Global Recovery : through Mental Well-being Reflections on Mental Illness and the Buddhist Approach to Mental Health Ashin Sumanacara Mahidol University, Thailand Introduction Buddhism regards health as “the highest gain (ārogya paramī lābhā).”1 In the constitution of the World Health Organization (WHO), health was defined as being “a state of complete physical, mental and social well-being and not merely the absence of illness or infirmity”.2 Needless to say, this holds true for all aspects of health, both physical and mental. Health is related to many aspects of our life. To be a healthy human being: it is necessary to develop both our physical and mental health. However, mostly we care for only our physical health and neglect to care for our mental health. But Buddhism emphasizes caring more for mental health rather than physical health. For example, once when Nakulapita visited the Buddha in old age and the Buddha advised him to take care, to remain mentally healthy, even though the body is feeble.3 Disease or illness is considered a basic characteristic of life. According to the definition of dukkha (suffering), illness is a cause of suffering in life (vyādhi pi dukkha).4 In Buddhism, the root cause of mental illness, generally considered, originates from the negative qualities of the mind. Therefore, Buddhism emphasizes care of the mind, as the solution. The whole teaching of the Buddha is directed towards the mental care of the individual. To cure one’s mind, Buddha prescribed his discovery of Four Noble Truths or Noble Eightfold Path which has great therapeutic value. In this regard, the teaching of Buddhist psychology could impact psychopathology, on the one hand, and influence therapy, on the other. Thus, it is essential for clinicians to understand the concept and practice of Buddhist psychology. In this essay, an attempt shall be made to discuss the causes of mental illness together with the Buddhist approach to mental health. The theme of mindfulness meditation is understood by many as a spiritual healing power of the dhamma. 1 Dhp. v. 204 . WHO (2006, 1) 3 S III 1 , . 4 S V, 420 2 519 Global Recovery The Buddhist Perspective Therefore, an attempt has been made in this essay to investigate its healing power. The source material for this essay mainly deals with the Buddhist Canonical texts, its Commentaries and Sub-commentaries. However, various academic writings and instructional manuals on Buddhist meditation and mental health have been consulted. It is the authors’ hope that this work will serve as a pathway which lead individuals to their mental wellbeing and meaningful living. Mental Illness A mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture.5 Buddhism recognized two kinds of illnesses: illness of the body and illness of the mind (dve vedan kāyika ca cetasika ca).6 In this regard Buddha said: Monks, there are to be seen, beings who can admit freedom from bodily illness for one year, for two years, for three years, four, five, for ten, twenty, thirty, forty and fifty years; who can admit freedom from bodily illness for even a hundred years. But monks, those beings are hard to find in the world who can admit freedom from mental illness even for one moment, save only those in whom the āsavas [are] destroyed.7 From the above saying of the Buddha, we can say only an arahant 8 has a perfectly healthy mind as he has destroyed all defilements. Beside an arahant, as worldlings9 we are all mentally sick, but there is of course some dissimilarity between abnormal behavior and mental illness. The word abnormal literally means ‘away from the normal’; and, mental illness refers to the mentally-sick or simply-mad. The P li term for this is ‘ummatta’. PED defines ummatta (ud+matta) as “out of one’s mind or mad”.10 That means those who are out of mind or mad, behave madly. A P li commentator described the nature of mental patients like thus: 5 Mental disorder, n.d. IV, 157. 7A V, 157. 8 Adopted by the Buddhisṭs as for one who has attained the Summum Bonum of religious aspiration (Nibb na). See PED s.v. Arahant 9 ‘Worldling’, ordinary man, is any layman or monk who is still possessed of all the ten fetters or defilements binding to the round of rebirths, and therefore has not yet reached any of the four or eight stages of holiness. A worldling, may be either a ‘blind worldling’ who has neither knowledge of, nor interest in the fundamental teaching (the Noble Truths, etc.); or he is a ‘Noble worldling’, who has such knowledge and earnestly strives to understand and practise the Teaching. 10 PED s.v.Ummatta. 6A 520 Global Recovery : through Mental Well-being Those who are seized with mental pain, however, tear their hair and thump their breasts and twist and writhe, they throw themselves over cliffs, use the knife, swallow poison, hang themselves with ropes, enter into fires; remorseful and with burning mind, they think on this or that misfortune.11 In the Vinaya piṭaka we find two kinds of mentally-ill persons, namely, one who does not remember aright, and the other who does not come aright.12 This was with regard to the individuals who forgot or failed to come at proper time and place for the observance and formal acts of the Order (saṅghakamma). Early Buddhism also recognized various types of abnormal behavior. An analysis of Buddhist doctrines gives a clear picture of different types of abnormal behavior among individuals. For instance, Devadatta, Aj tasattu, Aṅgulim la are the