A Buddhist Perspective on Mental Health - Tariki Books and Papers

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Caroline Brazier

Arc hiv ed Papers

BUDDHIST PERSPECTIVE ON MENTAL HEALTH

A BUDDHI ST PERSPECT IVE ON MENT AL HEALT H

Caroline Brazier

Paper for Nurturing Heart and Spirit: A National Multi-Faith Sym posium ; Held under the

auspices of the Nimh e Spirituality Project, Staffordshire University and T he Spirituality and

Mental Health Forum, Wednesday Nov em ber 1st 2006

INTRODUCTION

Buddhism is often seen as the most psy chological of the major world re ligions. It o riginated in a search for ananswer to the pro blem o f dukkha (affliction), the ex istential suffering that co mes from sickness, o ld age and

death. This search led Siddhartha Gotama, who was to beco me the Buddha and the founder of the faith, into a

spiritual journey . It was as a result of this journey that Siddhartha ev entually rec eived his transformative

ex perience, his enlightenment.

The insight which c ame from the Buddhas enlightenment underpins a Buddhist approach to mental health. The

insights that co nstitute the Buddhas first teachings offer a basis which has been elaborated and re-formulated i

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 Buddhas original conc ern with the sufferings involv ed in human life became the focus for his teaching. In

particular they pro vide the core o f the key teaching, known as the Four Noble Truths. This teaching consists of

four statements, the first of which emphasised the re ality o f affliction. The nob le truth o f dukkha, affliction, is

this: birth, o ld age, sickness, death, grief, lamentation, pain, depression, and agitation are dukkha. Dukkha is

being associated with what you do no t like, being separated from what yo u do like, and not being able to get

what youw ant. (Samyutta Nikaya 61 .11 .5) In other words, human life is unavo idably linked to situations whic

are distressing.

With affliction, c raving arises. The Buddhas second Noble Truth addressed the ar ising of crav ing. In the sutras

the descr iption 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 pro gres

through simple distraction to the co nstruction of psyc hological defences, and finally to the self-destructive

mind states associated with severe mental distress in their response to afflictions. The three elements, kama,

bhavaand abhava,can be translated as sensory pleasures (kama), becoming, or one c an understand, self

building (bhava), and non-becoming (abhava). These three wor ds can be interpreted as descr ibing the stages i

a proc ess of growing attachment. This clinging is itself a response to the affliction that has occ urred. In other
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words, when trouble occurs, peo ple habitually seek distrac tion and comfort, initially at the lev el o f the senses.

For ex ample, they might over-indulge in food o r alcoho l. Later, with frequent repetition of this habit of

distraction, the proc ess bec omes the subject o f identification and self-building. The sense o f self creates a wall

against raw experience, giv ing both identity and a restricted v iew of the world to support it. Eventually,

howev er, if trouble persists, ev en this self-building fails to pro vide sufficient distraction and breaks down into

destructive impulses.

The self-building process is itself a sourc e o f dukkha. Creating and maintaining the self-perspective multipliespain as it is founded in delusion. Other Buddhist teachings can be seen in the contex t of the teaching of the Four

Noble Truths as elaborating the proc esses whereby distressing or deluded states are created and maintained.

Broadly these include teachings that ex plain the proc esses of Dependent Origination whereby the ordinary

mentality is maintained through a cyc le of conditioned v iew. A number of key teachings elaborate these

processes and show how peo ple build their reality, and hence their self, through crav ing and attachment. This

process can take on positive o r negative forms. Our reactions to the ob ject world are ones of attraction or

aversion. Such reactions are habitual and form the basis of ones overall mentality. Oft repeated, they lead us to

create samskaras, mental formations, which we co me to identify with. These samskaras form the basis of our se

They lead us to habitual views and behav iours which, in turn, condition the maintenance o f the cy cle.

The teachings of Dependent Origination and the cy cle o f 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. A vidya literally

means not seeing, and this choice o f 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 th

Buddhas ministry during the latter forty y ears of his life.

