BUDDHIST MENTAL THERAPY
The Anagarika Sugatananda
Vol. VIII, No. 2, 1961
It has been estimated that one out of every four persons in the world's great cities today is in need of psychiatric treatment, which is equivalent to saying that the percentage of neurotics in present-day civilisation runs well into two figures.
This high incidence of personality disorders is believed to be a new phenomenon, and various factors have been adduced to account for it, all of them typical features of modern urban life. The sense of insecurity arising from material economic discord; the feeling of instability engendered by excessive competition in commerce and industry, with booms, slumps, redundancy and unemployment; the fear of nuclear war; the striving to 'keep up' socially and financially with others; the disparity between different income levels combined with a general desire to adopt the manner of life of the more privileged groups; sexual repression which is at the same time accompanied by continual erotic titillation from films, books and the exploitation of sex in commercial advertising, all these and a host of subsidiary phenomena related to them are characteristic of our age. Not least among them as a disturbing influence is the need to feel personally important in a civilisation which denies importance to all but a few.
Each of these is doubtless a potential cause of psychological unbalance, and taken all together they may well be expected to produce personality maladjustments of a more or less disabling nature, particularly in the great capitals where the pressures of modern life are felt most acutely. The widespread emotional unbalance among the younger generation, which has developed into an international cult, with its own mythology and folklore and its own archetypal figures symbolic of the 'beat generation', seems to substantiate the belief that we are living in an era of psychoneurosis.
Yet it is necessary to review this startling picture with caution. We have no statistical means of judging whether people of former days were less subject to neuroses than those of the present. The evidence of history does not entirely bear out the assumption that they were. Patterns of living man change radically, but human nature and its themes remain fairly constant in the mass. When Shakespeare, in the robust and full-blooded Elizabethan era, drew his picture of neurosis in Hamlet he was drawing from models that had been familiar from classical times and could doubtless be matched among his contemporaries. Greek and Roman history records many outstanding cases of behaviour which we now recognise as psychotic, while the Middle Ages abounded in symptoms of mass neurosis amounting to hysteria. The fear of witchcraft that held all Europe in its grip for three centuries was a neurosis so prevalent that it constituted a norm while almost the same may be said of the more extravagant forms of religious behaviourism characteristic of that and later periods. The extraordinary Children's Crusade of 1212, when thousands of children from France and Germany set out on foot to conquer the Holy Land for Christendom, and never returned, is one example. Here the influence of a prevailing idea on young and emotionally unstable minds is comparable to the international climate of thought which in our own day has produced the 'beat generation'. There is no strict line of demarcation between a religious ecstasy and a nihilistic expression of revolt, as we may learn from Dostoievsky, himself a neurotic of no mean stature. The private mystique of the neurotic may be caught up in the larger world of mass neurotic fantasy, where it adds its contribution to a world that is apart from that of its particular age but which reflects it as in the distortions of a dream. Because of this, the neurotic is often found to be the spokesman and prophet of his generation.
Facilities of communication have made this more than ever possible, creating a mental climate of tremendous power that knows no barriers and can only with difficulty be kept within the bounds of the prevailing norm. Adolph Hider turned a large section of German youth into psychopaths, firstly because his personal neurosis found a response in theirs, and secondly because he was able to communicate it to them directly by means of radio, newspapers and other modern media of propaganda. At the same time, the unstable personality of the neuropath drew support and an intensification of its subliminal urges from the response it evoked in countless people who had never come into personal contact with the source. The real danger of neurosis today is its increased communicability; people are in contact with one another more than they have ever been before. The tendency to standardize, undesirable in itself, has the further disadvantage that it too often results in the wrong standards being accepted. Epidemic diseases of the mind are more to be feared than those of the body.
But those who are inclined to believe that personality disorders are a phenomenon of recent growth may draw comfort from Burton's Anatomy of Melancholy. 'There we have a compendium of cases of individual and collective neuroses gathered from all ages, and showing every variety of hallucinatory and compulsive behaviour ranging from mild eccentricity to the compete alienation from reality which is classed as insanity. Psychopathic degeneration, criminality, alcoholism, suicidal and homicidal tendencies are as old as the history of mankind.