example of [perceived] psychopaths; Pat c ra and Kis gotamī are the example of psychotics and so on. In the J taka stories too, we find various types of abnormal behavior, as Harischandra describes: The Bodhisatta, prince of Banaras, is told that in this world there are eight categories of “ummada” meaning psychiatric disorders, namely: 1. kama-ummadaya (sexual dysfunction) 2. krodha-ummadaya (mania) 3. darshana-ummadaya (hallucination) 4. moha-ummadaya (mental retardation) 5. yaksha-ummadaya (possession disorder) 6. pitta-ummadaya (melancholia) 7. sura-ummadaya (alcohol dependence) 8. vyasana-ummadaya (depression) Of the above, the 5th, 6th and 7th are based on aetiology, where as the 1st, 2nd, 3rd, 4th and 8th are based on symptoms.13 These are some types of the abnormal behavior found in the Buddhist J taka stories. 11 Vibh-a I, 126. Vin III, 163. 13 Harischandra (1998, 65-66). 12 521 Global Recovery The Buddhist Perspective The Causes of Mental Illness In his first sermon known as “Dhammacakkapavattana Sutta (Turning the Wheel of Dhamma)”14, the Buddha preached the Four Noble Truths in a cyclical order namely, the Noble Truth of suffering (dukkha ariyasacca); the Noble Truth of the origin of suffering (dukkha samudaya ariyasacca); the Noble Truth of the cessation of suffering (dukkha nirodha ariyasacca) and finally, the Noble Truth of the way leading to the cessation of suffering (dukkha nirodhagāminīpaṭipadā ariyasacca).15 In the Visuddhimagga, Buddhaghosa defines Buddha’s analysis of Four Noble Truths thus, “The truth of suffering is like an illness, the truth of origin is like the cause of the illness, the truth of cessation is like the cure of the illness, and the truth of the path is like the medicine.”16 Therefore, we can say the first one is pathological, the second is diagnostical, the third is ideal, and the fourth is prescriptive. In Buddhism, mental and physical illness is considered as dukkha. The P li word dukkha usually is translated into the English as “suffering”. However, in Buddhism, birth, aging, illness, death, sorrow, lamentation, pain, grief, and despair, association with the unbeloved, separation from the loved, not getting what is wanted are considered as dukkha. In short, the five clinging-aggregates are dukkha.”17 Dukkha is the first of the Four Noble Truths taught by the Buddha and it is one of the three characteristics of life along with anicca (impermanence) and anatta (no-self).18 In every person’s life there is some sort of dukkha. But sometimes we don’t realize dukkha as they are. The Buddha added, “Whatever is felt, is connected with dukkha (yam kiñci vedayitam tam dukkhasmin).”19 According to Buddhist-thought, all conditional states of life, are: dukkha. It is the truth of existence. Dukkha arises from various sources such as stress, interpersonal conflict, depression, confusion, hatred, anger, greed, or behavior problems. Some of our dukkha is existential, such as sickness, old age, dying, separation from the beloved one, etc. The Buddha said: 14 S V,.420. S V, 420. 16 Vism 586. 17 S V, 420. 18 S V, 420. 19 S IV, 216. 19 Vin, II 193. 20 15 522 Global Recovery : through Mental Well-being There is no doubt that the worldlings experiences dukkha, owing to the defilements (kilesā)20, for the enjoyment of worldly happiness. Living beings in the water and on the land search for food, shelter, for their living - by day and by night. Such dukkha, more readily allows for defilements to arise.21 Therefore, according to Buddhist psychology, all temptations brought about by the defilements are regarded as the cause of mental illness. In most of the Buddhist scholars’ and Buddhist psychotherapists’ opinion also support the above statement that mental defilements, ‘kilesā’, are the causes of mental illness.22 The ten kinds of defilements that cause mental illness are: 1. Lobha – greed or attachment, 2. Dosa – hatred or ill-will, 3. Moha – delusion or ignorance, 4. Māna – pride or conceit, 5. Diṭṭhi – false views, 6. Vicikicchā – skeptical doubt or indecision, 7. Thina – sloth, 8. Uddhacca – restlessness, 9. Ahirika – moral shamelessness, 10. Anottappa –moral fearlessness.23 Among them, lobha, dosa and moha are three taproots. With regard to these rootcauses Fulton and Siegel state: Buddhist psychology describes three “root causes” – grade, hatred, and delusion –that give rise to suffering. The similarity of the first two rootcauses to Freud’s instincts is evident: erotic drive = greed and aggressive drive = hatred. Both psychodynamic and mindfulness meditation traditions describe how these forces wreak havoc on mental life, and 20 The defilements (kilesā) are so called because they afflict (kilissanti) or torment the mind, or because they defile beings by dragging them down to a mentally soiled and depraved condition. 21 S I, 3. 22 See Nissanka (1993,.2) [Editor’s Comment: clearly, our conference-author is lacking knowledge of the neuro-sciences] 23 Dhs 1229ff. Vism XXII 49, 65. 