Symposium on Mental Health and
Mindfulness Psychology
“Health is a state of complete
physical, mental and social well-being and not merely the
absence of disease and infirmity”[1]
--World Health Organization
The WHO and many governmental institutions
of health have long made it a point that health is not just the absence of any
illness. Most health experts agree that just treating patients’ illness is an
outdated approach to health care. To make sure people are healthy in society,
health prevention is as essential, or even more important than treating
illnesses. Furthermore, professional health care workers should not only look
at physical health, but be aware of the patient’s mental and social context.
Although a holistic approach to medicine is
widely appreciated these days, the scientific illness-focused method that lies
at the basis of modern medicine should not be underestimated. These days, we
presume that a doctor will start his work with a thorough diagnosis of the
symptoms, before moving on to a prognosis and the correct treatment. However,
these steps in treating a patient have only been recently, since early modern
times, developed as a standard for every physician to follow. One could make an
argument that much of the development of modern medicine is based on following
these steps, approaching medicine in a scientific and problem-focused manner.
In modern times, Buddhism has often been
compared to science, in that Buddhism promotes critical thinking and an
experiential approach in which the practitioner honestly puts the Buddha’s
teachings to the test before putting his faith in them. In recent decades, many
scholars have argued that this is mostly a 19th-century Western
approach to Buddhism, which has been adopted by many Asian Buddhist leaders to
cope with the threat of colonialism and to offer a strong response to the
Western missionaries and colonists who tried to convert the population to a
Western understanding of science and religion.
Nevertheless, by
claiming that the modern Asian approach to Buddhism is not more than a response
to Western colonialism, we risk taking away the agency of the Asian Buddhist,
and make a bold, insubstantial claim that Asia did not have its own forms of scientific
inquiry. For example, the idea of comparing the Buddha to a physician is in
fact very old,[2]
and it has often been pointed out by Buddhist writers that the Four Noble
Truths are remarkably similar to the approach used in modern medicine. You
could, for example, compare the First Noble Truth of suffering (dukkha)
to an analysis of the symptoms of an illness; the Second Noble Truth of the
cause of suffering (samudaya) to establishing the diagnosis of the
nature of the illness; the Third Noble Truth of the cessation of suffering (nirodha)
to the (positive) prognosis of the illness; and the Fourth Noble Truth of the
path to the cessation of suffering (nirodhagāminī paṭipadā) to the
treatment of the illness.
But this is not
the only time where the Buddhist path of practice is described in terms of health
care. In the early texts, we find the Buddha comparing Nirvana (Nibbāna)
to a state of health.[3] In the Dhammapada
verse 204, he says
“Health is the best possession;
contentment is the best wealth;
confidence is the best relative;
Nibbāna is the best happiness”
And in the Majjhima Nikāya, the
Buddha points out that “Health is the highest gain, nibbāna the highest
bliss; And of ways, the Eightfold leads to deathlessness, to security.” In
other texts, the Buddha directly defines Nirvana as a state of health. In the Māgandiya
Sutta he states “This is that health, this is that Nibbāna”.
However, this does not mean that early
Buddhism understood health as merely a mental state or quality. In the Sivaka
Sutta, the Buddha mentions eight causes why people get ill: 1) disorders of
the bile; 2) disorders of the phlegm; 3) disorders of internal winds; 4) a
combination thereof; 5) a change of climate; 6) an “uneven care” of the body;
7) injury; and 8) results of karma. There are different ways to interpret this sutta,
but I will not expand on this now. For the scope of this speech, the main point
of the sutta is that illness and suffering are not things to be accepted
fatalistically, but we have the freedom to create good karma in the present and
take good care of our health right here, right now. In other words, our karma
from the past, including past lives, can affect our health, but it does not
need prevent us from taking good care of our body and mind. This, of course,
also holds for our mental health.
Buddhist studies scholar Pinit Ratanakul,[4] and with him many other
scholars, has made it a point that early Buddhism looks at health holistically:
physical and mental health are interconnected, and karma can affect both body
and mind. In a pair of suttas known in Thai tradition as the anāyussa
suttas, part of the Aṅguttara Nikāya,[5] the Buddha discusses in
detail how you should take care of your body and mind in a way that leads to a
long and healthy life. Here, we can clearly see the Buddha’s preventive and holistic
view of health put into practice. A long life, the Buddha argues, relies on the
principle of suitability[6] (sappāya) in your
life. Sappāya means that what you use or consume is favorable to your
health. As a second factor, however, we find that even with regard to such
things favorable, we should know the right measure for ourselves and observe
moderation.