Nor is there any real evidence that people living in simpler and more primitive societies are less prone to psychological disturbances than those of modern urban communities. The rural areas of any European country can show their proportion of neurotics in real life no less than in fiction, while in those parts of the world least touched by Western civilisation the symptoms of mental sickness among indigenous peoples are very common and are prone to take extreme forms. Where an inherent tendency to confuse the world of reality with that of dreams and imagination is worked upon by superstitious fears, morbid neurotic reactions are a frequent result. The psycho-somatic sickness produced by the witch-doctor's curse, which so often culminates in death, is even more common than are the mentally-induced diseases of the West that are its counterpart.
In one respect primitive societies are superior to those of today, and that is in the preservation of initiation ceremonies. These give the adolescent the necessary sense of importance and of 'belonging'; they served as tests which justify the place in tribal life that the initiate is to take up. By their severity they satisfy the initiate that he is worthy. Initiation rites have survived to some extent in the boisterous 'ragging' given to new arrivals in most institutions for the young, but they have no official sanction and do not confer any acknowledged status. To be psychologically effective an initiation ceremony must be either religious or in some way demonstrative of the new manhood or womanhood of the initiate. It then dispels feelings of inferiority and the self-doubtings which are a frequent cause of neurosis, and sometimes of delinquent behaviour in young people. Primitive societies, however, have their own peculiar causes of mental disturbance and it is a mistake to suppose that they are superior in this context to more sophisticated social structures.
The fact is that more attention is given to minor psychological maladjustments today than was the case in former times, and departures from the normal standards of behaviour are more noticeable in civilised than in primitive societies. The instinct to run to the psychiatrist's couch has become a part of contemporary mores. It is true that modern life produces unnatural nervous stresses; but strain and conflict are a part of the experience of living, in any conditions. There has been merely a shifting of the points of tension. The more man is artificially protected from the dangers surrounding primitive peoples, the more sensitive he becomes to minor irritants; yet man in a completely safe environment and free from all causes for anxiety—if that were more than theoretically possible—would be supremely bored, and boredom itself is a cause of neurosis. Human beings can be psychologically as well as physically over-protected, and the civilised man falls a prey to psychological conflicts brought about by situations which are much less truly anxiety-producing than those that menace the lives of primitive peoples every day. Habituated by education and example to expect more of life than the human situation gives him any reason to expect, the modern man feels the impact of forces hostile to these expectations more keenly than he need do. Modern commercial civilisation is continually fostering and propagating desires which all men cannot satisfy equally, and desire artificially stimulated only to meet with frustration is a prime cause of psychological disorders. Herein lies the chief difference between our own and former eras. There is also the need for periods of true relaxation which many people deny themselves in their desire to be continually entertained.
The systematic study of abnormal psychology began with the work of J. M. Charcot in 1862. Closely following upon that the advent of psychoanalysis brought the subject of personality disorders into prominence. There then came a breaking down of the distinction which had formerly been made between normal and abnormal psychology, and the two became merged in what is now called dynamic psychology. It was found that the obsessions and compulsions of neurosis are not something distinct from the ordinary modes of behaviour but are only extreme and sharply-defined forms of the prejudices and habit patterns of the 'normal' person. In defining abnormality it has become the custom to place the line of demarcation simply at the point where the extreme symptoms make some form of treatment necessary for the person who deviates persistently from the average standards of his group. Thus 'normal' and 'abnormal' are purely relative terms whose only point of comparison is that provided by the generally-accepted habit patterns of a particular group. If the group itself is collectively abnormal its units must be considered 'normal', with the result that we are compelled to make reinterpretation of what meant is by these terms of reference.
All behaviour is a form of adjustment, and this is true equally of behaviour that is socially acceptable (the 'norm') or socially unacceptable. It is really the active response of a living organism to some stimulus or some situation which acts upon it. The ways in which certain persons deviate from normal standards in behaviour are nothing but individual ways of meeting and adjusting to situations. This new way of regarding the problem is of the utmost importance, particularly when we come to examine the Buddhist system of psychology. In Buddhism, all modes of consciousness are seen as responses to sensory stimuli and these responses are conditioned by the predetermining factors from past volition. For example, where one person sees an object and is attracted to it, whilst another is repelled by the same object, the cause is to be found in mental biases set up in the past. All reactions, furthermore, are conditioned by a universal misapprehension of the real nature of the object as it is congised through the senses.