523 Global Recovery The Buddhist Perspective both suggest ways to understand and address their influence. Where they depart, however, is the ultimate status of these forces.24 The Buddha compared these three taproots with bamboo plant and its fruit. He said, “They appear in one’s mind and destroy his life as like bamboo, reed, and banana plant are destroyed by their fruits.”25 Therefore, we can say that lobha, dosa and moha are the three main defilements which cause mental illness. Moreover, according to Buddhist psychology, ten kinds of fetters (saṃyojanā)26, four kinds of cankers or intoxicants (āsavā)27, four kinds of floods (oghā)28, four kinds of bonds (yogā)29, four kinds of knots (ganthā)30, four kinds of clinging (upādānā)31, six kinds of hindrances (nivāraṇa)32, seven kinds of latent dispositions (anusayā)33 can also be considered as the causes of mental illness. Furthermore, eight worldly conditions (aṭṭhalokadhammā)34, one’s own kamma35 and environment36 also can be considered as the causes of mental illness. Again, with regard to the Dependent Origination (paṭiccasamuppāda) we can say that ignorance (avijjā) is the cause of mental illness and with regard to the Four Noble Truths (ariyasacca) taṅhā (craving) is the source of mental illness. Ignorance (avijjā) plays a key role in Buddhism. It is the primary cause of all dukkha. Buddha defines avijjā as absence of knowledge of dukkha, absence of knowledge of the cause of dukkha, absence of knowledge of the cessation of dukkha, 24 Fulton and Siegel (2005, 43). S I, 3. 26 Ten fetters, according to Sutta piṭaka are: the fetters of (1) sense objects, (2) attachment to fine-material existence, (3) attachment to immaterial existence, (4) ill-will or hatred, (5) conceit, (6) wrong views, (7) adherence to rites and ceremonies, (8) doubt, (9) restlessness, (10) ignorance. 27 Four cankers or intoxicants are: the intoxicant of (1) sensual desire, (2) (attachment to) existence, (3) wrong views, (4) ignorance. 28 Four floods are: the flood of (1) sensual desire, (2) (attachment to) existence, (3) wrong views, (4) ignorance. 29 Four bonds are: the bond of (1) sensual desire, (2) (attachment to) existence, (3) wrong views, (4) ignorance. 30 Four knots are: the knots of (1) covetousness, (2) ill-will or hatred, (3) rites and ceremonies, (4) dogmatic belief that “This alone in truth”. 31 Four clinging are: the clinging to (1) sense-desire, (2) wrong views, (3) rites and ceremonies, (4) the theory that the soul exists. 32 Six hindrances are: the hindrance of (1) sense-desire, (2) ill-will, (3) sloth and torpor, ill-will, restlessness and worry, (5) doubt, (6) ignorance. 33 Seven latent dispositions are: the disposition to (1) sense-objects, (2) attachment to existence, (3) ill-will, (4) conceit, (5) wrong views, (6) doubt, (7) ignorance. 34 The eight worldly conditions are: gain (lābha) and loss (alābha), fame (yasa) and defame (ayasa), praise (pasaṃsā) and blame (nindā), happiness (sukha) and pain (dukkha). 35 A solid example is Cunda, the pork butcher. In his whole life he slaughtered many animals. Due to this bad kamma he became mad, crawled in his house for seven days, grunting and squealing like a pig and finally died. 36 Alteration in a previously supporting environment. 25 524 Global Recovery : through Mental Well-being absence of knowledge of the way leading to the cessation of dukkha. This is called avijjā.37 Avijjā, synonym of moha (delusion) is the primary root of all evils in the world. It clouds one’s mental eyes and preventing him from seeing the true nature of things– impermanence (anicca), non-satisfactoriness (dukkha) and ego-lessness (anatta). Avijjā is one of the fifty-two mental states (cetasikā) and belongs to ‘moha-cetasika’. This cetasika is present in every ordinary person. The Buddha compares avijjā as floods (ogha)38, as yoke (yoga)39, as fetter (saṃyojana)40, as obsession (anusaya)41. Due to the avijjā we do not see or understand dukkha; its cause; its cessation and the way to its cessation. Because of avijjā we are holding the wrong conception of ‘I’, ‘my’; taking impermanent as permanent; un-satisfactoriness as happiness and as a result we are wandering in the wheel of existence (saṃsāra). Craving (taṇhā) is the very origin of dukkha (mental illness) in the lives of all beings, throughout all their existence.42 Corresponding to six-sense objects, there are six classes of craving, namely, craving for forms (rūpa-taṇhā), craving for sounds (sadda-taṇhā), craving for odours (gandha-taṇhā), craving for flavors (rasa-taṇhā), craving for tangibles (phoṭṭhabba-taṇhā) and craving for mind-objects (dhamma-taṇhā).43 With regard to the six kinds of craving, each kind is held to be threefold, according to its mode of occurrence as the craving for sensuality (kāma-taṇhā), craving for becoming (bhava-taṇhā), craving for non-becoming (vibhava-taṇhā).44 Among the negative ideas, kāma is one of those most repeatedly mentioned and also one of those most categorically condemned. Every individual is driven by this kāma-taṇhā. The Buddhist attitude to kāma is strongly negative. In the Bhayabherava Sutta45, the Buddha narrated kāma as a synonym for ‘fear’, ‘suffering’, ‘illness’, ‘abscess’, ‘bond’, and ‘bog’. In the Alagaddupama Sutta46, kāma has been likened to skeleton, piece of meat, grass-torch, pit of coals, dream, borrowed goods, of fruits on a tree, butcher’s knife and block, snake’s head, etc. In the Magandiya Sutta47, kāma has been compared as painful to the touch, very hot 37 Vibh 180. See Ogha sutta, S V, 59. 39 See Yoga sutta, A II, 10. 40 See Saṃyojana sutta, A V, 17. 41 See Anusaya sutta, A IV, 9. 42 Actually craving is not the only cause for the arising of dukkha. There are numerous causes and effects which are interdependent and related to one another in the universe. But craving is to be understood as the proximate cause of dukkha. 43 M I, 46. 44 Iti 58. 45 M I, 16. 46 M I, 130. 47 M I, 501. 