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founded by S. N. Goenka in the tradition of Sayagyi U Ba Khin

 

 

 

 

 

Before and After: Five Case Studies of Improvement in Mental Health

-By Dr. Raman Khosla

Vipassana is a scientific method to purify the mind, by observation of the interaction between mind and matter by meditators within themselves. All the benefits seen in a Vipassana meditator are the direct results of a pure mind and are proportionate to the degree of purity. From the Vipassana point of view, mental disorders are the result of the accumulation of large numbers of mental impurities in the domain of craving and aversion. All persons whose minds are not totally purified are seen as having some degree of mental disorder. The difference between an individual with and without a mental disorder as defined in psychiatric terms is only a matter of degree of these defilements. The defilements in the aversion spectrum include: anger, hatred, ill will, animosity, irritability, restlessness, anxiety, sadness, fear, guilt, inferiority and jealousy; while those in the craving spectrum include passion, ego, greed, arrogance, self-indulgence, possessiveness and vanity. Many persons with mental disorders have undergone Vipassana courses to date. Special considerations given to such persons include: prior preparation in certain cases, accompaniment by a family member during the course, relaxation of meditation timings, and extra supervision by the course guide. A ten-day Vipassana meditation course is only a beginning for the eradication of the mental defilements in the individual. It is absolutely essential for the meditator to continue his or her daily practice even after the course and to sit follow-up courses. If the person continues to do this, there is no doubt that sooner rather than later the mental defilements will get reduced, thereby causing the individual's mental disorder to show marked improvement. Five cases of individuals with mental disorders are presented here to emphasize the change in these persons due to the impact of Vipassana. An attempt is made at the end of each case report to briefly highlight the dynamics behind the improvement as seen from the Vipassana point of view.

Psychological parameters studied in the individual before Vipassana and one year after Vipassana were as follows:

  1. Personality-based hardiness index which measures the personality characteristics and dynamics
  2. Symptom checklist which measures the psychological and physiological symptoms
  3. Hamilton Depression Scale
  4. Ways of Coping Questionnaire which measures the individual's coping to stress. In all these tests, the lower the scores on these scales, the greater is the improvement in the persons

Case Study One: Alcohol Dependence

Mr. X, a well-educated, unmarried man in his mid-20s, was alcohol dependent for over seven years, although his father, also an alcoholic, had died young. Over the past two years, he wanted to give up alcohol because of his health and financial problems as well as loss of job, but was unsuccessful. He even attempted detoxification with the help of doctors and alone, stayed at a rehabilitation centre, attended AA (Alcoholics Anonymous), and undertook various spiritual trips, but he could never keep off alcohol for more than a month. In his own words: "I was fed up because the Devil got me each time I started thinking that now it is in my control. I started believing what others said, 'Once an alcoholic, always an alcoholic.' I even thought of suicide but did not attempt it, thinking of what would happen to my aged mother after me." Mr. X took his first Vipassana course immediately after the detoxification, as well as two more courses in the next one a half years. Since the first course, he has been totally off alcohol, has a stable job, has no sadness, and is optimistic about his future: "I was ignorant as long as I blamed circumstances or alcohol for my problem. Though AA taught me to accept total responsibility for my alcoholism, I felt even more miserable on the non-meeting days, because I was drinking. Even now I do feel an occasional craving to drink, especially when I see my colleagues drinking, but I can control it. The reason is that Vipassana has made me realize that my craving is not to alcohol, but to my own pleasant sensations which alcohol induces in me, and an aversion to the unpleasant ones arising during its withdrawal."

His test scores are:

Test Pre-Vipassana 1 Year Later Personality Hardiness 82 46 Symptom Checklist 194 78 Depression Scale 14 4 Coping Scale 116 74 An alcohol drinker develops craving to retain the pleasant sensations caused by alcohol and to remove the unpleasant sensations caused by its absence. It is not alcohol which is the problem, but craving towards one's own sensations which is the root of the problem. As a drinker develops in the technique of Vipassana, he or she becomes more equanimous to both the pleasant and unpleasant sensations, thereby breaking the "vicious cycle" of craving. The old stock of alcohol-related craving will then arise, producing sensations. If one continues to be equanimous to them, they will also pass away, thereby putting an end to the individual's dependence on alcohol.

