Medication or Meditation? Often Both...

The following post is from James Ure, a Zen Buddhist who follows in the tradition of Vietnamese Zen Master Thich Nhat Hanh. James enjoys teachings from all Buddhist traditions and is influenced by Taoism and Secular Humanism. James is a nature lover and lives with Schizo-Affective Disorder...

This is a long post but an important one because it touches on an issue--mental illness, which some in spiritual circles choose to ignore. As many of you know I have been living with schizoaffective disorder for most of my life and have found great refuge, relief of symptoms and calm from Buddhism and meditation in particular. Of course, we all are "mentally ill" or else we wouldn't be here in samsara but some have severe, biological mental illnesses and require a hybrid approach of therapies and practices.

I notice that the more I meditate the easier it is to deal with my condition. Yet meditation alone isn't enough in my situation because despite meditating I still am debilitated by disabling symptoms such as paranoia, hallucinations, delusions (psychiatric delusions such as being convinced that you are the most horrible person on Earth), mood swings and chronic depression.

Thus I have found medications help fill the void and basically keep me alive because my depressive episodes easily lead to suicidal thoughts. I have found an excellent psychiatrist who has found a great balance of medications to keep myself as stable as can be expected outside finding a cure to the disease. In addition I talk regularly with a psychotherapist to help me keep track of my mood swings and give me tips on how to better manage my illness through establishing routines and developing other techniques. So I was excited when I read an excellent article in the current Buddhadharma magazine that arrived in my mailbox today about this very subject:

When Buddhism first came to the West, many teachers and practitioners initially dismissed psychotherapy as superficial, unnecessary and possibly counterproductive. As time went on...psychotherapy's relationship to spiritual practice started to undergo a reevaluation, and the two disciplines began to intermingle a bit more. In fact, many therapists and meditation teachers now agree that meditation and psychotherapy can be mutually facilitating. Meditators seem to progress more quickly in therapy, while psychotherapy can improve the effectiveness of their meditation.

James: I am one of those meditators who have progressed more quickly in therapy thanks in part to my meditation practice. In fact, when I come into therapy and am having a difficult time with my mental illness she always asks if I'm meditating and the answer is often, "no." So in a lot of ways my meditation practice is a type of medication though I still do have episodes despite meditating. When I meditate on a regular basis it takes some of the severity out of my symptoms. That said, while meditation is very effective it isn't the entire solution and I think we Buddhists must admit that meditation isn't the solution to everthing--especially when medical issues are involved. It is true that meditation has been shown to reduce blood pressure, induce relaxation and other health benefits but it can not solve severe, biological mental illness symptoms in total.

Combining meditation and psychotherapy makes sense if we appreciate how they work in complementary ways. For the most part, meditation focuses primarily on developing capacities such as concentration and awareness, whereas psyschotherpay focuses primarily on changing the objects of awareness, such as emotions and beliefs. Of course there are significant overlaps, but this complimentarity suggests why combining both approaches can be very helpful. Meditative qualities can facilitate psychotherapeutic healing of painful patterns, while the psychotherapeutic healing of these painful patterns can reduce the disruption of spiritual practice.

James: Medication has toned down the volume of distracting stimuli in my head such as the hallucinations and calmed my nerves to enable me the opportunity to actually be able to practice. Before medications I wouldn't have had the patience to meditate due to manic episodes that kept my thoughts racing too fast to have the concentration needed to sit even for a few minutes. It's like trying to do meditation effectively after drinking four pots of coffee in an hour. Either that or I'd be so depressed that I couldn't get out of bed let alone have the motivation and intention to meditate.

So the medication has lowered the volume and reduced the static in my brain to put me in a position where meditation is actually even an option and be able to not just do it but find great benefit from it. I was drowning without medication and the water was up to my mouth and nose so the medications have drained the water down to my chest level. So while it's difficult to walk through chest deep water at least I can now (for the most part) breath comfortably, which gives me the freedom to meditate and have the ability to make progress upon the path that otherwise would be basically impossible. When it comes to using medication in combination with a Buddhist practice there are basically too camps according to the author of this article. First, the purists and second the pragmatists (I fall into pragmatist category):

Spiritual purists argue that if mental suffering is fundamentally spiritual and karmic, spiritual practice alone is appropriate to treat it. Moreover they are concerned that medication may dull or derail spiritual practice. They also worry that medications may reduce or distort awareness, and thereby make practice more difficult. In this view, medications can be novel forms of the "mind clouding intoxicants" prohibited by the lay precepts to which many Buddhists practitioners adhere. Therefore, taking these modern pharmacological agents is tantamount to violating this precept.