38 525 Global Recovery The Buddhist Perspective and scorching, etc. In the Potaliya Sutta48, the other synonyms of kāma found in the scriptures are as follows– kāma as canker (āsava), kāma as craving (taṇhā), kāma as flood (ogha), kāma as bond (yoga), kāma as grasping (upādāna), kāma as hindrance (nīvaraṇa), kāma as defilement (kilesa), kāma as fetter (saṃyojana), kāma as latent defilement (anusaya), and so on.49 So, we can see that kāma occupies the first place in all kinds of immoral categories. According to Buddhist philosophy, in the beginning of the world men enjoyed self-delight, the delight arising in their mind. Sensual pleasures came afterwards and became their need; then their crucial need; then appeared as the meaning of human life which controlled men’s mental activities. Since then, men’s sensual desire turned to be the principal cause. This chief cause has put strong influences on men’s thoughts and feelings and brought up men’s sensual desire. The more men feel unsatisfied with sensual pleasures and sexual pleasures, the more they thirst for them. For this reason, Lord Buddha said: Monks, I know of no other single form by which a man’s heart is so enslaved as it is by that of a woman. Monks, a woman’s form obsesses a man’s heart. Monks, I know of no other single sound by which a man’s heart is so enslaved as it is by the voice of a woman. Monks, a woman’s voice obsesses a man’s heart. Monks, I know of no other single scent... savor ... touch by which a man’s heart is so enslaved as it is by the scent, savor, and touch of a woman. Monks, the scent, savor and touch of a woman obsess a man’s heart. Monks, I know of no other single form, sound, scent, savor and touch by which a woman’s heart is so enslaved as it is by the form, sound, scent, savor and touch of a man. Monks, a woman’s heart is obsessed by these things.50 Early Buddhist chronicles mention many mental case histories which are mostly caused only by k ma-taṇh . As tamanta j taka51 tells how a blind and aged woman fell in love with a pupil of her son and planed to kill her own son in order to have unhindered sex. This indicates that ignorance and sense pleasures are the forerunner of such madness. Furthermore, in the Kaṇavera j taka,52 Darīmukha j taka,53 Kuṇ la j taka,54 and some other j taka stories – these, indicate that various 48 M IV, 359. S V, 45-49. 50 A I, 1. 51 J I, 61. 52 J I, 318. 53 J I, 378. 54 J I, 536. 49 526 Global Recovery : through Mental Well-being types of mental illness are mainly caused by k ma-taṇh . In the case of mental patients, their defilements are so clouded by ignorance and overwhelmed by craving that they act abnormally or psychotically which lead them to mental suffering. Therefore, we can say that avijj and taṇh are the two leading forces and causes of mental illness. Buddhist Approach to Mental Health The Buddha announced the most notable remark: “Whoever, monks, tends to me should also tend to the sick.”55 He is known as a supreme physician of human beings; His dhamma is equaled with great healing power. At many occasions he claimed himself as an “Unsurpassable Doctor and Surgeon (anuttaro bhisakko sallakatto).”56 The Buddha himself declared that he is compared to a physician who pulls out a poison arrow from a wounded person. The patient at first experiences a worsening of suffering but subsequently the healing process can begin. The Buddha the explained this analogy: the wound represents the six inner sensefields, the poison represents ignorance, the arrow is craving; the surgeon’s knife symbolizes pure insight, the surgeon’s probe represents mindfulness, and the physician and surgeon is the Tathāgata himself.57 The above saying of the Buddha demonstrates his approach to health as a skilled physician and surgeon; then there is the story of “Kisa Gotamī and mustard seed”58, which also illustrates the Buddha as a skilled healer. In the Buddhist scriptures there are several other stories where the Buddha applies his relationaltherapy quite successfully. Following the various therapeutic application of the Buddha, not only Kisa-Gotamī but also Patac ra, Aṅgulim la, and many more individuals not only regained their mental health but also attained Arahatship.59 Birnbaum notes: The Buddha taught patients according to the severity of the illness. Those with fatal illness received lessons on impermanence, while those who could be cured were taught to meditate on the “seven limbs of enlightenment.60 The Buddha not only focused on changing abnormal behavior, but also of creating insight. 55 Vin III, 26. Iti100. 57 M III, 44. 58 See Gotami sutta S I, 129. Thī X, 1. 59 Arahatship: the highest stage of the Path. 60 .Birnbaum (1980, 10). 