There is therefore a common denominator of misunderstanding which takes the form of collective delusion; it constructs the world of sensory apperceptions and values out of the abstract world of forces which is the actuality of physics. Where there is in reality nothing but processes and events, an ever-changing flux of energies, the mind construes a world of things and personalities. In this world the human consciousness moves selectively, clinging to this, rejecting that, according to personal preferences of habit and prior self-conditioning. The consciousness-dominating factor known to Buddhism as Avijja(nescience), Moha (delusion) or Vipallasa (misapprehension) is essentially a condition of mental disorder, a hallucinatory state. The Pali axiom Sabbe puthujjana ummattaka,* "All worldlings are deranged", indicates that the whole purpose of Buddhism is to apply mental therapy to a condition which, accepted as the norm, is in truth nothing but a state of universal delusion.
The Puthujjana or 'worldling' who is thus described is the average man; that is, all human beings except those who have entered on the four stages of purification, the Sotapanna (Stream-enterer), Sakadagami (Once returner), Anagami (Non-returner) and Arahant (Saint). The Puthujjana is characterised by mental actions of craving for states which are impermanent, subject to suffering, devoid of reality and inherently impure. These he wrongly imagines to be permanent, productive of happiness, invested with self-existence and pleasurable. His hankering for them is accompanied by mental biases (asavas), mind-defiling passions (kilesa) and psychological fetters (samyojana), which in Buddhism are seen as the root causes of wrong action and consequent unhappiness. What we call the 'norm' is an average balance of these mental factors and their opposites, in exactly the same way that a state of normal physical health is merely the balance of power between the various classes of bacteria in the body. If one class of bacteria gains ascendancy over the others it begins to have a destructive effect on the living tissues, and a state of disease supervenes. Psychologically, an increase in any one of the mental defilements constitutes the change over from a normal to an abnormal psychology. Since all 'worldlings' are deranged, what we are concerned with in dynamic psychology is the degree of derangement and its underlying causes. This is the case also in Buddhist psychology.
Freudian psychoanalysis works on the assumption that when the origin of a personality disorder is known its influence on unconscious motivation will automatically disappear. Freud endeavoured to trace all psychic traumas to experiences in infancy or early childhood, and made the libido the basis of his system. His work opened up many hitherto unsuspected areas of personality and made a great contribution to our knowledge of the subject. But the defects of Freud's theories can be understood in terms of his system, for he tended to exaggerate certain motives unduly, and in deliberately searching for these he worked on a method of personal selectivity that was bound to become apparent to Jung and others among his successors. His therapeutic methods may also be questioned, for the conflicts engendered by unconscious motivation do not always cease when the original cause of the trauma is brought to the surface. For this and other reasons psychotherapy has not so far produced the benefits which were once expected of it. In many cases the most it can do is to enable the subject to come to terms with himself and 'live with' his condition. The limited nature of its success is indicated by the need to resort to physical treatment for cases that have passed from neurosis to psychosis, such as electroconvulsive therapy for acute depressive moods, insulin injections for the early stages of schizophrenia, frontal lobotomy for prolonged anxiety states and the use of the class of drugs known as tranquilizers which act upon the vegetative interneurotic circuits of the brain.
In contrast to the expedients of Western psychiatry, Buddhist mental therapy aims at total integration of the personality on a higher level. Since craving is the root cause of suffering it is necessary to diminish, and finally, extinguish craving. But desire is also the mainspring of volition, so the first stage of the process must be the substitution of higher objectives for the motivations of the libido and their offshoots. The libido-activated urges must give place to the consciously-directed motives of the Adhi-citta, or higher mind. It is here that Buddhism introduces a point of reference which Western psycho-therapy has been unable to fit comfortable into its theories—the field of ethical values.
