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RELIGION AND SPIRITUALITY

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RELIGION AND SPIRITUALITY

Buddhism and psychiatry: confluence and conflict

Graham Meadows

Objective:

To describe the relationship between Buddhism and psychi-atry, from a personal perspective.

Conclusions:

The present paper introduces Buddhist thought for thoseunfamiliar with it, then describes some of the sites of confluence and conflictbetween this tradition and those of Western mental health care. It does sofrom the perspective of a Westerner who has made some exploration ofBuddhism, mainly within one of the Tibetan traditions.

Key words:

Buddhism, psychiatry, religion.

HISTORY OF BUDDHISM

he historical Buddha lived in Northern India approximately2500 years ago, and so was a contemporary of Pythagoras. Hetaught for many years, extensively sharing his personal experience

with a wide range of audiences. The teachings spread widely, beinglocally interpreted in transmission, with, broadly speaking, two routes ofdevelopment. One was north of the Himalayas, including the Tibetangroup, eastward into China finally into Japan and Vietnam; there wasalso a southerly route including Sri Lanka, Thailand, Burma and Cambo-dia. Latterly, there has been an explosion of teachings in the West, withincreased travel, availability of more and better translations, of accessiblepresentations by Westerners

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and, in the case of Tibetan teachings, theeffect of the outflow of teachers consequential on the Tibetan diaspora.Australia and New Zealand have a surprising number of these refugeesand migrants, with many very senior teachers providing teachings in awide range of traditions.

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The recent Australian Census identifiedBuddhism as the fastest growing spiritual tradition in the country.

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BUDDHIST THOUGHT

We are what we thinkAll that we are arises within our thoughtsWith our thoughts we make the worldSpeak or act with an impure mindAnd trouble will follow youAs the wheel follows the ox that draws the cart

Tibetan Dhamammapada

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Buddhist thought is very psychological in nature; a great deal of thecontent of Buddhist teachings has to do with promoting more positivestates of mind. Included within these states of mind are states that are freeof afflictive emotions such as anger, despair, and negative types of desire.

Codification of Buddhist teachings

The Buddha’s presentation of his teachings varied somewhat accordingto the audience and the context. Because he taught in many settings overa large number of years, this could be a source of confusion. During thespread of Buddhism in Tibet, there were efforts made to reduce possibleharm from this. Arising out of these efforts we have a number of versionsof teachings called the ‘Graded Path’.

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Tibetan Buddhism also commonlymakes use of a figure the Buddha composed within his lifetime, that ofthe ‘Wheel of Life’ (Figure 1).

Graham Meadows

Associate Professor, Department of Psychiatry, University of Melbourne, Melbourne, Vic., Australia

Correspondence

: Assoc. Professor Graham Meadows, Department of Psychiatry, University of Melbourne, Bell Street Academic Centre for Community Mental Health, 126 Bell Street, Coburg, Vic. 3058, Australia.Email: meadows@unimelb.edu.au

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The wheel of life (e.g. http://www.buddhanet.net/wheel1.htm for a guided tour and http://www.digitaldharma.org/g15.asp for an extended explana-tion) depicts a wrathful figure grasping a large plate-like image. Around the edge of this are imagesdepicting the ‘links of independent origination’ –from one o’clock onwards:

1. At the base of all problems is ignorance of the truenature of reality, depicted by a blind man.

Then a further series of images conveys concepts thatbuild on this:

2. because of ignorance, we create karma;

3. because of karma, we create consciousness;

4. because of consciousness, we create ‘the aggregates’;

5. because of the aggregates, we create the senses;

6. because of the senses, we create contact;

7. because of contact, we create suffering;

8. because of suffering, we create craving;

9. because of craving, we create grasping;

10. because of grasping, we create conception;

11. because of conception, we create rebirth;

12. because of rebirth, we create death.

Within this circle are the six realms. These imagescan be taken as signifying actual environments for

rebirth; metaphors for different aspects of the humancondition; or in more subtle interpretations, as dif-ferent states of mind that lead to different kinds ofsuffering, which involve the subjective perception ofdifferent environments. Clockwise from the top wehave the God Realms, the Human Realm, the HungryGhosts, the Hell Realms, the Animal Realm and theJealous Gods. Within this we have a depiction of therising and falling of mental states with the alterna-tion of positive and negative mental states, then inthe centre we have the three root poisons of anger,desire and ignorance symbolized by the snake, therooster and the pig. The whole of this space – psychicexistence or Samsara – is embraced by Yama, the Lordof Death. Within the frame but outside Samsara isalso a Buddha, illustrating that escape to enlighten-ment outside this constricted universe is possible.

