The Value of Anapana and Vipassana in psychological and psychosomatic illnesses

-By Dr. K. S. Ayyar

Goals of Vipassana and Psychiatry

It is important to note that physical and mental well-being are by-products and not the goals of Vipassana meditation. For the diligent meditator, nibbana, the washing away of all mental impurities, is the goal. Self-purification by self-observation is the process by which this washing away occurs, which may sound similar to "working through" in psychoanalysis. Purification means removal of greed, anger and ignorance, which are considered to be mental pollutants. During Vipassana, body and mind experience the reality of impermanence and change (anicca). The sense of self, ego, will be altered and egolessness will prevail. Equanimity is cultivated in all situations.

The goals of modern medicine and psychiatry are modest in comparison. We seek to relieve physical and mental suffering and anguish and return the person to his social and work environment, ideally at his pre-illness level of functioning. Modern medicine is ever open to new techniques of therapeutic value, provided they are adequately researched. Attention may be drawn to the fact that the 1985 issue of the American Journal of Psychiatry carried an article on Vipassana which was given prominence, both on the cover and within the journal, though not much research has been done on the subject. Sarpagandha for hypertension, yoga therapy and Mahesh Yogi's Transcendental Meditation are examples of Indian therapies finding their way into the textbooks of medicine and psychiatry. Anapana and Vipassana too can be included in the relevant textbooks, after systematic studies on their utility and limitations as therapeutic modalities.

Personal Experience of Vipassana as a Somato-Psychic Therapeutic Modality

The ten day Vipassana course is an initiation into the two techniques of Anapana (breath awareness) and Vipassana (mind-body awareness), and not a therapeutic regime. Medical professionals are concerned with the body, the bodily sensations and the impact of the emotions on the bodily organs. In psychiatry there are several therapies which proceed from the body towards the mind. Deep muscle relaxation by Jacobson's method, other modified muscle relaxation techniques and biofeedback therapy are classic examples. Behavior therapy too tackles the body and its actions or responses first and emotions later, or sometimes never. Thus Vipassana has similarities to these therapies, in contrast to the psychotherapies. Psychoanalysis, which begins with the mind and the emotions, pays scant attention directly to the body, but still manages to provide relief from somatic symptoms.

I found that with Anapana (breath awareness), concentration is attained quickly. With my regular experience with deep muscle relaxation and self hypnosis, I might have found it easier than an uninitiated layman.

During the Vipassana course, a state of partial sensory deprivation exists: no TV, no radio, no writing, no reading, no conversations. This absence of stimuli prevents the conscious mind from going into its usual habit patterns of thinking, behaving, and emoting. The circumstances are thus ideal for unconscious repressed feelings to surface and for sensations and events from the past to break into conscious awareness.

With about 110 hours of sustained concentration during a ten day course, there is ample opportunity for the accumulated complexes from the past to express themselves on the body and get eradicated. The partial sensory deprivation is akin to the Freudian couch, where the person under analysis has the same view in front of his eyes and has to maintain a constant position on the couch. The difference is that 100 hours of analysis would take about 4-5 months, and in practice, in psychotherapy, it is difficult to get the Indian patient to follow up for more than 6-10 sessions of about 45 minutes each. Here Vipassana has an advantage. I also observed during meditation that minor physical ailments like nasal stuffiness or eye discomfort disappeared quickly. Sympathetic and para-sympathetic discharges occur spontaneously. Palpitations, sweating, throbbing, tingling, vibrations, abdominal movements and kinaesthetic sensations, appear and disappear. Sensations related to the central nervous system like muscle discomfort, aches, pains and cramps also occur, and persist for varying duration of time. Spontaneous emotional states like fear, panic, anger and sexual arousal can appear and disappear during meditation. Since whatever happens to the body and mind during Vipassana stems mostly from the past, accumulated physical and mental tensions are relieved by this technique.

Clinical Indications for Vipassana Meditation and Research on Vipassana

Vipassana may be used to produce general physical well-being and also general mental well-being. It can relieve minor physical ailments like rhinitis and muscle spasms. It can relieve minor psychological abnormalities like irritability and short-temperedness.

It may prove useful in the treatment of psychosomatic disorders like spondylitis, headache, migraine, peptic ulcer syndrome, colitis, neurodermatitis, psoriasis and eczema, hypertension, diabetes, arthritis etc.

Among psychiatric disorders, anxiety neurosis, depressive neurosis, phobias, addictions and personality problems may be benefited by Vipassana meditation.

The theoretical benefits from Vipassana have been discussed in the American Journal of Psychiatry (Jan 1985). Dr Paul Fleischman, a psychiatrist, has discussed the beneficial effects on both mind and body in his booklet, "The Therapeutic Actions of Vipassana: Why I Sit." To Dr. Fleischman, every aspect of the training course and the lectures during the course has psychotherapeutic significance and contributes to producing improvement in mind and body functions.

Vipassana has been tried out on prisoners and jail officials in Rajasthan and was found to produce perceptible attitudinal changes. Sinha et al., in an uncontrolled study with poor experimental design, found improved attention span, alertness and mental stability. During the Vipassana Research Institute Seminar in 1986, several individual meditators reported significant improvement in several psychosomatic and stress related syndromes, from cervical spondylosis and essential hypertension, to degenerative diseases like muscular dystrophy. Such self-reports are usually exaggerated, and suffer from a positive bias and what is called the "attribution" or "halo" effect. The symptoms of such effects were seen in the excessive stress on the pristine purity, the antiquity and the Indian origin of the technique and excessive adulation of the teacher. Anecdotal examples, though insufficient proof by themselves, are useful in leading to controlled scientific investigation which will be acceptable to the scientific community at large.

