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

 

 

 

 

 

Vipassana and Psychiatry

-By Dr. K.N. Dwivedi

As a teacher in Preventive and Social Medicine, I learned to appreciate that subtle cultural forces of superstition and mystification maintained a high level of disease load in India. Meditation to me had a similar connotation, but Professor of Psychiatry O.N. Srivastav inspired me to attend a course of Vipassana. Probably my motive was to find effective weapons to fight the bad mystical influences on our health culture, but to my surprise I could find no clash between the scientific way of thinking and Vipassana. Fascinated by the psychiatric implications of this meditation technique, I joined psychiatry. Here I do not wish to establish any theories but to point out a few links between ideas and practices of Vipassana and that of psychiatry. Psychiatry today is a diverse discipline and varies across psychiatrists, institutions, nations and cultures. The two so-called major schools are organic and psycho-dynamic.

Dynamic psychiatry visualises psycho-social forces leading to mental illness and employs various pedagogical psychotherapy techniques for therapeutic purposes. Behavior therapy, therapeutic community approach, social therapy, marital and family therapy, vector therapy, transactional analysis, gestalt therapy, drama therapy (psychodrama, remedial drama, sociodrama), art therapy, occupational therapy, and primal therapy are just a few examples.

In psychoanalysis the subject reports his free-associations as they occur and is helped to understand his mental mechanisms. A student of Vipassana also finds himself free associating during meditation. However, psychoanalysis and Vipassana differ in their attitudes towards and interpretations of the material of free-association. In Vipassana, the emphasis is on maintaining a continuum of awareness of somatic sensations and inculcating a neutral attitude of indifference and non-indulgence, upekkha, in the ideational material. In psychoanalysis, the ideation material is welcome. In Vipassana the interpretation is mainly phenomeno-logical in terms of the transitory nature, anicca, illusory nature (creating the illusion of "I" etc.), and binding nature dukkha, of emotive processes of clinging raga, aversion dosa and ignorance moha. In psychoanalysis, the interpretation is semantic and helps to decode the messages from the system unconscious, revealing the universal struggle between various forces. Objects Relation Theory recognises some of the illusory nature of ego, anatta, as most of it is made by internalisation of objects (mother's breast, etc.).

R.D. Laing's "knots" take the full leap:

Although One Is Full Inside

One Is On The Outside

Of The Inside Of The Outside

Of One's Own Inside

And By Getting Inside The Outside

One remains Empty Because

While One Is On The Inside

Even The Inside Of

The Outside Is Outside

And Inside Oneself

There Is Still Nothing

There Never Has Been

Anything Else

And There Never Will Be.

Krishnamurti offered us the phrase- "freedom from all conditioning." Behavior therapy cares to control conditioning and has various therapeutic applications as treatment of phobias; modification of behaviors such as sociability of chronic schizophrenics; speech training in autistic children; training of mentally subnormals, physically handicapped, socially inadequate control of eating, drinking, sexual and other behaviors; contract marital therapy, biofeedback, etc. Conditioning is almost an alternative explanation of the system unconscious and is a process of binding in a person of juxtaposed events through the cement of emotive ingredients. In Vipassana, one works to sharpen one's perceptual mechanisms and learns to be aware of subtle emotional processes. Conditioning requires the cement of emotion at subtle emotive levels. Continuous awareness of the subtle emotive processes with a neutral attitude would free oneself from conditioning.

Systematic desensitisation involves reciprocal inhibition, since relaxation and anxiety are incompatible. The subject is taught to relax and is presented either in reality or in imagination with specific anxiety-provoking stimuli in a systematic manner. As he faces them in a relaxed state he learns not to react with anxiety. It thus resembles Vipassana. Some of the physiological and biochemical measurements on meditation support the obvious hypothesis of built-in relaxation. Bio-feedback studies confirm the controllability of autonomic, electroencephalographic and emotive processes through awareness.

