INTRODUCTION
Buddhism is often seen as the most
psychological of the major world religions. It originated in a search for an
answer to the problem of dukkha (affliction), the existential suffering that
comes from sickness, old age and death. This search led Siddhartha Gotama, who
was to become the Buddha and the founder of the faith, into a spiritual
journey. It was as a result of this journey that Siddhartha eventually received
his transformative experience, his enlightenment.
The insight which came from the Buddha’s
enlightenment underpins a Buddhist approach to mental health. The insights that
constitute the Buddha’s first teachings offer a basis which has been elaborated
and re-formulated in many ways, but still remains the central presentation of
the Buddhist position. Detailed interpretation of these primary teachings has
fascinated Buddhist scholars through the centuries, but their centrality
remains undoubted.
The Buddha’s original concern with the
sufferings involved in human life became the focus for his teaching. In
particular they provide the core of the key teaching, known as the Four Noble
Truths. This teaching consists of four statements, the first of which emphasised
the reality of affliction. The noble truth of dukkha, affliction, is this:
birth, old age, sickness, death, grief, lamentation, pain, depression, and
agitation are dukkha. Dukkha is being associated with what you do not like,
being separated from what you do like, and not being able to get what you want.
(Samyutta Nikaya 61.11.5) In other words, human life is unavoidably linked to
situations which are distressing.
With affliction, craving arises. The
Buddha’s second Noble Truth addressed the arising of craving. In the sutras the
description of the second Noble Truth ends with the phrase kama, bhava, abhava.
It is my feeling that this latter statement provides a useful typology for the
progress of mental distress. It describes how people progress through simple
distraction to the construction of psychological defences, and finally to the
self-destructive mind states associated with severe mental distress in their
response to afflictions.
The three elements, kama, bhava and abhava, can be
translated as sensory pleasures (kama), becoming, or one can understand, self
building (bhava), and non-becoming (abhava). These three words can be
interpreted as describing the stages in a process of growing attachment. This
clinging is itself a response to the affliction that has occurred.
In other
words, when trouble occurs, people habitually seek distraction and comfort,
initially at the level of the senses. For example, they might over-indulge in
food or alcohol. Later, with frequent repetition of this habit of distraction,
the process becomes the subject of identification and self-building. The sense
of self creates a wall against raw experience, giving both identity and a
restricted view of the world to support it. Eventually, however, if trouble
persists, even this self-building fails to provide sufficient distraction and
breaks down into destructive impulses.
The self-building process is itself a
source of dukkha. Creating and maintaining the self-perspective multiplies pain
as it is founded in delusion. Other Buddhist teachings can be seen in the
context of the teaching of the Four Noble Truths as elaborating the processes
whereby distressing or deluded states are created and maintained.
Broadly these
include teachings that explain the processes of Dependent Origination whereby
the ordinary mentality is maintained through a cycle of conditioned view. A
number of key teachings elaborate these processes and show how people build
their reality, and hence their self, through craving and attachment. This
process can take on positive or negative forms. Our reactions to the object
world are ones of attraction or aversion.
Such reactions are habitual and form
the basis of one’s overall mentality. Oft repeated, they lead us to create
samskaras, mental formations, which we come to identify with. These samskaras
form the basis of our self. They lead us to habitual views and behaviours
which, in turn, condition the maintenance of the cycle.
The teachings of Dependent Origination
and the cycle of conditioning describe the way that all unenlightened people
(and for practical purposes we can say all people) are held in a state of
delusion, avidya.
Avidya literally means not seeing, and this choice of word
demonstrates the Buddhist emphasis on perception as a key element in constructing
mental states. All these teachings are recorded in the Buddhist texts or sutras
which describe the Buddha’s ministry during the latter forty years of his life.
Many people in the West associate
Buddhism especially with its mind training exercises. Undoubtedly meditation in
its various forms has played a key role in developing an elaborate and detailed
system of understanding the factors of conditioning and in developing methods
for unhooking ourselves from the objects of craving.
This process of
“unhooking” is described in the third and fourth Noble Truths. Meditation and
other mental exercises combined with study and analysis of the teachings led to
the a further collection of Buddhist texts called the Abhidharma, which were
compiled shortly after the Buddha’s time, and to many later works by
philosophers and practitioners in India, China, Tibet and all the other major
centres of the Buddhist world.
The Buddhist teachings and the practical
knowledge which comes from two and a half thousand years of study and practice
clearly have much to offer by way of guidance for those working in the field of
mental health.
This contribution has been recognised and there have been a
number of significant attempts to draw on Buddhist teachings and methodology in
Western psychotherapeutic practice. Early Western theorists, notably William
James and Carl Jung, were influenced by Eastern thought, although such
influences were often based on misunderstandings and limited context. More
recently we have seen an influx of techniques such as the use of meditation,
mindfulness and visualisation, all of which have roots in Eastern, and often
specifically Buddhist, practice.
In the last decade or two, as a more
general interest in the interface between the psychological and the spiritual
has arisen, a number of Buddhist approaches have been introduced and taught to
professionals working in mental health fields.