56 527 Global Recovery The Buddhist Perspective Dhamma, as the Medicine In psychotherapeutic point of view, Buddhism is entirely a system of psychotherapy. Gomez states: “Buddhism is a therapy, as a way to heal a sick soul a mind in error or a person in pain.”61 Deatherage notes: Buddhism uses both philosophy and direct “therapeutic” intervention to accomplish its goal of enlightenment. Therefore the Buddhist approach establishes logical tenets and then provides a way of personality verifying them. For example, the beginning teachings in Buddhism– the Four Noble Truths, observe that everything is impermanent, including one’s own life, and that the impermanence of the material world is a primary and direct cause of unhappiness (things and people deteriorate and pass away).62 Buddha’s teaching is known as the greatest medicine amongst all medicine. His preaching of the dhamma can be compared to the administration of medicine to the sick by a physician. The Buddha said: “One thing only do I teach: dukkha and its end to reach.”63 His advice is to know our own dukkha. His theory of ‘paṭiccasamuppāda (dependent origination)’ simply states dukkha occur because it is caused and also, the theory of ‘kamma (action, deed)’ reveals why dukkha occurs in individual. The Buddhist emphasis on “anicca (impermanence)” can also be seen as a potential contribution to the promotion of mental health. The Buddha was the healer of the supreme illness with which each living being is infected by dukkha. His healing powers relate to both mental and physical illnesses and scatters them, as both originate from a common source: dukkha. From the time of his enlightenment until his parinibbāna64, he interpreted various dhammas as utmost in pointing out dukkha and the way leading to the end of dukkha. Mindfulness Meditation In Early Buddhism we find different psychotherapeutic approaches used for different types of individuals tormented with mental illness, such as ‘the four foundations of mindfulness meditation (satipaṭṭhāna bhāvanā)’, ‘the Four Noble Truths (caturārya saccā)’, ‘dependent origination (paticcasamuppāda)’, ‘the characteristics of nature (tilakkhaṇa)’ and so on. To train our mind, the Buddha 61 Gomez (2003). Boorstein and Deatherage (1982,.20). 63 M I, 22. 64 [pari+nibb na] "complete Nibb na" in two meanings: 1. complete extinction of khandha life; i.e.: all possibility of such life & its rebirth, final release from (the misery of) rebirth and transmigration, death (after the last life—span of an Arahant). PED s.v. Parinibbāna. 62 528 Global Recovery : through Mental Well-being prescribed to us: mind-culturing techniques or meditation (bhāvanā). From the ancient times bhāvanā has been used as a means of transcending dukkha and acquiring a healthy distance between ourselves and our thoughts. As almost all types of mental illness are caused by the mental defilements, Buddhism emphasizes us to annihilate those mental defilements by bhāvanā. It is a technique that cultures and purifies mind, and finally annihilates the evil roots of mind. In Buddhism, there are generally two types of bhāvanā technique, namely, “samatha bhāvanā” and “vipassanā bhāvanā”. “Samatha” means ‘tranquility’, ‘calm’, ‘peaceful state of mind’, etc. It also refers to ‘concentration meditation’. Any objects of awareness, internal or external, may be an object of concentration.65 The Visuddhimagga narrates that there are forty kinds of samatha meditation or meditation subject (kammaṭṭhāna)66 which suits one’s temperament (carita)67. The word “vipassanā” means ‘seeing things as they are or seeing in different ways what is happening in our mind and body’. Another term, equivalent to “vipassanā bhāvanā” is mindfulness meditation, and this term is widely used in psychological literature. Nyanaponika Thera named this meditation as ‘the heart of Buddhist meditation’ or even ‘the heart of the entire doctrine’ (dhamma-hadaya).68 In this regard mindfulness is the essence of Buddhist mental health therapy. The P li term of ‘mindfulness’ is ‘sati’; the word ‘sati’ which is a noun is related to the verb ‘sarati’, to remember. Etymologically ‘sati’ is derived from the Sanskrit ‘smṛti’ means memory, recognition, mindfulness, alertness, remembrance, attentiveness etc. Thich Nhat Hanh interprets sati, as: “remembering to come back to the present moment.”69 In other place, he states mindfulness as: “Keeping one’s consciousness alive to the present reality.”70 Nyanaponika states, “It mostly refers there to the present, as a general mental-term, it carries the meaning of ‘attention’ or ‘awareness’.”71 With mindfulness one reflects only what is presently happening and in exactly the way it is happening. Therefore, it is: present-time awareness. The definition of sati appears in the Abhidhamma text as follows: 65 Examples of internal objects of meditation includes words, an image (might be religious), a kinaesthetic feeling (breath) etc. Objects of external concentration might be a flame, a dot, etc. 66 Forty kinds of samatha-bhāvanā are these: ten kasinas (totalities), ten kinds of foulness, ten recollections, four divine abiding, four immaterial states, one perception, one defining. Vism III, 112. 67 ‘Temperament (carita)’ means nature or character of a person as revealed by his or her conduct and behaviour. The temperaments of people differ as determined by the kamma productive of the rebirthlinking consciousness. Buddhist tradition explained six types of temperament, namely, greedy temperament (rāga-carita), hating temperament (dosa-carita), deluded temperament (moha-carita), faithful temperament (saddhā-carita), intelligent temperament (buddhi-carita), and speculative temperament (vitakka-carita). See discussion in Vism III, 102. 68 Nyanaponika (1992, 7). 69 Nhat Hanh (1998, 59). 70 Nhat Hanh (1987, 11). 71 Nyanaponika (1992, 10). 