Awareness of feelings or sharpening of sensitivity is one of the major tools in group therapy, where the subject is helped by others who keep reminding him of his current emotional state, so that he can evolve his own monitoring equipment. However, there is a qualitative difference in the sensitivity of the "radars" built through Vipassana and through group and other therapies. A group "radar" picks up imageries and such gross lump sum feelings as hatred, anger, sadness etc. Vipassana "radar," on the other hand, continuously concentrates on subtle somatic sensations beyond the cloud of imageries, ideation and lump sum feelings. One learns to recognise the illusory and transitory nature of "cloud" formation.

There is an association between subjective mental states and peripheral activity. Cannon emphasised the influence of the central nervous system on peripheral mechanisms, while James and Lange emphasised the influence of peripheral activity on the central subjective state. Because of these associations, anxiety can become self-perpetuating. Someone may insult me once, but the idea (or the memory) that someone insulted me can keep me troubled repeatedly for a very long period. The idea breeds peripheral changes and peripheral changes feed the idea; the vicious cycle thus goes on. Vipassana aims to break the cycle by awareness of the peripheral activity and appreciation of its transitory nature.

Primal therapy postulates encapsulation of traumatic memories in somatic sensations and guides through the path of somatic sensation, recollection of the primal traumatic experience, reliving the suffering and freedom. It has its parallel in abreaction. This attitude of confrontation is the basic tool of Vipassana where the student confronts his somatic sensation, such as pain in the knee. However, he is not advised to indulge in the story behind the pain. Instead he stays face to face with pain to appreciate its illusory and transitory nature. Reality therapy, existential therapy and many other approaches in psychiatry recognise the value of facing the painful reality as it is.

The reason why Vipassana ignores dwelling on the "worm in the apple" (as in primal therapy) is because of its frame of reference of reality, i.e. sensations and not idealization or imaginations. Reality is here and now, the rest is illusion. But most of our lives are lived in illusion. Vipassana provides the training opportunity to live in reality. Gestalt therapy takes up this issue of "here and now", as well as many other principles found in Vipassana (e.g. continuum of awareness, confrontation, etc.). It differs from Vipassana by being a cafeteria-like approach, using techniques to deal with idealizing material, fantasies, dreams and psycho-motor behaviors, etc.

Client-centred Rogerian therapy is non-directive and finds empathetic and compassionate orientation of the therapist most therapeutic. Freudians view the basic human nature (id) as instinctively selfish while Vipassana reveals compassion when one gets rid of accumulated impurities. George Kelly (originator of Personal Construct Theory) constructed man as basically an investigator. A doctor-patient relationship accordingly is analogous to the relationship between a guide and research scholar. Vipassana provides each of its research scholars a superb laboratory for scientific explorations of physical and mental phenomena, life and death.

Organic psychiatry with its phenomeno-logical orientation explores and manipulates physical causation, hereditary influences and biochemical changes associated with mental illnesses. For example, in schizophrenic and effective (depressive and manic) disorders, the levels and/or ratios of Neurotransmitters are found to be disturbed. Neurotransmitters are biochemical agents which regulate and are involved in the transmission of messages or impulses through the nervous system, e.g. Dopamine, Noradrenaline, Acetylcholine, Serotinine, etc. Their levels and ratios may be influenced by hereditary, dietary, immunological and many other mechanisms. Along with Professor Udupa, the Director of the Institute of Medical Sciences, Varanasi, and others we conducted several studies on students of Vipassana and found definite changes in the levels of many of these neurotransmitters after a ten-day course of meditation. However, the study did not have a control group to assess the effect of dietary changes. The electrophysiological changes in Vipassana demand further exploration of possible relationships between the consequences of electroplexy and Vipassana, influences of Vipassana on epilepsy, sleep, dreams, etc.

Psychiatry, however, cannot be replaced by Vipassana, nor Vipassana by psychiatry. They differ in their terms of reference and value systems. Vipassana is not used for treatment, treatment may be a by-product. The desire to get treated may become a hindrance on the path of Vipassana. However, a treated person may have improved capacity to undertake Vipassana. Vipassana can reduce the development of mental illness in society and therefore reduces the need for psychiatry.