These approaches, though all
based on a Buddhist understanding, differ considerably from one another. This
is because some rely more upon Buddhist methodology, whilst others focus on the
theoretical understanding of mental process arising from Buddhist teachings,
and also because they draw roots from different Buddhist traditions and from
different Western schools of psychotherapy.
In the UK we can identify the
various mindfulness based programmes deriving from the work of Kabat Zinn, the
Core Process training of the Karuna Institute, and the programme in Buddhist
Psychotherapy run by my own organisation, Amida Trust.
Also worthy of mention,
though less well known in the UK, is the work of David Reynolds and the Todo
Institute in Canada. Reynold’s approach, Constructive Living, is based on two
Japanese therapies, Naikan and Morita which apply Buddhist teachings in ways that
offer an important and striking critique of many Western assumptions about
mental distress.
Whilst there is not space here to
explore in detail these different therapies, it is worth noting that some are
now being widely used in mainstream establishments and have been subject to
research evaluation. In particular mindfulness based programmes have become
popular in the West, whilst in Japan Naikan has been extensively used in the
prison system. Similarly, Vipassana meditation retreats run by the Buddhist Goenka
movement have also proved transformative for prisoners in India.
A BUDDHIST APPROACH TO MENTAL WELL
BEING
One way of understanding a Buddhist
approach to mental health is to look at another of its key teachings. Buddhism
is described as having three pillars, or key elements. These are Sila, Samadhi,
and Prajna. We can use this formulation to understand characteristic aspects of
the approach.
Sila is generally understood to mean the
discipline or ethical framework of a person’s life. The Buddha taught much
about life style. His teachings can all be taken as practical advice on how to
live well. The lifestyle which he prescribed for his disciples, which still
forms a model for practitioners today, is one that is morally sound, concerned
for others, grounded in sober living and respect for living things. This
lifestyle is seen as foundational for the cultivation of healthy mental states.
In keeping with teachings on the conditioned nature of mind, an ethical,
non-indulgent life forms the ground upon which mental health can rest.
Samadhi as the second pillar of Buddhism
is generally understood to mean the state of mind that arises when a person is
spiritually grounded. Often this is specifically linked to meditation and
concentration, but it is also well translated as a state of rapture, and can
result from any visionary or inspirational experience. In the experience of
samadhi we see both the state of calm and peace which is associated with
spiritual alignment, and the more ecstatic states that can arise through
spiritual practice which have the power to offer lasting change.
Prajna as the final element means
understanding or wisdom. Literally the word means “seeing through” or seeing
deeply. It is cognate with the western term diagnosis. In prajna we experience
a deep integration of the knowledge which the Buddhist teachings offer. This
includes insight into the impermanence of mental constructs, the samskaras, and
the conditioned nature of our thinking.
From these three pillars and the other
Buddhist teachings a number of points can be identified which are significant
in the Buddhist understanding of mental well being:
- Behaviour conditions mental states;
ethical behaviour conditions positive states
- The Repetition of habitual patterns of
action and view lie at the root of mental states
- We feel a compulsion to cling to
habitual views and states. Thus there is a sense in which we can see all mental
problems as a form of addiction and the focus of these addictive patterns as
being the self.
- Everyone is in a state of avidya
(delusion) so mental ill health is just a more extreme version of states we all
suffer from.
- Psychotic states are extreme versions
of common mental states and are based on more extreme clinging to delusional
factors which build the self structures.
A Buddhist approach to mental health is
therefore likely to be based on loosening concern with identity, inviting a
shift away from rigidity of view, encouraging deeper connection with others and
with the environment.
A person who is mentally healthy is not self-preoccupied,
but is interested in the people and things around him or her.
A Buddhist
approach offers a psychology based on the concept of non-self; an other-centred
perspective that emerges as a person becomes less caught up in maintaining
their sense of identity and the corresponding world view that supports it. It
is grounded in the importance of looking for the reality of things.
In terms of
practice this can be linked to the centrality of taking refuge, the act that
defines the Buddhist.
The Buddhist takes refuge in Buddha,
Dharma and Sangha, i.e. in the founder, teachings and religious community. At
another level we can see this as refuge in the enlightened source of wisdom, in
the truth of reality that is always available for discovery, and in the
community of others. Beyond the state of delusion, something real and wonderful
is available.
In my own tradition, Pureland Buddhism,
the central practice is a practice of calling on this ever present Buddha-ness,
represented in the figure of Amida, the measureless Buddha.
This tradition
emphasises our ordinary state, which is enmeshed in karma and thus deeply
deluded. Its acceptance of our imperfection carries with it a profound sense of
our acceptability to Buddha, which is accompanied by a view of the universal
dimension that is radically non-judgemental.
The object of our practice is the
eternal quality of Buddha Amida. Amida is always clouded in the mystery by our
copious distortions and limits of view, yet remains a foundation for our
attention which potentially takes us out of self-preoccupation.