529 Global Recovery The Buddhist Perspective The mindfulness which on that occasion is recollecting, calling back to mind; the mindfulness which is remembering, bearing in mind, the opposite of superficiality and of obliviousness; mindfulness as faculty, mindfulness as power, right mindfulness – this is the faculty of mindfulness that there then is.72 The term ‘sati’, mindfulness is also known as “sampajana” which means ‘clear comprehension’ or ‘seeing the object of meditation thoroughly and all its aspects’. Moreover, it is a ‘choice-less awareness’. In this form of mindfulness meditation one pays attention to ‘whatever momentarily arises in the body and mind. Mindfulness as a mental quality closely related to attention (manasikāra), is a basic function which, according to the Abhidhamma analysis, is present in any kind of mental state. Therapeutic Mindfulness The word mindfulness can be described under a therapeutic definition. In mindful- awareness, a practitioner is present and aware for the experience of life. With mindfulness one ‘stays with’ whatever happens as it happens. Thus, mindfulness maintains a sense of connection with changing events. Kabat-Zinn notes, mindfulness is: “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.”73 Deatherage gives another therapeutic definition of mindfulness meditation; he defines this, as: The accurate, continuous registering at the conscious level of all events occurring in the six sensory modes: seeing, hearing, touching, smelling and thinking, without qualitative judgment, evaluation, mental comment or behavioral act.74 From the above definitions, it is deemed that when mindfulness is applied in the clinical system or in mental therapy, its definition often includes ‘non-judgment’, ‘letting go’, ‘present moment awareness’, etc. Mindfulness is a way of paying attention non-judgementally; to what goes on in the present moment in our bodymind and the world around us. Mindfulness perceives a thought, a feeling, or a situation, as if or as it is. It is based on observing moment-to-moment experience the desire, excitements, pleasures, satisfactions, anxieties, frustrations, disappointments, etc. When one is mindful, the attention is focused on the present so judgment cannot 72 Dhs14. Kabat-Zinn (1994, 4). 74 Deatherage (1975, 19). 73 530 Global Recovery : through Mental Well-being be placed. All thoughts are welcomed into the mind equally so that one does not judge the thought or the self for thinking the thought. Mindfulness is accepting experience as it is, as it appears to be. Acceptance does not mean that one has to like what comes up (painful sensation, stressful memory, etc.), it simply means one is willing to be with it, rather than trying to push it away. Mindfulness is letting go. Choosing to fix one’s attention on one thing is letting go of diversity and moving to its opposite, unity. Generally we cling on to a particular thought or emotional state and we don’t let go. However, developing the ability to let go is important in every day life. When one holds on to any experience, whether pleasant or painful or neutral, one hinders one’s ability to simply be present in the here and now, without judgment. Letting go is the natural consequence of a willingness to accept things as they are, as they appear to be. In meditation, ‘sati’ has an important role to play. During meditation, generally, we put our attention towards the meditation subject. But the nature of the mind is to wander away from our attention, from the object of meditation. Only mindfulness reminds us that our mind is wandering from our main attention or focus; it pulls back our mind in the object of meditation. It is an incomparable means of developing self-awareness or attentiveness. Buddhism emphasizes us to be our own therapist. Therefore, one way of effectively dealing with mental illness is that of the Buddhists’ practice of mindfulness meditation. In the Satipaṭṭh na sutta Buddha said: Bhikkhus, this is the direct path for the purification of beings, for the surmounting of sorrow and lamentation, for the disappearance of pain and grief, for attainment of true way, for the realization of Nibbāna, namely four foundation of mindfulness.75 There are several other discourses in the teaching of the Buddha where it indicates that various forms of illnesses including mental illness can be cured or minimized through mindfulness meditation. For example, once when the elder Kassapa was ill, his pains increasing, the Buddha visited him and said: 75 According to the Satipaṭṭh na sutta, the four applications of mindfulness are: Mindfulness of the body (kāyānupassanā-satipaṭṭhāna), Mindfulness on the Contemplation of feelings (vedanānupassanā satipaṭṭhāna), Mindfulness on the contemplation of consciousness (cittānupassanā-satipaṭṭhāna), and Mindfulness on the contemplation of mental objects (dhammānupassanā-satipaṭṭhāna). See M I, 55. 531 Global Recovery The Buddhist Perspective Kassapa, these seven limbs of wisdom76 fully expounded by myself, when cultivated and made much of, conduce to full comprehension, to the wisdom, to Nibbāna.77 One of the seven limbs of wisdom is mindfulness. After receiving and accepting the full teaching of the seven limbs of wisdom, Ven. Kassapa rose up from that sickness. There and then that sickness of the Venerable Kassapa was cured. He regained his physical as well as mental health. Again, when Ven. Girim nanda is in pain, severely ill; the Buddha asked Ven. nanda: “ nanda, if you go to the monk Girim nanda and tell him ten perceptions78, it’s possible that when he hears the ten perceptions his illness may be allayed. Then, Ven. nanda, having learned these ten perceptions in the Blessed One’s presence, went to Ven. Girim nanda and told them to him. As Ven. Girim nanda heard these ten perceptions, his illness was allayed; and Ven. Girim nanda recovered