The discarding of many conventional and religious moral attitudes, on the ground that they are for the most part contingent and arbitrary, has left the psychologist without ethical determinants in certain important areas of his work. Whilst accepting as the norm the standards of contemporary life he has not been able to work out any universal basis on which what is 'right' and what is 'wrong' in some aspects of human conduct can be established. The defect has been a serious handicap in the treatment of anti-social and delinquent behaviour, for the psychiatrist confronted with examples of deviationist and unacceptable behaviour finds himself unable to decide on what authority he is setting up as the 'norm' a standard which he knows to be mostly a product of environment and social convenience. Clinical diagnoses and moral judgments do not always point in the same direction.
Buddhist ethico-psychology cuts through the problem by asserting boldly that the measure of immoral behaviour is simply the degree to which it is dominated by craving and the delusion of selfhood. This at once gives an absolute standard and an unchanging point of reference. It is when the ego-assertive instinct overrides conventional inhibitions that behaviour becomes immoral and therefore unacceptable; it is when the over-sensitive ego fears contact with reality that it retreats into a fantasy of its own devising. The neurotic creates his own private world of myth with its core in his own ego, and around this his delusions of grandeur, of persecution or of anxiety revolve. Neurosis then passes imperceptibly into psychosis. The ordinary man also, impelled by ego-assertiveness and the desire for self-gratification, is continually in danger of slipping across the undefined border between normal and abnormal behaviour. He is held in check only by the inhibitions imposed by training. The attainment of complete mental health requires the gradual shedding of the delusions centred in the ego, and it begins with the analytical understanding that the ego itself is a delusion. Therefore the first of the fetters to be cast away is Sakkayaditthi, the illusion of an enduring ego-principle.
The doctrine of non-self (Anatta) is a cardinal tenet of Buddhism and the one that distinguishes it from all other religious systems, including Hindu Yoga. Ever since the time of Aristotle the 'soul', the pneuma or animus which is supposed to enter the body at birth and permeate its substance, has been taken as the entelechy of being in Western thought; but Buddhism denies the existence of any such entity. Modern psychology and scientific philosophy confirm this view. Everything we know concerning states of consciousness can be postulated without reference to any persisting ego-principle. Like the body, the mind is a succession of states, a causally conditioned continuum whose factors are sensation, perception, volition and consciousness. Introspective examination of the states of the mind in order to realise this truth is one of the exercises recommended in Buddhism.
The understanding of the Buddhist principles of impermanence, of suffering (as being the product of craving) and non-ego brings about a re-orientation of mind which is characterised by greater detachment, psychological stability and moral awareness. But Buddhism points out that this is not an effect which can be obtained by external means; it is the result of effort, beginning with end sustained by the exercise of will. There must first of all be the desire to put an end to suffering, and that desire must be properly canalised into 'Sammappadhana', the Four Great Exertions; that is, the effort to eliminate existing unwholesome states of mind; to prevent the arising of new unwholesome states; to develop new wholesome states and to maintain them when they have arisen. The unwholesome states of mind are nothing but products of mental sickness that derive from the ego and its repressed desires.
Here it should be pointed out that Buddhist teaching is non-violent, and this non-violence is to be exercised towards one's own mind as well as towards the external world. To repress natural desires is merely to force them below the surface of consciousness where they are liable to grow into morbid obsessions breaking out in hysteria or manic depressive symptoms. Buddhism does not favour this rough treatment of the psyche, which has produced so many undesirable results in Western monasticism. Instead of repression it works by attenuation and sublimation. Visualising the passions as fire, Buddhism seeks to extinguish them by withholding the fuel. For example, sensuality is reduced in stages by contemplation of the displeasing aspects of the body, so that there comes a turning away from the sources of physical passion. Attraction is replaced by repulsion, and this finally gives way to a state of calm indifference. Each impure state of mind is counteracted by its opposite.