Certain studies, like that of Kabat-Zinn in 1982, definitely prove that Vipassana has a role to play in chronic diseases. It was proved to be of value in relieving chronic pain by reducing the experience of suffering by cognitive reappraisal. The cause of the pain may not disappear, but the attitude to the pain changes and therefore suffering is diminished considerably. Similarly, with neurodermatitis, psoriasis, and eczema; where the patient can learn to ignore the itching sensations, or observe them in a detached way and avoid scratching. Thus he breaks the itch-scratch-itch cycle which in turn helps to heal the lesions.

At the end of the Vipassana Research Institute Seminar three years ago, I was part of a group which prepared guidelines for research on the medical and psychological aspects of Vipassana. Monitoring basic parameters like blood pressure, maintaining case records, regular follow-up records, and bio-chemical and electrophysiological monitoring of sincere meditators were some of the suggestions given. I am told that it may take some time to work out a programme for getting medical and psycho-physiological data on meditators.

Results of Application of Anapana in Psychiatric Patients:

Breath awareness has been used by me over the last two and a half years with neurotic and psychosomatic disorders. I have not conducted any systematic study to compare it scientifically with other psychiatric treatments. But the following observations from my experience with 40 patients may be relevant.

1. Anapana-sati is easy to teach. It can be easily practiced in a sitting position.
2. Together with other physical techniques, it provides variety in treatment and keeps the patient from giving up the technique out of boredom. With Jacobson's relaxation technique, it has been found that most patients stop doing it or become highly irregular in practice after the second month.
3. Anapana is as effective as Jacobson's technique in producing relaxation and in keeping the mind calm and peaceful.
4. Roughly 80% of patients who were taught and practised Anapana showed good clinical improvement. (Benson's relaxation response, Woolfolk's breathing meditation, Carrington's clinically standardised meditation, autogenic exercises, Finland exercises and biofeedback also decreased arousal during their application, just as occurs with Anapana, and all these techniques yield similar results to Transcendental Meditation in comparable patient groups. Anapana and Vipassana too, when researched, should yield similar observations. T.M., it is worth noting, has been the most widely researched meditation technique, much more than yoga therapy, for example, in psychiatric patients.)
5. Non-specific healing aspects of a Vipassana meditation course:

• A ten days vacation from daily routines is itself psycho-therapeutic in nature.
• The enforced silence, temporary isolation and unique calm atmosphere are probably being experienced for the first time in the individual's life. To the average person it is highly esoteric and other worldly, and their experience of having lived in a different world for ten days has its therapeutic benefits.
• The average Indian probably cheats in little ways even when observing fasts. So following the rigid code of discipline during Vipassana, with total control over one's eating habits, speech and sleep, from 4 a.m. to 9.30 p.m. each day, gives a sense of mastery over oneself. The very idea that one was able to go through this apparently strenuous self-discipline lightens the mood, produces a sense of euphoria and has definite therapeutic potential.
• The effects will depend upon the amount of praise heaped upon the technique by the person recommending it. Vipassana, like other therapies with esoteric and mystical qualities, such as hypnosis, may have great placebo effect.
• The charismatic influence of Mr. S. N. Goenka will produce favorable results, though he takes great pains to avoid a cult relationship.
• Hope means expectation of success. The teacher looks very confident. The patient is assured of relief because of this. Thus the placebo effect is activated.
• Trust: the teacher appears to be a sincere, honest, trustworthy, genuine and authentic person. These qualities themselves are capable of improving the patient by activating the placebo effect.
• Faith: During the lectures, Goenkaji's sensitivity to human problems, empathic understanding, skill, wisdom and positivity and assuredness are communicated to the meditator, and this engenders faith. And this faith by itself, through a placebo effect, is capable of producing improvement.
• Goenkaji himself wants the improvements to occur by the technique alone. But all the above factors help to undo anxiety. The disruptive physiological effects of anxiety are brought under control. So energies are now conserved and diverted to dealing more effectively with existing problems and situations.

6. Resistance to Vipassana meditation among patients.

The psychiatrist Dr Paul Fleischman finds a therapeutic benefit in all aspects of Vipassana, but states in his book that he would not recommend it to patients unless they inquire about it. He cites professional and cultural reasons for this.

Certain phobic and anxious patients resist being diverted to another helping agency because their dependent relationship with the psychiatrist is then dissolved. A few patients I had directed to Goenkaji's recent lecture at Malad were not interested in what they saw as Buddhist techniques. The present communally charged atmosphere and the problem of prejudices sometimes prevent individuals from accepting something highly beneficial.

Sometimes patients have unrealistic expectations; for example a doctor from Borivili said that in ten days only two techniques were taught. She probably expected a new technique every day. Similarly a Bombay consultant was unable to accept the ideology and the explanations and was thus put off from practicing the technique after completing the course.

Though Vipassana is universal in its application, it may not suit all patients, even if they belong to one of the clinical categories where it can be helpful. Similarly, through no fault of the technique or its teaching, some patients will not be able to benefit from it because of their individual developmental experiences and mental make-up. A scientific study of the people who drop out of courses would thus be useful to clarify the characteristics of the individuals who benefit from Vipassana.