James: Let me say that I have found personally (and I've read that this is the case for many others) that my medications do the opposite of "dull or derail spiritual practice," "reduce or distort awarness." Without them I was so depressed, mislead by hallucinations (voices) and detached by dissociation that I was a nihilist believing in nothing and wanting the world to explode to end everyone's misery. At least that's what I thought at the time in my deluded mind.

It wasn't until I started to lower the static in my head through medications that I saw the benefits of spirituality and sought out Buddhism. Before then my mind was clogged and preoccupied with constant mental torment and anguish. It simply didn't have the stability at the time for a spiritual practice. Thus is was before medications that I had a dulled spiritual practice--not after. The medications increased my awareness of reality rather than dull it as they helped sharpen my concentration, focus and attention (I have Attention Deficit Disorder as well) to enable me to actually have a chance at understanding concepts like mindfulness. I know for certain that I'd be spiritual lost still without the addition of medication to give me a somewhat stable mind to build a spiritual foundation upon.

By contrast, pragmatists hold that spiritual practice alone is simply insufficient, or at least not optimal, for healing all mental suffering. While not denying the validity of some purist concerns, pragmatists argue that certain problems and pathologies respond best to other therapies, and one of those therapies can be medication.

James: Buddhism can indeed be more than enough for the regular depression and anxiety that occur with living in samsara. However, those diagnosed with a severe biological mental illness that involves chemical imbalances within the brain need the additional help that comes with proper medication and therapeutic monitoring. It can be very dangerous and irresponsible to prevent someone with severe deperssion from seeking psychiatric help because suicide is a very real threat and should never, EVER be ignored or blown off.

People with a severe mental illness who do not seek medication are usually playing with a loaded gun that could very easily go off in the form of suicide. Some people can get by with herbal supplements and vitamins but most people with severe mental troubles need stronger medicine. I tried the "natural route" and it didn't even cut the symptoms much at all.

The author who is a professor of psychiatry (and a Buddhist) did a study with Buddhist practitioners with suffer from mental illness: Our team of researchers, all physicians and long-term meditators, investigated a group of nineteen Buddhist practioneers (thirteen women and six men) diagnosed with major depression. These practioneers had all been doing meditation, mainly vipassana, for at least three years, had participated in two or more weeklong retreats, and had used antidepressants in the last two years.

Most of our subjects reported that antidepressants helped them with multiple emotional, motivational, and cognitive functions. Emotional changes were consistent with an antidepressant effect. The painful emotions of anger and sadness decreased significantly, but fear showed a smaller response. The positive emotions of happiness, joy, love, and compassion all increased, as did self-esteem. Subjects also felt calmer and that their awareness was clearer. One would expect this kind of result, given that the subjects were no longer wrestling with intense, painful emotions.

Clearly the large majority of these meditators felt that they, and their spiritual practitice, benefited significantly from taking antidepressants. Several subjects reported that the antidepressants enabled them to recommence or significantly improve their meditation and spiritual practice.

James: So while there still is no cure for schizoaffective disorder and while I still suffer from hallucinations, paranoia, bipolar, etc., the medications have given me my life back to where I can pursue things like spritituality. It has allowed me sharpen my awareness of reality and this life whereas before I was living in a kind of fog and everything was out of focus. So I can attest to the benefits of psychotherapy and medications. Thus, when added with meditation and other Buddhist practices it forms a powerful combination that has helped me greatly.

It's time that we realize that interdepenence includes science helping spirituality and spirituality helping science. The two working together can accomplish great things and don't necessarily have to be at odds. Sure there are some tensions between the two groups but there are areas where they fit perfectly and accent each other to benefit a great many people.