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

 

 

 

 

 

Psychiatry and Meditation

-By Dr. Dhananjay Chavan

 

(This paper, from the 1994 seminar at New Delhi was updated in November, 2006)

A lay person is often confused about psychiatry, meditation and the relationship between the two. Health professionals, especially mental health professionals have a different understanding of meditation. At the same time, most lay people are clueless about the scope of psychiatry. Though there is increased awareness about meditation and psychiatry, there is lack of clarity.

Both the words "psychiatry" and "meditation" carry mystical auras. Psychiatry, as we know it today, is a very young science, barely a century old. On the other hand, many meditation techniques derive from the ancient past. Meditation practices are methodologies developed and practiced centuries ago by the scientists of mind and matter, by the sages, the saints and the Buddhas. To answer the question, is meditation “scientific”, let us first understand what science is? Science is built upon an objective observation and analysis of data, and its application. Science seeks to know the truth.

Various meditation practices involve an effort to concentrate on a particular object. While discussing meditation, we will restrict our discussion to Vipassana meditation as discovered and taught by the Buddha, often called the Great Physician. In Vipassana objective observation of reality is of fundamental importance. Vipassana is not merely a concentration practice, it is an investigation into the phenomenon of mind and matter. (Some understand mind to mean the human consciousness that is manifested especially in thought, perception, emotion, will, memory, and imagination. When I use mind in here I use it in this general dictionary sense. But “mind and matter” are used as separate discreet fundamental entities that were discovered by Buddha. In this usage, mind is still close to the above dictionary definition and matter means the physical body including, of course, all the physical substrates that required for manifestation of mind. I do not get into the debate about whether mind is function of brain or whether brain is a physical substrate required for manifestation of mind.)

People think of psychiatry as a science dealing with abnormal “minds”. Actually it is the study of abnormal “behavior”. To define normality is a difficult task. Normality generally means "average." Behavior refers to observable behavior, which means vocal or physical actions, i.e., vocal or physical behavior. It may include real or intended behavior. Recently brain imaging has added a new dimension. In psychiatry and psychology, mental behavior is studied only by inference after it manifests in vocal and physical actions. The aim of these sciences is to bring the behavior of an individual closer to normal. (Of course, the psychological disciplines don’t aim for some statistical average but acknowledge that there is a range of normality and often there are deviations which are also considered perfectly normal.)

We might use a more modern definition of psychiatry: an application of neuroscience to the problems of particular groups of patients. This is a very truthful definition. Initially the scope of psychiatry was not well defined. As a result, psychiatrists were dealing mostly with minor illnesses. During the 1960s and 1970s, many psychiatrists in the West were practicing psychoanalysis. Often their subjects were people with very minor psychiatric problems; very rarely were they psychotic. During this period an impression was created in some quarters that psychiatry can deal with all the problems of humanity. In reality, psychiatry was not contributing to peace in the general society in any major way. Still, it was rendering invaluable service to a small but significant number of patients.

Reasonable psychiatrists gradually realized that the boundaries of psychiatry are not coextensive with those of all human mental activity. This realization is of immense significance, since it helps both the psychiatrist and the common man to define the scope of psychiatry. Failure on the part of a lay person to understand the scope of psychiatry has led to various problems. For example, at times a psychiatrist is called upon to help when the problem is not actually psychiatric, stemming from the unreasonable faith and expectation that the psychiatrist knows everything about the mind. In contrast to this conception of the psychiatrist's omniscience, there is the other side of the coin: a lack of faith in the whole specialty, even on the part of some health professionals, with the result that psychiatric help is not sought even when it is appropriate and has the potential of immense benefit.

In recent times psychiatry has emerged as a branch of medicine with more focus on major psychiatric illnesses. This has redefined the role of psychiatry as a biological science, and psychiatrists are now playing the more appropriate role of specialists treating biological disorders which are accompanied by behavioral disturbances. This certainly does not mean that the psychiatrist’s role is limited to prescribing medicine; various other modalities of therapy are an important part of his repertoire. More and more, psychiatrists have started restricting themselves to their proper domain: the treatment of major psychiatric disorders. These conditions are ones which psychiatrists are better trained, better equipped and better qualified to treat. Psychiatrists are trained to deal with "abnormal" behavior. In cases which are closer to normal (or average) behavior, the difference in effectiveness between psychiatric treatment and other treatment modalities rapidly decreases.

