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

 

 

 

 

 

Vipassana Meditation-A Clinical Model

-By Dr. R. M. Chokhani

Introduction

One of the more widespread modern adaptations of traditional consciousness-training practices is the Vipassana Meditation technique, which has recently become popular among both the lay public and workers in the mental health field.

Vipassana is a Pāli word meaning "insight". It is a system of self-transformation by self-observation; the object is to eventually reach a state of inner and outer calmness and balance of mind (Thray Sithu Sayagyi U Ba Khin, 1983).

Meditation as a practice of self-liberation was developed in all cultures by and for members of religious groups in the context of their cosmology (Kutz I. Borsenko J.J. & Benson H., 1985). The Teachings of Gotama, the Buddha, embody a psychological system as well as a cosmology. Known as Abhidhamma, this is the most systematic and intricately laid out psychology-presenting a set of assumptions and concepts for understanding mental activity and methods for healing mental disorders, which differ markedly from the contemporary psychotherapeutic outlook (Goleman D., 1977).

The Abhidhamma Model of Mind

This model of mental activity is an "object relation" theory in the broadest sense: its basic dynamic is the ongoing relationship of mental states to sensory objects. "Sense objects" include precepts in the five main sensory modalities, plus thought or cognitive activity, which in this system is seen as a "sixth sense". "Mental states" are in continuous change and flux: in this analysis, the rate of change of the smallest unit of mental states-a mind moment which is a moment of awareness-is incredibly fast, described as arising at the rate of millions in the time of a flash of lightning.

Each successive mental state is composed of a set of properties, or mental factors, which gives it its distinctive characteristics: there are 52 basic perceptual, cognitive and effective categories of these properties (Narada Thera, 1968). The basic dichotomy in this analysis of mental factors is that between pure, wholesome or healthy and impure, unwholesome or unhealthy mental properties. Just as in systematic desensitisation, where tension is supplanted by its physiologic opposite relaxation (Wolpe J., 1957), healthy mental states are antagonistic to unhealthy ones, inhibiting them. Vipassana Meditation aims to eradicate these unhealthy properties from the psychological economy. The operational definition of mental health is their complete absence, as in the case of the arahat or saint (Goleman D., 1977).

Mechanism & Psychological Effects

Vipassana meditation trains the concentrated attention to follow the mechanics of mental processing in a detached fashion. This perspective of an observer allows the controlled release of mental contents like craving and aversion, past and future in a seemingly endless stream of memories, wishes, thoughts, conversations, scenes, desires, dreads, lusts and thousands upon thousands of emotionally driven pictures of every kind-which rise to the surface of the mind and pass away without provoking a reaction, while simultaneously anchoring one in concrete, contemporary reality (Fleischman P.R., 1986). Since the meditator is at the same time deeply relaxed, the whole contents of his mind can be seen as composing a "Desensitisation hierarchy"; in this sense, Vipassana meditation may be natural global self-desensitisation (Goleman D.,1977).

The mind is deconditioned with meditation altering the process of conditioning per se, so that it is no longer a prime determinant of future acts (Goleman D.,1977); a refinement of awareness occurs and one responds consciously to life situations thereby becoming free from limitations which were forged by mere reactions to them. One's life becomes characterised by increased awareness, reality-orientation, non-delusion, self-control and peace (Fleischman P.R., 1986). Such a person attains a state of inner and outer calmness and is able to make quick decisions, correct and sound judgement and concerted effort-mental capabilities which definitely attribute to success in contemporary life.

A Model for Clinical Application

The clinical utility of Vipassana Meditation is more likely to be in terms of providing a general psychological pattern of positive mental states rather than as a response to any particular presenting problem; generally, the conventional psychotherapies are generated as treatments for the latter. All the same, the author has been using a cognitive therapeutic technique, derived from the system of Vipassana Meditation, as a supplementary treatment and has found it to be effective in psychoneurotic and psychosomatic disorders.

It should be noted that the therapist ought to be well conversant with the technique of Vipassana Meditation and a mature meditator himself. Speaking in Vipassana parlance, the patient observes his respiration (Anapana meditation), while the therapist practices Metta (loving kindness meditation).

Before commencing the formal therapy, the therapist explains to the patient its potential benefits, particularly relaxation, which helps reduce the latter's apprehension and enables him to co-operate and participate actively in the treatment. In addition, it is necessary to ensure that the physical environment is one which will facilitate relaxation; the room should be quiet and free from interruptions and the patient's couch should be reasonably comfortable.

The patient is asked to lie comfortably on the couch, close his eyes and observe the flow of respiration by concentrating on the area of the upper lip just below the nostrils; whether in-breath or out-breath, deep or shallow, fast or slow, natural breath, bare breath and only breath. If and when his mind wanders, the patient is instructed to passively disregard the intrusion and repeatedly focus his attention on his breath, without getting upset or disturbed about the drift.

Two things happen: one-his mind gets concentrated on the flow of respiration and two-he becomes aware of the relationship between mental states and the flow of respiration, that whenever there is agitation in the mind-anger, hatred, fear, passion, etc... the natural flow of respiration gets affected and disturbed. He thus learns to simply observe and remain alert, vigilant and equanimous.

The patient is advised to continue practicing the technique at his residence, twice daily, in the morning and at night, each session lasting for about 30 minutes. The therapist reviews this technique with his patient from time to time and encourages him to continue to strive for his personal autonomy (Surya N.C.,1979)-that is, to take personal responsibility for his own health.

Conclusion

It is my contention that this technique shortens the total duration of treatment, and helps the patient to cope better in the community, by providing a general pattern of stress-responsivity less likely to trigger specific over-learned mal-adaptive responses, whether psychological or somatic. Moreover, there is a change in the patient's internal state, whereby his attention is focused, his perceptual and motor systems function optimally, and his anxiety is minimal; and this in spite of, and while meeting a great variation in the external environmental demand by virtue of self-regulating and developing one's internal capacities with Vipassana Meditation.

Multicentred controlled clinical trials of this technique with sophisticated experimental designs would help to study its value and limitations in the prevention and treatment of various psychiatric disorders. Also, it needs to be clarified as to which patient, with what clinical problem, will benefit with Vipassana Meditation as the treatment of choice, vis-à-vis other self-regulation strategies, such as biofeedback, hypnosis, transcendental and other meditation techniques, progressive relaxation and the like.

References

  • Fleischman P.R.(1986), The Therapeutic Action of Vipassana and Why I Sit, Buddhist Publication Society, Kandy, Sri Lanka.
  • Goleman D. (1977), Meditation And Consciousness: An Asian Approach to Mental Health, Am. J. Psychother. 30: 41-54.
  • Kutz I., Borysenko J.J. & Benson H. (1985), Meditation and Psychotherapy, Am. J. Psychiatry, Vol. 142, No. 1:1-8.
  • Narada Thera (1986), A Manual of Abhidhamma, Buddhist Publication Society, Kandy, Ceylon.
  • Syrya N.C. (1979), Personal Autonomy And Instrumental Accuracy, in "Psychotherapeutic Processes", Editors: M.Kapur, V.N.Murthy, K.Satyavathi and R.L.Kapur, N.I.M.H.A.N.S., Bangalore, India : 1-19.
  • Thray Sithu Sayagyi U Ba Khin (1983), The Essentials of Buddha Dhamma in Meditative Practice, Vipassana Journal, Hyderabad, India: Vipassana International Meditation Centre, 1-6.
  • Wolpe J. (1958), Psychotherapy by Reciprocal Inhibition, Stanford University Press, Stanford, California.