Case Study Two: Depression

Mrs. A, a married lady in her mid-40s, and an active member of a religious sect, had been feeling very sad for over three years. The onset was triggered by the accidental death of her father and brother. Initially she became markedly anxious, would weep and feel guilty, saying that she had wasted her life. Over the past two years, she had lost interest in most daily activities, was worried about her teenage children, and had pessimistic thinking and insomnia. "I was doing all my daily chores because I had to do them", she said, "I became even more religious and started reading the G²t± daily. While reading, I felt a bit better, but within hours I would again feel miserable." She consulted many private psychiatrists who gave her anti-depressants, "With them, I would feel about 60% better; but whenever I tried reducing the medicines, I would again feel terribly low." Very willing when told about Vipassana, she sat her first course over a year ago and benefited a lot. Regularly practising at home, after one year, she felt about 90% better, "I have never felt so well in the past four years. My life is totally changed with Vipassana. I had heard and read all along about equanimity in the G²t± and even considered myself to be a very equanimous person, but the first time I faced a major disappointment in my life, I broke down. Then all my religious knowledge did not help me much. However, Vipassana has now made me realize that the true meaning of religion lies in the practice of being equanimous in the face of all the ups and downs of life."

Her test scores are as follows:

Test Pre-Vipassana 1 Year Later Personality Hardiness 74 52 Symptom Checklist 226 60 Depression Scale 20 4 Coping Scale 92 44 Defilements related to sadness and anxiety with the base of unpleasant sensations was the core problem of this lady. Mental diversion in the form of reading, alteration by means of chemicals or alteration in the level of awareness through medicines provided only temporary relief. The root of her trouble lay in a lack of equanimity with unpleasant sensations caused by anxiety and depression, thereby causing her to continue to tie more knots of depression. With regular practice of Vipassana, she became more equanimous to the unpleasant sensations within, and her depression automatically lifted.

Case Study Three: Anxiety, Panic Disorder

Mr. B, a 19-yr. old student, above average academically, studying in first year medical school and staying in the hostel, spent most of the first year roaming with friends, bunking college and seeing movies. As a result, he failed his first year exams. This was a major blow to his self-confidence, as his friends had passed the exams. For over one year, B was anxious, worrying about how to tell his parents the news, was not able to concentrate on anything or study; had a heavy head and could not sleep well. He filled out his exam application form twice again, but did not appear. Thinking about the exam or how to tell his parents the truth would give him panic attacks. He consulted a private psychiatrist who gave him an anxiolytic medication which kept him dull and drowsy for most of the day so that he could not study. His friends and seniors also tried to counsel him but, "None of their advice helped me become less tense. I realized that I was becoming dependent on the medicine and hence, I was looking for some natural way to solve this problem." B sat his first Vipassana course over one year ago and another one recently. Six months ago he passed his first year exam. He has been on no medicine since his first course. In his own words: "My concentration in my studies has improved tremendously thanks to Vipassana. My tensions and sleep problem are back to normal. I am a much happier person now than ever before. I recommend Vipassana to all students who have concentration problems in their studies."

His test scores are:

Test Pre-Vipassana 1 Year Later Personality Hardiness 62 40 Symptom Checklist 110 53 Depression Scale 6 2 Coping Scale 80 54 The vicious cycle of accumulated mental reactions of aversion to the unpleasant sensations triggered off by the panic attacks was the central theme of this person's problem. As his equanimity increased due to daily practice of Vipassana, the anxiety-related defilements automatically decreased to a significant extent.