Plainly, this presentation is greatly abridged. Con-cepts such as ‘the aggregates’ require substantialexposition, and many of the terms that appear famil-iar are being used here in quite specific ways. Whatmay be clear, however, from this summary is theextent to which the doctrines of Buddhism place agreat deal of close emphasis on the nature of internalstates. Allied with the doctrinal teachings are exten-sive meditative techniques that encourage the practi-tioner to become very much aware of internal statesand the way in which mental states are created out ofour habitual ways of perceiving things. ‘Habitualways of perceiving things’ in fact is one way oflooking at the whole concept of karma within Bud-dhism. Our accustomed and habituated ways of con-struing the world will tend to influence how weexperience it and how we respond to it.

CONNECTIONS BETWEEN BUDDHISM AND MENTAL HEALTH CARE

Theoretical connections and the nature of consciousness

Western psychology is currently grappling mightilywith the nature of consciousness.

6–8

Although it hasmade little impact yet into the thinking aroundclinical mental health care, where a number ofconventional assumptions regarding cognitive–behavioural and psychodynamic psychology standcentre stage, waiting in the wings as it were are someradical reformulations of the nature of personhoodand the mind. Consciousness theorists and investiga-tors preoccupy themselves with issues such as the‘binding problem’ whereby disparate sensory inputsarriving at different times in the sites through whichawareness might be coordinated seem to be experi-enced as simultaneous. They concern themselves alsowith speculations on the nature of ‘zombies’ or non-conscious humans – whether such creatures mightexist and indeed if you were one whether you wouldknow it or not.

Figure 1: The wheel of life.

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Workers in this field have had a couple of reasons tobecome interested in Buddhist thinking. First, Bud-dhism contains some highly developed models ofmind based on the fruits of extended contemplativeexploration of the nature of mental self.

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Second, thetechniques of meditation offer some promise in open-ing up the possibility of more intensive explorationof mental phenomena.

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Buddhist techniques offer toconsciousness study investigators the possibility of,to borrow a phrase from Guy Claxton, ‘sharpeningthe gizmo’

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in relation to introspection on theorigin and nature of conscious experience.

Practical utility of mindfulness and other Buddhist techniques for therapists

Training in psychiatry in particular presents somepsychological and mental challenges for the practi-tioner. Phenomenological mental state examinationrequires the development of a particular observingfacility: a capacity to create a representation in one’sown mind of the events in another, and thencogently describe this. This is a developed form ofempathy that requires a certain kind of mental poiseand pliancy.

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This in itself represents a reason forseeking out techniques that may sharpen the intro-spective faculties.

Further reasons for seeking out techniques that maysupport mental health and stability include: dealingwith the day-to-day stresses of work, with the impactsof transference and counter transference on our ownpsychologies, as well as the stress of making oftenpainful and risky decisions. My own encounters withBuddhism came in part from this root, starting out inpsychiatry and feeling that some kind of relaxationpractice might be beneficial in containing stresses ofthis type of work. This along with encounters withsome other political writings from a Buddhist orien-tation,

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were part of my own early journey intocontact with Buddhism.

Buddhist meditation techniques emphasize theimportance of a concept known as ‘mindfulness’. Toillustrate the centrality of this concept: a story is toldof the Buddha being stopped on the road by a groupof soldiers who were going to battle, telling him thatthey might die that day and that they needed toknow what teaching he could give them that was atthe core of his spiritual lessons. He is said to havereplied with one word: ‘awareness’. Meditation tech-niques, by encouraging the strengthening of thecapacity to focus single-pointedly on an indicatedobject, with the gentle but progressive developmentof self-accepting strategies for dealing with intrusionson that concentration, provide important resourcesfor the clinician in dealing with the at times bewil-dering array of influences and stresses that confrontus in clinical mental health practice. Also withinBuddhist practice are extensive techniques for culti-vating positive attitudes towards others. I remember

encountering as a trainee psychiatrist the Rogerianproposition that ‘unconditional positive regard’ was adesirable feature to be cultivated by an effectivetherapist. However, this was in the context of notbeing provided with any very clear directions as tohow to develop such a desirable state. Buddhistteachings and meditation aspects have their placehere.

Buddhism as a source for therapeutic techniques

There has long been a degree of cross-fertilization ofideas between Buddhism and psychological therapies.There is a substantial school of Tibetan psychologicalstrategies taught within Buddhism described as‘thought transformation’ training,

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many of whichhave similarities with reframing strategies in cogni-tive restructuring and other cognitive–behaviouraltechniques. A large number of mental health practi-tioners also make some use of meditative techniquesand there is extensive evidence of their psychologicalhelpfulness. One recently published treatment man-ual illustrates well the potential for cross-over in thisarea.