Techniques of meditation (bhavana) in Buddhism are designed for specific ends, according to personality of the meditator and the traits it is necessary to eliminate. They are prescribed by the teacher just as treatment is given by a psychiatrist; the mode of treatment is selected with the individual requirements of the patient in view. The forty subjects of meditation, known as Kammatthana (bases of action),** cover every type of psychological need and every possible combination of types. Their salutary action is cumulative and progressive from the first stages to the ultimate achievement. From the beginning, the Buddhist system of self-training makes a radical readjustment within the mental process, a readjustment which is founded on the acceptance of certain essential concepts that differ from those ordinarily held. The old scale of values, with its emphasis on the cultivation of desires, is seen to be false and a source of unhappiness; but this realisation does not result in a psychic vacuum. As the old, unwholesome ideas are discarded, new and invigorating ones take their place, while the lower motivations give place to consciously-directed impulses on the higher levels of being. So the personality is moulded anew by introspective self-knowledge.
One defect of psychoanalysis as it is practised in the West is that it often reveals ugly aspects of the personality before the patient is ready to accept them. This some times has highly undesirable side effects and may even cause disintegration of the personality. The Buddhist system of mental analysis teaches us to confront every revealed motivation in a spirit of detached and objective contemplation in the knowledge that there is nothing 'unnatural' in nature, but that an impulse which is 'natural' is not necessarily also desirable. The Buddhist who has brought himself to think in terms of the kinship of all living organisms, a concept inherent in the doctrine of rebirth, is not appalled by the coming to light of subconscious desires that are contrary to those permitted in his particular social environment. The distinction between human and animal conduct, which science has done much to prove illusory, is not sharply defined in Buddhist thought, where all life is seen as the product of craving-impulses manifesting now on the human, now on the animal level. Where sadistic or masochistic impulses exist they are viewed realistically and with detachment as residual factors of past motivation, and they can be dealt with accordingly. Terms such as 'perversion', which are already obsolete in modern psychology although they survive in popular writing and speech, have never existed in Buddhist thought. All Buddhism recognises is craving and its various objects and degrees. Because of this, the moral climate of Buddhist thought as it concerns the libidinal impulses and inclinations is different from that of the West with its Judeo-Christian discriminations. The distinction that craving is 'good' while that is 'bad' is foreign to Buddhism. for Buddhism is not concerned with the morality of fluctuating social conventions but with a concept of mental hygiene in which all craving is seen as a source of misery, to be first controlled and then eradicated. Thus, although its ultimate ideals are higher, the rational morality of Buddhism as it still operates in many Buddhist communities is not so destructive in its effects as the discriminative theological morality prevailing in the West. No Buddhist feels himself to be a 'lost soul' or an outcast from society because his desire-objects are different from those of the majority, unless his ideas have been tainted with Judeo-Christian influences. The Western psychiatrist who seeks to reassure a patient of this type whom he cannot 'cure' suffers from the disadvantage that he has the whole body of theological popular morality against him, and nothing can remove this devastating knowledge from his patient's mind. Hence we find that guilt and inferiority complexes, a dangerous source of psychological maladjustment, are certainly more prevalent, coming from this particular cause, than they are where standards common to antique world still survive.
It would be well if more attention were to be paid by present-day moralists to the cult of violence that has arisen as the outcome of commercially-exploited brutality and sadism in films, popular literature and most of the curiously misnamed 'comics' which give children and adolescents a morbid taste for the torture and extermination of their fellow-beings. Aggression is another instinct natural to man, but to encourage it for profit is certainly one of the true sins against humanity. Here again of course, we have nothing that is entirely new; cruelty is a prominent feature of many traditional and classic stories for children. What is new is the enormous quantity of such entertainment and the facility with which it is distributed on a global scale to create an international climate of thought and a subconscious reversal of all the standards that civilisation nominally upholds. We should not feel surprised at the psychological dichotomy it produces. Sooner or later we shall again have to pay heavily for the cult of outrage we have encouraged.