Case Study Four: Obsessive- Compulsive Disorder

Mr. Y, a 20-yr. old post-graduate science student with a pre-morbidly obsessive personality, had been having a problem for four years. It started in 11th grade and progressed relentlessly, "The past one and a half years have been hell for me, as I hardly go to college due to my problems." He had multiple obsessive thoughts, doubts, imageries and ruminations about almost all daily activities, with compulsions which markedly prolonged his daily schedule. Dirt, sex and mortality/morbidity occupied most of his obsessions, with washing and touching being his predominant compulsions. He would get obsessive impulses to harm people or break things occasionally, which would make him agitated and later cry. Adequate dose trials of anti-depressants and clomipramine by private psychiatrists helped only marginally. Y sat his first Vipassana course 14 months ago. Before that, he was taught Anapana to reduce his restlessness during the course. He sat his third course recently. Now he has been admitted to an engineering college and feels more than 90% better, being off of all medicines. He says: "Earlier I tackled my inner thoughts wrongly by thinking about them or trying to solve them. Both would increase my anxiety. Suppressing my impulses only lead to more restlessness. I kept on tying new knots every moment in the process. The fundamental change with Vipassana is that now I have learnt how to leave these thoughts alone, whatever their content be. And working with my sensations, I realize that all those disturbing thoughts come from the depths to the surface of my mind to go out, provided I watch them without reacting. Now I realize how I had become a slave of my own mind."

His test scores are:

Test Pre-Vipassana 1 Year Later Personality Hardiness 102 64 Symptom Checklist 144 58 Depression Scale 12 2 Coping Scale 124 86 The obsessive phenomena produced anxiety and associated unpleasant sensations in this individual. Trying to solve the problem of one thought by another only kept increasing the anxiety because the body sensations were totally ignored. When these unpleasant sensations exceeded a threshold level, he indulged in compulsive physical acts. Through Vipassana he learned to try not to remove these obsessive thoughts but accept them, giving more attention to the accompanying sensations and observing them with equanimity. This is how he managed to not generate new obsessive reactions and allowed the old stock of these reactions to arise and pass away, thereby giving him much relief.

Case Study Five: Borderline Personality Disorder

Mr. P. a 22-yr. old unmarried well-educated man, had a problem of showing extremes of emotion, especially angry outbursts which consequently strained all his relationships, "I tried to keep myself busy, but whenever I was alone I felt lonely and had to take a drink. This has been my nature since many years. I have tried specially to reduce my anger but in vain. I sometimes felt like ending my life but could not gather courage enough." He was much better for a year when on a combination of lithium and carbamazepine, but, "When I started to reduce it and stop it, the same complaints started coming again. My psychiatrist told me I may have to take medicines lifelong and this shook me up." P took two Vipassana courses in the span of five months and has hardly missed a day of practice in the past year, "My blaming others stopped. I realized that the cause of my own misery was the constant craving and aversion which made me continuously judge others or myself as all good or all bad. My expectations of others when not fulfilled would cause me to fight with them, break up and then suffer even more. Now my anger and sadness are reduced considerably. Most importantly, I am off medicines. This is just the beginning for me. As our teacher puts it, it is a long journey within, and I am experiencing its benefits."

His test scores are:

Test Pre-Vipassana 1 Year Later Personality Hardiness 104 76 Symptom Checklist 208 122 Depression Scale 16 6 Coping Scale 112 66 Craving and aversion to sensations resulting from labelling people and objects as good or bad was the crux of his problem. Alcohol helped in reducing the unpleasant sensations accompanying the feelings of sadness by reducing the level of awareness towards them. Verbal and physical outbursts were merely external manifestations of these mental defilements of frustration, anger, and restlessness. Learning to deal with unpleasant sensations with equanimity has been the major gain so far in this person which has started to change his personality.

Conclusions

It is evident from the above case studies that regular proper practice of Vipassana meditation will help in alleviating mental disorders. However, it requires a lot of patience and diligence on the part of the meditator and professional psychiatric advice, in addition to guidance by a qualified Vipassana teacher.