Buddhism. I believe that Buddhism has never been more needed in the world and that it is vital that young people in particular hear about it.

Depression is a disorder that can be treated very effectively and those suffering from it should be encouraged to seek help from a doctor or other qualified professionals. For other psychiatric disorders, including schizophrenia and bipolar disorder, an ailment characterized by severe mood swings, there are now new ways of treatment that are proving very effective and enabling sufferers to lead normal lives. Previously, people suffering from schizophrenia often spent long periods of time, often years, in mental hospitals as inpatients and led very restricted lives. This has changed completely. I now have one young schizophrenic patient who has obtained a college degree in art and design and another who is pursuing an engineering degree. This was previously unheard of. Therapists can instill a feeling of hope in their patients. Continued efforts are needed to reduce the stigma related to mental illness so that those affected are treated with the respect they deserve.

Many outstanding psychiatrists and psychologists have made invaluable contributions to this field, too numerous to mention. Carl Rogers exercised unconditional regard and respect for his patients in relation to therapy. This mirrors Bodhisattva Never Disparaging and the recognition of everyone's innate Buddhahood. Psychiatrist Viktor Frankl formulated his theories of treatment from his experience of surviving a concentration camp in World War II. In his theory of Reciprocal Inhibition, Joseph Wolpe showed that focusing on something can block negative thoughts. Similarly, when I chant the daimoku, Nam-myoho-renge-kyo, I focus on the sound of my voice and the movement of my mouth. In this way, I get less distracted by other thoughts. Facing fears and difficulties with a determination to grow is part of psychology's behavioral therapy and is also a part of one's human revolution.

In conclusion, I would like to quote the words of Swiss philosopher Simone Weil: "At the centre of the human heart is a longing for the absolute good" as well as the words of SGI President Ikeda: "I believe that Buddhism is the supreme psychology of hope, the supreme life philosophy of hope."

Charles Byrne

[Translated and adopted from an article in the August 2005 issue of Daibyaku Renge, Soka Gakkai, Japan]