THE BUDDHIST ATTITUDE TO MENTAL ILLNESS
The Buddhist perspective is not one that
generally encompasses ideas of justice or retribution. Buddhists, at least in
the West, do not generally posit a deity or supernatural force who intervenes
in human affairs, and even where Buddhism comes close to this position with
invocations of celestial beings or Bodhisattvas, the influence these figures
might exert would generally be seen as benevolent and limited.
In Buddhism the suffering which people
experience is of two kinds (although this distinction is not strongly made in
the texts). Some suffering arises from our existential circumstances. As such
it is unavoidable and to be faced with fortitude. Other suffering arises from
our conditioned minds. This can be addressed by learning to face the primary
suffering and by breaking out of our habitual patterns of escape which compound
the afflictions. The choice to do this, however, is seen as a personal matter.
Failure to address one’s mental state is not seen as bad, but rather, as
missing an opportunity which human rebirth offers. Where a person is in a
mental state where practice is not possible, this would be generally seen as a state
worthy of compassion, not condemnation.
In Pureland, the emphasis on faith is
particularly relevant here. This particular Buddhist approach is somewhat more
pessimistic than that of other schools about our capacity to help ourselves
through the kind of mind-training exercises commonly associated with Buddhism.
Here the interminable nature of our karmic heritage is recognised and people
are seen as ordinary, fallible and in the grip of “fathomless blind passions”.
Against this background, the view of mental illness would be that if a person
can simply reach some sense of the immeasurable presence of Amida beyond their
personal turmoil, a moment of faith, that contact will sustain them and achieve
ultimate salvation. Psychologically speaking we can see this as indicating the
importance of even small breaks from the cycle of self into contact with other
reality.
This view encompasses a sense of
commonality between humans. We are all enmeshed in our own karma, and thus
similarly caught in states of delusion and confusion. There may be differences
of form and degree, but we can relate to those in high distress with a sense of
fellow feeling and compassion which arises from our knowledge of our shared
human frailty.
More problematic areas of behaviour that
arise from mental ill health, such as suicide, self-harm, anger and so on
would be viewed by Buddhists as sad occurrences, which in one way or another
condition ongoing pain and distress.
Theories of dependent origination and
karmic consequence point to the idea that any behaviour creates the seeds for
future actions. Thus a Buddhist view would, where possible, discourage a person
from making expressions of anger in order to help them avoid feeding negativity
in their mentality.
Similarly suicide and self-harm would be
viewed as laying dangerous patterns which potentially create downward spirals
for the individual, but also create karmic consequences for others involved.
Such views can both be taken on the mundane level – the child of a suicidal
parent will themselves run a greater risk of suicide, and on the metaphysical
level – suicide may be seen as leading to a bad rebirth. In such cases, the
response of other Buddhists would be gentle encouragement to a better course of
action, but above all, compassion for the person who is taking the action.
It should be noted here that karmic
consequences are generally linked with intentionality, so it is quite
reasonable to argue doctrinally that in many cases a person who is mentally ill
is not intending harm and therefore not subject to karmic consequences of their
deeds.
One area of difficulty that has led to
recent discussion on a UK Buddhist discussion forum is the subject of dementia.
For some Buddhists the idea that after a lifetime of striving to reach clearer,
more refined mental states, one’s mind can suddenly fall into severe delusion,
muddled thinking and even anger and negativity is very troublesome. Such
concern is understandable where the practitioner sees the mental state at the
time of death as being of great importance to future re-births. The latter view
is common and impacts on people’s views of a number of ethical and medical
dilemmas, such as, for example, palliative care at the end of life, and the
donation of organs. At a personal level, I cannot say the matter is one which
troubles me greatly, since my own view would be that whatever forces are
operating in the matter cannot be solely dependent upon our physical condition
at death if they are to affect our future beyond this life.
SUMMARY
Buddhist views of mental health and
mental illness emerge from the understanding of mental process offered by
Buddhist teachings.
The Buddha was pragmatic offering many practical methods
for working with mental process. Some examples are remarkably similar to modern
therapeutic method. For example, we find descriptions of working with fear and
dread (Majjhima Nikaya 4) by a process resembling desensitisation.
We see
advice on different strategies for working with distractions and discomforts
(Majjhima Nikaya 2) We see dream analysis (Majjhima Nikaya 23) and many
teachings that gave ethical guidance and advice on living harmoniously with
others.
As with any religious system the
interpretation of textual and other material in the modern context and particularly
in the field of mental health gives much space for variations of view, and as
with other religious positions, there is no Buddhist consensus on particular
controversies, nor a single approach that can be advocated as the sole Buddhist
view.
What Buddhists contribute is a richness
of direct observation of mental process and an ethical underpinning which
concurs in most ways with the broader ethical views of society.
Beyond its
obvious contribution of methodologies for calming and focusing the mind, it
offers an understanding that whilst critiquing some Western attitudes to the
self, increasingly aligns with practical approaches being offered by secular
agencies in the treatment of ill health. Most importantly, though, it is
grounded in a view of compassion and wisdom as the corner stones of human
improvement. Such basic commodities as must indeed underpin whatever attempt we
make to be of service to others.
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