Many peo ple in the West associate Buddhism especially with its mind training ex ercises. Undoubtedly

meditation in its various forms has playe d a key ro le in develo ping an elaborate and detailed system o f

understanding the factors o f conditioning and in developing methods for unhooking ourselves from the objects

of crav ing. This process of unhooking is described in the third and fourth Noble Truths. Meditation and other

mental exe rcises co mbined with study and analysis of the teachings led to the a further co llection of Buddhist

texts called the A bhidharma, which were co mpiled shortly after the Buddhas time, and to many later works by

philosophers and prac titioners in I ndia, China, Tibet and all the other major centres of the Buddhist world.

The Buddhist teachings and the practical knowledge which c omes from two and a half thousand y ears of study

and practice c learly hav e much to offer by way of guidance for those working in the field of mental health. This

co ntribution has been reco gnised and there have been a number of significant attempts to draw o n Buddhist

teachings and methodology in Western psy chotherapeutic practice . Early Western theorists, notably WilliamJames and Carl Jung, were influenced by Eastern thought, although such influences were often based on

misunderstandings and limited contex t. More recently we hav e seen an influx o f techniques such as the use of

meditation, mindfulness and v isualisation, all of which have roots in Eastern, and often spec ifically Buddhist,

practice.

In the last decade or two, as a more general interest in the interface between the psychological and the spiritua

has arisen, a number o f Buddhist approaches hav e bee n introduced and taught to pro fessionals working in

mental health fields. These approac hes, though all based on a Buddhist understanding, differ co nsiderably from


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one another. This is because so me rely more upo n Buddhist methodology , whilst others focus on the theoretica

understanding of mental process arising from Buddhist teachings, and also be cause they draw roots from

different Buddhist traditions and from different Western sc hools o f psyc hotherapy . In the UK we c an identify th

various mindfulness based programme s deriv ing fro m the wo rk of Kabat Zinn, the Core Process training o f the

Karuna Institute, and the programme in Buddhist Psychotherapy run by my own organisation, Amida Trust.

Also worthy of mentio n, though less well kno wn in the UK, is the wor k of David Reynolds and the Todo I nstitute

in Canada. Reynolds approach, Constructive Living, is based on two Japanese therapies, Naikan and Morita

whic h apply Buddhist teachings in ways that o ffer an impor tant and str iking c ritique o f many Weste rn

assumptions about mental distress.

Whilst there is no t space he re to ex plo re in detail these differ ent therapies, it is worth not ing that some are no w

being widely used in mainstream establishments and hav e been subjec t to research ev aluatio n. In particular

mindfulness based pro grammes 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 mov ement hav

also prov ed transformative for prisoners in India.

A BUDDHI ST APPROACH T O MENT AL WELL BEING:

One way of understanding a Buddhist approach to mental health is to look at another of its key teac hings.

Buddhism is described as having three pillars, or key elements. These are Sila, Samadhi, and Prajna. We c an use

this formulation to understand characteristic aspects o f the approach.

Sila is generally understood to mean the discipline or ethical framework of a perso ns life. The Buddha taught

much abo ut life sty le. His teachings can all be taken as practical advice on how to live well. The lifesty le which h

prescribed for his disciples, which still forms a model for practitioners today , is one that is morally sound,

co ncerned for o thers, grounded in sober living and respect for liv ing things. This lifestyle is seen as foundationfor the cultivation o f healthy mental states. In keeping with teachings on the co nditioned nature o f mind, an

ethical, non-indulgent life forms the gro und upon which mental health can rest.

Samadhi as the seco nd pillar of Buddhism is generally understoo d to mean the state o f mind that arises when a

person is spiritually grounded. Often this is specifically linked to meditation and co ncentration, but it is also we

translated as a state of rapture, and can result from any v isionary or inspirational experience. In the expe rienc

of samadhi we see bo th the state of calm and peace which is associated with spiritual alignment, and the mo re

ecstatic states that can arise through spiritual practice which hav e the power to offer lasting change.