This, however, is a question of social- psychology; we are now dealing with individual psychology as it is affected by modern conditions and in the light of the Buddhistic axiom, Sabbe puthujjana ummattaka. We have already noted that the four stages of mental purification beyond the puthujjana state begin with the attainment of Sotapatti magga, the 'path' of one who has 'entered the stream' of emancipation. This is followed immediately by Sotapatti-phala, the 'fruit of stream-winning'. It is at this point that the erstwhile puthujjana becomes one of the four (or eight) classes of Noble Personalities. In the scheme of Ten Samyojanas he has eliminated the first three fetters: ego-delusion, doubt as to the truth and addiction to vain rituals which have no place in the higher endeavour. He then goes onto the next stage, that of the Sakadagami. This is marked by the weakening of the next two fetters in the series: sensuous passion and ill-will. In the next phase of development he completely frees himself from these first five, which are called the 'lower fetters'. The remaining five fetters are attachment to existence on the higher levels of being (intellectualised existence), craving for existence on the purely mental plane (the spiritual life freed from the body), pride (the 'pride of the saint in his sainthood'), restlessness (the perturbed condition of the mind distracted by desires) and nescience. The last of these is the root-condition referred to previously; it is only eliminated in full at the last stage. The aspirant has then gained the full mental liberation of an Arahat. While the mental and bodily formations continue to function he experiences Sa-upadisesa-nibbana, or Nibbana with the elements of existence still present. At death this becomes Anu -padisesa-nibbana or Parinibbana, the complete extinction of the life-asserting, life-sustaining factors. No form of Nibbana can be attained before this last stage; the three classes of Noble Personalities that precede it gain assurance of the reality of Nibbana but they do not experience the actual Sa-upadisesa nibbana until all the defilements are removed.
It is not the purpose of this article to deal with the state of Nibbana, but merely to indicate the difference between the condition of the 'worldling' with his illusions and cravings, and that of the fully-emancipated and mentally healthy being. Buddhism itself is concerned more with the path than with end, since it is the path which has to be followed, and the end must automatically reveal itself if the path is followed rightly. It is true that the goal, Nibbana, is never very far from Buddhist thought; it is the motivating principle and raison d'etre of the the entire Buddhist system. But the stages on the way are our immediate concern. They involve an approach which is fundamentally therapeutic and progressive. Buddhist meditation is of two types, complementary to each other: Samatha bhavana, the cultivation of tranquillity, and Vipassana-bhavana, the cultivation of direct transcendental insight. For the latter it is necessary to have a teacher one who has himself taken the full course of treatment, but much benefit can be obtained by an intelligent application of Buddhist ideas in the preliminary stages without a guide other than the original teachings of the Buddha. Everyone can, and should, avoid what he knows to be unwholesome states of mind; should cultivate universal benevolence in the systematic Buddhist manner; should endeavour to impress on his deepest consciousness the truths of impermanence, life-suffering and its cause, and the unreality of the ego. A period of quiet meditation, in which the mind is withdrawn from externals, should be set aside every day for the purpose. By this method Buddhism enables every man to be his own psychiatrist, and avoids those dependences on others which so often produce further emotional entanglements in the relationship between the psychotherapist and his patient.
Any philosophy of life which does not include rebirth must be incomplete and morally unsatisfactory, and the same is true of psychological systems. Some psychological disorders have their origin in past lives; they are then often congenital and sometimes involve the physical structure of the brain or neural system. These are the psycho-somatic conditions which call for the use of surgery, drugs and the other physical treatments already mentioned. As resultants of past Kamma they may respond to treatment or they may not; all depends upon the balance of good and bad Kamma and the interaction of causes, not excluding external and material ones. But in any case, the knowledge that no condition is permanent, and the certainty that disorder will come to an end with the exhaustion of the bad Kamma-result, be it in this life or another, gives courage and fortitude to the sufferer. By understanding our condition we are able to master it, or at least to endure it until it passes away. This salutary understanding can also be applied beneficially in the case of those who have developed personality disorders through bad environmental influences, childhood traumas or any other cause traceable in this present life. Feelings of inadequacy, grievances against the family or social framework, emotional maladjustments can all be under stood in terms of Kamma and rebirth. The question 'Why has this thing happened to me?' with the sense of injustice that comes from experiencing undeserved pain, is answered fully and logicality by Buddhism. With that comes the beginning of an adjustment to circumstances which is in itself therapeutic. Together with this, the knowledge that one can be the sole and undisputed master of one's own future fate comes as the most effective psychological tonic and corrective that can be administered.
* Cf. Visuddhimagga Vol. II, page 208, lin 13, 6th Syn. Edit
** See The Light of the Dhamma, Vol. V. No. 3, p. 14
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