from his illness. That was how Ven. 79 Girim nanda’s illness was abandoned. In several other discourses the Buddha included mindfulness meditation as a remedy of illness. So, we can say mindfulness itself is helpful in regaining lost health whether it is physical or mental health. One of many benefits of mindfulness meditation is that it helps one to develop a greater level of compassion toward oneself and others. Because mental illness like anxiety, stress, grief etc., often leaves behind feelings of shame, guilt, and frustration, this is of particular value. Mindfulness helps one to watch one’s feelings and thoughts. It is an important tool not just for reducing symptoms but for minimizing the effect of mental illness on one’s self-esteem. Mindfulness cultivates various qualities that are highly suited to establishing a strong therapeutic force. Mindfulness based health interventions have developed over the last fifty years into a method for curing mental illness and present day, mindfulness meditation has been used as a method of psychotherapy. Nissanka, who has promoted mindfulness based Buddhist psychotherapy and who has been treating mental patients for more than forty-five years, states that various mental 76 The seven limbs of wisdom refer to seven Enlightenment factors (bojjhaṅga). They are: mindfulness (sati-sambojjhaṅga), investigation of things or dhammas (dhammavicaya-sambojjhaṅga), energy or effort (vīriya-sambojjhaṅga), rapture (pīti-sambojjhaṅga), tranquility (passaddhi-sambojjhaṅga), concentration (samādhi-sambojjhaṅga) and equanimity (upekkhā-sambojjhaṅga). 77 S V,.66. 78 The perception of inconstancy, the perception of non-self, the perception of unattractiveness, the perception of drawbacks, the perception of abandoning, the perception of dispassion, the perception of cessation, the perception of distaste for every world, the perception of the undesirability of all fabrications, mindfulness of in-&-out breathing. 79 A V, 108. 532 Global Recovery : through Mental Well-being illnesses including schizophrenia can be and have been cured by this therapeutical method.80 According to him, the Buddhist system of psychotherapy is nothing but getting the patient to practice meditation.81 The purpose of cultivating mindfulness is to help the patient to see and to know the cause of his illness, and this itself is the cure of the illness. This technique helps one to see or realize one’s own defilements; to control the defilements; to suppress the defilements; and finally it help one to uproot the defilements. By focusing mindfully in their body and mind, patients learn not just to prevent and tame their anger, but also to transform the consuming fires of greed, hatred and delusion appreciation for the well being of others. Therefore, through this meditation one should carefully examine one’s own illness. Many psychologist and patient have found a total cure as a result of regular practice of mindfulness meditation. When this meditation properly carried out and developed, the patient are claimed to regain and develop their mental health. In mindfulness meditation, if the mental patient able to understand that besides the five aggregates there is no ‘I’, you; there in no ‘self’ or ‘soul’; all are mirage then he will accept the reality and will not grieve or sorrow for the reality. With a peaceful and calm mind he will face his illness and will try to regain sound health. By practicing mindfulness the patient becomes aware of just how clouded and distorted his awareness of the world (and himself) has become. Jon Kabat-Zinn, who is a founding director of the stress reduction clinic and the center for mindfulness in medicine, health care, and society at the University of Massachusetts Medical School, notes: Cultivating mindfulness means learning to tap and focus our own wasted energies. In doing so, we learn to calm down enough to enter and dwell in states of deep relaxation. This nourishes and restores body and mind. At the same time it makes it easier for us to see with greater clarity the way we actually live and therefore how to make changes to enhance our health and the quality of life. In addition it helps us to channel our energy more effectively in stressful situations or when we are feeling threatened or helpless. This energy comes from inside us and is therefore always within our reach and potential control.82 80 Nissanka (2002, 1). Nissanka (2002, 6). 82 Kabat-Zinn (1990, 11-12). 81 533 Global Recovery The Buddhist Perspective In the view of Deatherage: Mindfulness meditation, like any other approach, is most powerful when employed as part of an overall program of psychotherapy designed specifically for the individual patient. It can be a primary, secondary, or supplementary appropriate for the patient.83 Although mindfulness meditation derived from the 2,550-year-old Buddhist tradition; it is only fairly recently that the clinicians and psychologists have started to apply this technique in mental therapy. Several researches on mindfulness meditation have been proved also its effectiveness in mental therapy. Therefore, the clinicians should feel encouraged by the research evidence. Furthermore, there is a possibility for awakening in every moment. The practice of mindfulness meditation may seem to be very difficult to a patient, but a little awareness with mindfulness will indicate a deeper reality of life. Mindfulness is openness to reality, without distortion. It is a