Prajna as the final element means understanding or wisdom. Literally the word means seeing through or seein

deeply . It is cognate with the western term diagnosis. In prajna we ex perience a dee p integration of the

knowledge which the Buddhist teachings offer. This includes insight into the impermanence of mental

co nstructs, the samskaras, and the co nditioned 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 under standing of mental well being:

- Behaviour co nditions mental states; ethical behav iour co nditions positive states;


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- The Repetition of habitual patterns of action and v iew lie at the roo t of mental states,

- We feel a compulsion to c ling to habitual views and states. Thus there is a sense in which we c an see all mental

problems as a form of addiction and the focus of these addictiv e patterns as being the self.

- Every one is in a state of avidya (delusion) so mental ill health is just a more ex treme v ersion of states we all

suffer from.

- Psyc hotic states are extreme v ersions 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 c oncern with identity , inv itin

a shift away from rigidity of v iew, encouraging deeper connec tion with others and with the env ironment. A

person who is mentally healthy is not self-preocc upied, but is interested in the people and things around him o

her. A Buddhist approach offers a psyc hology based on the conc ept of non-self; an other-centred perspec tive

that emerges as a person beco mes less caught up in maintaining their sense of identity and the c orrespo nding

world v iew that suppo rts it. I t is grounded in the impo rtanc e o f loo king 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, teac hings and religious

co mmunity. A t another lev el we can see this as refuge in the enlightened source o f wisdom, in the truth of reali

that is always av ailable for discov ery , and in the community of others. Bey ond 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 ev er 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. I ts acceptance of our imperfection carrie

with it a pro found sense of our acceptability to Buddha, whic h is ac companied by a v iew of the univ ersal

dimension that is radically no n-judgemental. The object o f our practice is the eternal quality of Buddha Amida

Amida is alway s c louded in the myste ry by our copious disto rtions and limits of view, y et remains a foundation

for our attention which potentially takes us out o f self-preocc upation.

T HE BUDDHIST A T T IT UDE T O MENT AL ILLNESS:

The Buddhist perspectiv e is not one that generally enco mpasses ideas of justice or retribution. Buddhists, at

least in the West, do not generally po sit a deity or supernatural force who interv enes in human affairs, and ev en

where Buddhism comes close to this position with inv oc ations of celestial beings or Bodhisattvas, the influence

these figures might exert would generally be seen as benev olent and limited.

In Buddhism the suffering which people ex perience is of two kinds (although this distinction is not stro ngly

made in the texts). Some suffering arises from o ur ex istential circumstances. As suc h it is unavoidable and to b

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 compo und the

afflictions. The cho ice to do this, however, is seen as a personal matter. Failure to address ones mental state is

not seen as bad, but rather, as missing an oppo rtunity which human rebirth offers. Where a person is in a menta

state where practice is not possible, this would be generally seen as a state worthy of compassion, not

condemnation.


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In Pureland, the emphasis on faith is particularly relev ant here. This particular Buddhist approach is somewhat

more pessimistic than that of other schools abo ut our capac ity to help o urselves through the kind of mind-

training ex ercises c ommonly associated with Buddhism. Here the interminable nature o f our karmic heritage is

reco gnised and people are seen as o rdinary, fallible and in the grip of fathomless blind passions. A gainst this

background, the v iew of me ntal illness would be that if a person can simply reach so me sense of the

immeasurable presence of Amida bey ond their personal turmoil, a moment o f faith, that contac t will sustain

them and achieve ultimate salvation. Psycholo gically speaking we can see this as indicating the importance ofev en small breaks from the cy cle of self into co ntact with other reality.

This v iew encompasses a sense o f commonality between humans. We are all enmeshed in our o wn karma, and

thus similarly caught in states of delusion and co nfusion. 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 pro blematic areas o f behaviour that arise from mental ill health, such as suicide, se lf- harm, anger and so

on would be v iewed by Buddhists as sad occ urrences, which in one way or another c ondition ongoing pain anddistress. Theories of dependent origination and karmic consequenc e point to the idea that any behav iour

creates the seeds for future actions. Thus a Buddhist view would, where po ssible, discourage a perso n from

making expressions of anger in order to help them av oid feeding negativ ity in their mentality.