The World Health Organization is constantly trying to improve its diagnostic criteria for psychiatric disorders. The new International Classification of Diseases (ICD-10) is an important step in that direction. Effort is made to systematically demarcate the field of psychiatry to help psychiatrists concentrate on a specific sub-population, to assist researchers in seeking to find remedies for various disorders, and to protect people from improperly being labeled as psychiatric patients. However, the boundaries continue to remain fuzzy. Even a competent psychiatrist at times finds it difficult to decide whether to try treat a particular individual, or to conclude that the person is not in need of psychiatric treatment.

Whether they are in the domain of the psychiatrist or not, life throws up constant problems. What does one do when faced with life's problems? Every individual encounters the suffering that results when unwanted things happen, when wanted things do not happen; when one gets what one does not like, or loses what he likes. Where should one look for the solution?

Everyone suffers from various kinds of misery. When confronted with problems in business, one person might become anxious very easily, while another person is inclined to sadness. One may become angry and another one may become fearful. In such instances, the individual may well not have a psychiatric disorder. He or she might benefit as much from the advice and support of a wise friend or a wise relative as from psychiatric intervention. Even so, everyone's life is bound to have challenges, and suffering occurs again and again.

Mind is the principal factor. We have to study it, probe it to its depths in order to master it and in order to solve our problems. This is precisely what Vipassana is all about. Vipassana meditation is the science of exploring the entire phenomenon of mind and matter. Psychiatry studies mind only indirectly and only to the extent that it renders itself observable by its manifestation in vocal and physical actions. (Brain imaging techniques have added a new dimension to this study and have opened many doors for this study.) In the science of meditation, the mind is studied directly. This unmediated subjective observation was widely prevalent in Asia since ancient times.

Actions have their origin in the mind. But not everything that arises in the mind manifests as a vocal or physical action. Physical actions which appear to be similar might originate from quite different mental volitions. For example, a person who freezes when he sees a snake might have two entirely different reasons for this action. He may be extremely frightened; or he may be very calm and is staying immobile so as not to frighten the snake, or so as to observe the snake. Similarly, a person who gives a coin to a beggar may be giving it out of compassion; just to get rid of a nuisance; or because others are watching him and he does not want to appear to be a stingy person.

So the first problem with the psychiatric approach is that it is difficult to derive conclusions about the mind from vocal and physical behavior. The mind must be studied directly. We have some help from various brain imaging techniques and electrophysiological studies (such CT scan, MRI, PET scan, EEG etc) still the information gained by these is very limited. Another problem results from "Cartesian dualism," the arbitrary separation of mind and matter. For a long time the specialized medical profession studied body but excluded the study of mind. And when psychiatrists started studying the mind, in whatever manner, they ignored the body. Today the importance of a holistic approach is widely accepted. But there is neither a satisfactory method of enquiry, nor proper understanding of the interaction of mind and matter, with the result that there are many theories, but few facts. With modern imaging techniques and increasing awareness of body-mind interaction, the data is increasing but satisfactory methods of enquiry are still lacking.

We may find some solutions through proper understanding of meditation. The term "meditation" has a variety of meanings. In English, the term is loosely used to refer to thinking about something. Dictionaries define it as "contemplation": to exercise the mind in contemplation, to focus on a subject of contemplation; to ponder, muse, or ruminate. When we refer to meditation here, we are not using the term in this pedestrian sense.

The Enlightened One, Gotama the Buddha, used the word bhāvanā to describe practices of mental development. This word literally means development or training but is loosely translated as meditation. It refers to specific mental exercises, precise techniques for focusing and purifying the mind. When we use the word "meditation" here, we use it in this technical sense. Almost all Indian languages have specific words for different meditation practices because India has a rich tradition of these disciplines. Such words as dhyāna, japa, trāṭaka, sādhanā, vipassanā (vidarshanā), bhāvanā etc., refer to different kinds of mental practices. Broadly speaking, meditation is an exercise in the concentration of mind on various objects. Since concentration of mind is the prerequisite for any task, it is a very important factor in the exploration of the mind-matter phenomenon. There are many possible objects of concentration: visual, auditory, imaginations, verbalizations, etc.

The Buddha gave us a wonderful object of concentration, our own natural respiration. Unlike other objects which are either external or do not have any direct relation to our mind and body, this is an object which has many advantages. It is internal, and constantly present from birth to death. It is a tangible reality, even if a gross one. It is both conscious and unconscious, intentional and unintentional. Its rhythm is so intimately connected with the mental state that any defilement arising in mind, even the slightest agitation, disturbs the rhythm of the respiration. We cannot find any other object of concentration which is so intimately connected with the mind-matter phenomenon and yet renders itself so easily to observation.

But concentration is not the goal of meditation; it is only a tool. A tool for what?