way for both spiritual development and to overcoming mental suffering. Thus, Mindfulness is the specific antidote for mental illness. It is both the cure and the preventive measure. Conclusion What we can draw from the forgoing explanation is that every Buddhist approach to mental therapy is included in two methods of therapy: cognitive therapy and behavioral therapy. Mindfulness meditation is one cognitive approach in Buddhism. Even though there are various approaches of Buddhist mental therapy: the ultimate cure lies in meditation, in other words, in mindfulness practice. Unless one reflects with mindfulness, one will not cure completely. From the Buddhist point of view, becoming free from mental defilements or illness is not under the authority of any god or creator but just lies within oneself. We ourselves are the creator of mental defilements. With regards to this point, the Buddha said: By oneself, indeed, is evil done; by oneself is one defiled. By oneself is evil left undone; by oneself, indeed is one purified. Purity and impurity depend on oneself; no one can purify another.84 83 84 Boorstein and Deatherage (1982, 20). Dhp165. 534 Global Recovery : through Mental Well-being By delivering the above mentioned verse, the Buddha prescribed for us the greatest therapeutic formula. He emphasized, for us: to take refuge in ourselves; and to practice his teachings in order to purify our minds from mental impurities. Again and again, he reminds us that we are all sick, and therefore, we should diligently take the medicine to be healed. It’s true that illness cannot be avoided; instead of trying to avoid illness we should understand it so that we will be able to cure it and finally eradicate it. The teaching of the Buddha not only upgrades our health but also completely eradicate the defilements. The complete eradication of defilements refers to final liberation from dukkha, which is: Nibbāna. Abbreviation: A : Aṅguttara Nik ya Abhi : Abhidhamma Dha : Dhammapada Dhs : Dhammasaṅgaṇi ed./eds : edition/editor/editors Iti : Itivuttaka J : J taka M : Majjhima Nik ya PED : P li-English Dictionary S : Saṃyutta Nik ya Thig : Therīg th tr. : translation/translated Vibh : Vibhaṅga Vibh-a : Vibhaṅga-aṭṭhakath Vin : Vinaya Vism : Visuddhimagga vol/vols : volume/volumes 535 Global Recovery The Buddhist Perspective Bibliography (I) Primary Sources: Aṅguttara Nikāya: Gradual Sayings, vols. I-II, tr. F.L. Woodward, London: P li Text Society, 1979-1982. Dhammapada, tr. Narada Thera, Colombo: Buddhist Cultural Centre, 2000 (1963). Dhammasaṅgaṇi: Buddhist Psychology, tr. Mrs. Rhys Davids, New Delhi: Oriental Books Reprint Corporation, 1975. Jātaka: Stories of the Buddha’s Former Births, vols. I-VII, ed. E.W Cowell, New Delhi: Asian Educational Services, 2003(1895-1905). Majjhima Nikāya: The Middle Length Discourse of the Buddha, tr. Bhikkhu N namoli and Bhikkhu Bodhi, London: P li Text Society, 2001. Saṃyutta Nikāya: Kindred Sayings, vol. I, tr. Mrs. Rhys Davids, London: P li Text Society, 1979. Saṃyutta Nikāya: Kindred Sayings, vols III-V, tr. F.L. Woodward, London: P li Text Society, 1975-1980. Therīgāthā: The Elders’ Verses, tr. K. R. Norman, London: P li Text Society, 1971. Udāna: Verses of uplift & Itivuttaka: As It was said, tr. F.L. Woodward, London: Oxford University Press, 1948. Vibhaṅga Aṭṭhakathā (Sammohavinodanī): The Dispeller of delusion, tr. Bhikkhu Ñ namoli: London: P li Text Society, 1996. Vibhaṅga: The Book of Analysis, tr. Ashin Thiṭṭila, London: P li Text Society, 1969. Vinaya Piṭaka: The Book of Discipline, 5 vols, tr. I.B.Horner, London: Luzac & Co., 1949. Visuddhimagga: The Path of Purification, tr. Bhikkhu Ñ namoli, Singapore Buddhist Meditation Centre, 1956. 536 Global Recovery : through Mental Well-being (II) Secondary Sources: Birnbaum, Raoul (1980) The Healing Buddha, London: Rider and Company. Boorstein, Seymour. and Deatherage, G Olaf., Buddhism in psychotherapy, Kandy: Buddhist Publication Society, 1982. Deatherage, G. (1975) ‘The Clinical use of “mindfulness” meditation techniques in short-term psychotherapy’, in Journal of Transpersonal Psychology, vol. VII, no. 2, 133-144. Fulton, Paul R. and Siegel, Ronald D. (2005) ‘Buddhist and Western psychology’, in Mindfulness and Psychotherapy, Christopher K. Germer and Ronald D. Siegel (eds), pp. 28-51. New York: Guilford Press. Gomez, Luis O. (2003) ‘Psychology’, in Encyclopaedia of Buddhism, Robert E Buswell (ed.), vol. II, pp. 678-692. USA: Macmillan Reference. Harischandra, D.V.J. (1998) Psychiatric Aspects of Jataka Stories, Galle: Vijitha Yapa. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to Face stress, pain, and illness. New York: Dell Publishing, 1990. Kabat-Zinn, J. (1994) Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion. Nhat Hanh, Thich (1998) The Heart of the Buddha’s teaching, Berkeley: Parallex Press. ––(1987) The Miracle of Mindfulness, Boston: Beacon Press. Nissanka, H.S.S., (1993) Buddhist Psychotherapy, Colombo: Buddhist Cultural Centre, (2002). Nyanaponika T, (1962) The Heart of Buddhist Meditation: A handbook of mental training based on the Buddha’s way of mindfulness, Kandy: Buddhist Publication Society (1992). Rhys Davids, T.W. and Stede, William (1979) Pāli-English Dictionary, London: P li Text Society. (III) Website Sources: WHO int. Constitution of the World Health Organization, Basic Documents, Forty- fifth edition, Supplement, October 2006. 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