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In seeking to develop a maintenance form ofcognitive therapy for depression, Segal

et al

. decided,after going considerable distances up some blindalleys, that one of the key aspects of mental functionthat they wish to promote in helping people tomaintain the gains achieved during cognitive therapywas the ability to de-centre or distance from one’sown thinking; the ability to look at it from anobserving posture without being overly engaged withthoughts as the central definition of self. This theysaw as an important vehicle in the ability of people tobe able to apply lessons learned in cognitive therapyon a continuing basis. In their quest to find effectiveand cost-effective ways of promoting such an apti-tude, they found themselves exploring mindfulness-based approaches. This led to them completely revis-ing their treatment directions and developing a pack-age of mindfulness-based cognitive therapy fordepression that integrated Buddhist notions of mind-fulness and mental awareness with Western notionsof cognitive therapeutic techniques. This was thenmanualized, trialled, and produced good outcomes,particularly with people with multiple depressiverelapses. This whole exercise was funded by theNational Institute of Mental Health in the USA.

CONFLUENCE AND CONFLICT

It seems clear then that there are a number of pointswhere there may be confluence between Buddhistthinking and Western psychology and mental healthpractice. Many of the accessible and now (thanks to awide range of translations) readily available presenta-tions of Buddhism will provide material that will beof relevance as a resource in cognitive and behav-ioural therapeutic settings. Buddhist techniques havea role in collaborative work on understanding of thenature of mind. Practitioners may benefit from the

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mental stability and awareness developed throughmeditative practices, and others are likely to findtheir own sources of convergence that I have notpresented.

We might now move on to some of the areas ofdifference. In traditional presentations of Buddhism,there are teachings that are open (exoteric) andteachings that are secret (esoteric). The teachings sofar alluded to are substantially within the opengroup; within the traditionally secret group are in-depth teachings on ‘emptiness’ and also most of theteachings of tantra. Here we might find some of thedivergences.

Tantric techniques involve among other thingsextensive use of visualization practices and these aresomething that generally receive little attention orexploration in Western clinical mental health prac-tice. Teachings on ‘emptiness’ may seem to stand atodds with many of the tenets of cognitive therapy.Within cognitive therapy, the negative automaticthought is often presented as something to be faced,engaged with, addressed, challenged, debated, andthereby overcome. Beginning with mindfulnessteachings but then developed further with notions ofemptiness, Buddhism suggests different routes thanthese to dealing with negative thoughts. In empti-ness teachings, the nature of selfhood is exploredclosely and in depth; the features of the self, includ-ing thoughts, are seen as ‘dependant arisings’: prod-ucts of causes and conditions and not with inherentexistence.

Mindfulness traditions in meditation encourage theidea that troublesome thoughts can be simplyallowed to pass, and not necessarily engaged with ontheir own terms. Emptiness teachings go further thanthis, promoting the ability to respond to suchthoughts by invoking the understanding of theiressentially impermanent, conditioned, and evanes-cent nature. In this respect the invoking of emptinessto deal with frustrating or distressing thoughts doesnot involve engaging with the thoughts and grap-pling with them; rather, it involves applying a partic-ular mental posture to the experience of a thought, inresponse to which the distress associated with thethought is undermined, by the application of anattitude that holds that this troublesome thoughtreally has no existence. The full fruits of the experi-ential understanding of emptiness is a far from easything to achieve. I would certainly not claim it.However, even in partial forms, the use of theconcepts and the reflection on them as antidote toadverse situations can be powerful. Emptiness is oneinstance where, to my understanding, Buddhistthought would diverge from most applications ofcognitive therapy. Indeed, Buddhism may be in somedegree of tension with any psychological therapy thatworks in modalities that strongly intensify the notion

of a sense of self and selfhood. The Buddhistapproach may be described as rather generating amore diffuse and distributed, looser sense of self,which, in turn, is seen as freer, more flexible andmore spacious than is a self identified as local,enduring, and inherently existent.

As noted in the introduction, Buddhism is Australia’sfastest growing religion; a lot of this growth is innew converts to Buddhism among previously non-Buddhist Australians. Increasingly, people working inclinical practice may encounter Buddhists, includingBuddhists of Australian origin. As with any of themany cultural settings of practice, it may be impor-tant to understand the cultural context when concep-tualizing their problems. This may have particularimportance in Buddhism wherein the nature of thecultural content has so much in the way of materialthat is closely related to the application of psycholog-ical techniques.

The present paper can have only scratched the surfaceon an enormous set of topic areas. Presented here aresome suggested areas of convergence and divergencebetween two substantial bodies of thought and prac-tice. Others may find that parallels or distinctions Ihave attempted to make are not persuasive, and thereare often multiple valid ways to present the kinds ofconcepts referred to in the paper. If this is so, I at leasthope that this contribution will serve to promotediscussion and debate about the areas of commonground and constructive collaboration between twovery important traditions of philosophical and psy-chological thinking, and their associated bodies ofpractical psychological techniques.

ACKNOWLEDGEMENT

Thanks to the Venerable Ivan Milton BBSc, Mpsych, for helpful comments on an earlierversion of this paper.

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SHRUNK

Neil Phillips

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