Similarly suicide and self-harm would be v iewed as laying dangerous patterns which potentially c reate

downward spirals for the individual, but also create karmic consequences for others invo lved. Such v iews can

bo th be taken on the mundane level the child of a suic idal parent will themselv es r un a greater risk of suic ide,

and on the metaphysical level suicide may be seen as leading to a bad rebirth. In such cases, the respo nse of

other Buddhists would be gentle enco uragement to a better course o f action, but above all, compassion for theperson who is taking the action.

It should be noted here that karmic c onsequenc es are generally linked with intentionality, so it is quite

reasonable to argue doc trinally that in many cases a perso n who is mentally ill is not intending harm and

therefore not subject to karmic consequences o f their deeds.

One area o f difficulty that has led to recent d iscussion on a UK Buddhist discussion forum is the subject of

dementia. For some Buddhists the idea that after a lifetime of striving to reach c learer, more refined mental

states, ones mind can suddenly fall into severe delusion, muddled thinking and ev en anger and negativity isvery 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 v iew is common and impacts o n peoples v iew

of a number of ethical and medical dilemmas, such as, for ex ample, palliative c are at the end o f life, and the

donation of organs. At a personal level, I cannot say the matter is one which troubles me greatly, since my o wn

v iew would be that whatever forces are operating in the matter cannot be solely depende nt upo n our phy sical

co ndition at death if they are to affect o ur future bey ond this life.

SUMMARY


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Buddhist views o f mental health and mental illness emerge from the under standing of mental process offered by

Buddhist teachings. The Buddha was pragmatic o ffering many practical methods for working with mental

process. Some examples are remarkably similar to modern therapeutic method. For ex ample, we find

descriptions o f working with fear and dread (Majjhima Nikaya 4) by a proc ess resembling desensitisation. We se

advice o n different strategies for wo rking with distractions and discomforts (Majjhima Nikaya 2) We see dre am

analysis (Majjhima Nikaya 23) and many teac hings that gave ethical guidance and adv ice on liv ing harmonious

with others.

As with any religio us system the interpretat ion of tex tual and other material in the modern context and

particularly in the field of mental health gives much space for v ariations of v iew, and as with other religious

positions, there is no Buddhist consensus on particular co ntrov ersies, nor a single approach that can be

advocated as the sole Buddhist view.

What Buddhists contribute is a richness of direct observ atio n of mental pro cess and an ethic al underpinning

whic h concurs in mo st ways with the bro ader ethic al v iews of soc iety . Bey ond its ob vious c ontr ibution of

methodolo gies for calming and focusing the mind, it o ffers an understanding that whilst critiquing some Wester

attitudes to the self, increasingly aligns with practical approac hes being offered by secular agencies in thetreatment of ill health. Most importantly , though, it is grounded in a v iew of compassion and wisdom as the

co rner stones of human improv ement. Such basic commo dities as must indeed underpin whatev er attempt we

make to be of service to others.

FURT HER READING

Buddhist sutras: there are many sutras (suttas) on the web. Those quoted here such as the Majjhima Nikaya c an

be found at http:// www.ac cessto insight.org/

A few boo ks on Buddhist approaches in psy chology sho wing a range of integratio ns:

Brazier, C 2003 Buddhist Psycho logy , Constable Robinson UK

Brazier, D 1995 ,Zen The rapy Constable, UK

Epstein, M. 1996 Thoughts Without A ThinkerDuckworth, London

Kabat-Zinn, J 1 990Full Catastro phe Liv ing: Using the Wisdom of Your Body and Mind to Fac e Stress, Pain, an

Illne ssDelta, USA

Krech, G 200 2Naikan: grace, gratitude and the Japanese art of self-reflectionStonebridge Press, California

USA

Reynolds, D 1980 The Quiet Therapies, University of Hawaii, Honolulu

Caroline Brazieris an ordained memb er of the Order of Amida Buddha and is based at The Buddhist House,

12 Coventry Rd, Narborough LE19 2GR. Further information abo ut the Amida Order can b e found at

www.amidatrust.com

Paper for Nurturing Heart and Spirit: A National Multi-Faith Sym posium ; Held under the auspices of
http://www.accesstoinsight.org/


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