Here we encounter the third difficulty of the modern scientific approach, that of defining the problem itself. The four Noble Truths of Suffering are very simple, logical and universal: suffering exists; it has a cause; this cause can be eradicated; there is a path to its eradication. Yet these universal truths might not have been appreciated because in the past psychiatry has focused more on the "why" than on the "how." The same is true about some “spiritual” approaches. This attitude of searching for meaning while ignoring fundamental mechanisms of reality serves to obscure, rather than enhance, the study of the problems of the human mind. Concentration techniques of meditation increase ability to sustain attention and hence help in objective observation of fundamental mechanisms of reality.

The Buddha was a scientist of mind and matter; a scientist of misery and happiness. He not only explored the mind and matter phenomenon himself in its entirety and came out of all suffering, but he showed the method to do it so that other people by adapting that method could come out of their misery. He taught the observation of how the mind works, how mind and matter interact. He taught Vipas­sana.

Vipassanā means to see in a special way. It is objective observation of the internal reality. It is devel­opment of insight into one’s own nature. It involves no assumptions; rather, it is mere objective obser­vation. It is a practical way of understanding our problem of suffering and solving it. In the same way as the problem is universal, the remedy also is universal. In Vipassana we learn to observe our sensations objectively. Sensations are the meeting point of the inti­mate mind-matter interaction. Though sensa­tions arise in the body, they are felt by the mind. While observing the sensations, we start understanding how the mind works. Each of us becomes a scientist of mind and matter. We get direct knowledge. The Buddha described four fundamental processes of mind: consciousness (viññāṇa), perception (saññā), sensations (vedanā), and conditioning (saṅkhārā). No one need accept these processes intellectually; they become clear once we start experiencing the reality within. Viññāṇa cognizes the sense object that has come in contact with the sense door. Saññā evaluates the object—the evaluation is influenced by past reactions and past impressions. Vedanā is the resultant sensation that is influenced by the evaluation. Saṅkhārā is the reaction to the sensation of liking or disliking that creates a conditioning and sets a behavior pattern.

As we learn to observe the sensations inside, it becomes experientially clear that it is towards these very sensations that we keep continuously reacting. The sensations are the basis on which the conditioning, the patterns of reaction—craving and aver­sion—develop. This was a profound discovery of the Buddha. It is our conditioning (behavior pattern of the mind, saṅkhāra) which makes us suffer again and again, and this conditioning can be eradicated by the practice of objective observation of the sen­sations. We can learn not to develop new conditioning of craving and aversion towards the sensations; and as a consequence, start to eradicate the old conditioning. The practice is a process of gradual eradication of mental defile­ments. This nonsectarian technique is useful in enabling one and all to live a better life, a happy life, a peaceful life. For many who undergo a ten-day Vipassana course under the supervision of a competent instruc­tor, the course is a life-transforming experi­ence.

The practice of exploring mind and matter at the deepest level is not easy. It requires a certain mental and physical stabil­ity. A sincere seeker who wishes to undergo the training in Vipassana meditation needs to have a minimum mental and physical health. Generally all but those with severe psychiat­ric problems are fit to undertake a course. (It is advisable to contact the management of the Vipassana course in advance if an applicant’s mental suitability is in question.)

Vipassana is the universal remedy to the universal malady of misery. For those who are so mentally incapacitated as to be incapable of taking up the delicate task of self-observation in order to come out of suffering, psychiatrists have an important role to play. Except for this section of the popula­tion with severe psychiatric disorders, Vipas­sana can be useful to one and all.

Vipassana meditation is universal in scope because it encompasses all aspects of human mental activity. Psychology also purports to study the entirety of human men­tal activity, but is often reduced to the “science of behavior”. Behavior in this context is defined as anything a person does that can be ob­served in some way. The contention is that behavior, unlike mind, thoughts or feelings, can be observed and studied. Indeed sometimes, mental activity is also included to mean behavior but study still depends on outer manifestations or reports. For a psychologist of yesteryears, behavior was the only avenue through which internal mental events could be studied. Today, psychology is not so much in the clutches of behaviorists as it was a couple of decades ago. These days powerful imaging and investigating tools have given some validity to 'inner mental experiences' or first-person-experiences. Psychology as a scientific community is making a sincere attempt to understand the ancient mental training methods. This effort in true scientific spirit is bound to help society in general.

Any person who has practiced meditation of awareness and self-observation knows from his own experience that internal mental events can be observed directly. He or she becomes a true psychologist unto himself. This science of self-observation has the potential to help one and all to come out of all misery. However, unlike other scientific discoveries and technological advances where discoveries made by one person can be enjoyed by others, for one to benefit from Vipassana, each one has to make effort. That is a serious undertaking and requires a sincere wish to liberate oneself from all mental bondage.