The Dutch prime minister Willem Drees is
often mentioned in Dutch history as an example of Dutch thrift. The story goes
that shortly after the Second World War, Drees was visited by a representative
of the US government to discuss financial aid as part of the Marshall plan.
When Drees received the American government officer in his frugal household,
the officer was so surprised by the premier’s simple lifestyle, that she
approved the Marshall aid, since it would certainly be used economically.
Admittedly, the story may not be historical, and Drees has not always been on
the right side of history, but the point remains that Drees was famous for his
thrift, and he passed away at the long age of 102 years old. Added to that,
Drees was an active member of a teetotal organization that promoted complete
abstinence of alcohol, which brings us to the third factor of a long life: a
good digestion. This not only means having a healthy digestion system, it also
means to be mindful of how your body responds to what you eat—and drink. Early
Buddhism has a strong stance against alcohol, a point that is not always
appreciated by Western Buddhists in this current age, where teetotalism and
temperance with regard to alcohol have all but disappeared. Abstention from
alcohol is seen in early Buddhism as part of the practice of the five precepts,
part of an ethical life—the fourth factor on the list. The Buddha pointed out
that leading an ethical life leads you to live without regret and moral doubt,
which helps the mind and heart to flourish and be happy. The last item on the
list, it may surprise you to hear, is social in nature. The early texts
emphasize spiritual friendship and the great benefits this brings in physical
and mental health.
Although such a holistic approach of
health, including both physical, mental and social factors, maybe interesting
to find in ancient texts from over 2000 years ago, it may at this point be
useful to study the idea of mental health in more detail. Although the WHO’s
definitions of health as well-being certainly points us in the right direction,
it does not actually reveal how the healthy mind looks like. What
structure does it have? What is its nature? These questions are extensively
discussed in early Buddhism.
As I said previously, health in early
Buddhism is often mentioned in the same verses as the state of enlightenment,
and is even used to define it. It is therefore not surprising to discover that
in the Buddha’s perspective, people’s minds are seen to be ill, suffering from
mental defilements such as greed, hatred and delusion—to a greater or lesser
degree. The Buddha declares in the Aṅguttara Nikāya: [7]
“Monks, there are to be seen suffering from
bodily disease for one year, for two years, for three, four, five, ten, twenty,
thirty, forty, fifty years: who can admit freedom from bodily disease for even
a hundred years. But, monks, those beings are hard to find in the world who can
admit freedom from mental disease even for one moment, save only those in whom
the asavas [defilements] are destroyed.”
This translation is a bit cryptic, but the
point is to reiterate that health of mind means attaining enlightenment, the
freedom from defilements (kilesa) and affluents (asava), and that
such pure health is hard to find in this world. The mental diseases of greed,
hatred and delusion continually assail our human mind and heart. Mental illness
in this broader sense is more than just the illnesses recognized by modern
psychiatry—it is part of the human condition, and the highest aim in life is
for us to develop ourselves to transcend them.
Greed (lobha) is the unbridled defilement
of desires which are based on foolishness rather than wisdom. It comes from a
feeling of insatiable lack. It is different from desires such as a desire for
happiness, a desire for inner peace, and so on, because such things are based
on wisdom and do not cause this sense of lack. It could be desires for people,
for things to use, spend and own, and also includes abstract things like power
and status—all of which are impermanent and incapable of providing us with real
happiness.
Hatred (dosa) is the defilement of
destruction. Sneaky like a snake coming from behind, anger is easily justified.
It destroys quickly, but unlike greed, it can be both short or long in
duration. Delusion (moha) is however, both long in duration and
destructive. Moha can encompass all habits that cause us to see things
distorted from reality or merely at the surface of reality. This consists of
arrogance and conceit, but also subtle things like stress and self-doubt. The
defilements of the mind are in Buddhism considered the main causes why human
beings like you and me suffer. Although in the early Buddhist texts mental
illness in the common sense that we use it today is discussed and considered
real, the Buddha usually defined mental illness in broader terms of greed,
hatred and delusion. These defilements work subtly to cause us not to perceive
what benefits us and others, and what harms us and others, and are therefore
considered the real enemy of humankind.
But there is also good news. The early
Buddhist texts also state that our mind is luminous, if you were to look behind
the defilements. The defilements may be able to obstruct us from understanding
and seeing that reality, but the human mind can be made bright and clear by
training it. And early Buddhism describes the mind that is well-trained in
extensive detail:[8]
“When his mind is thus concentrated,
purified, cleansed, unblemished, rid of defilement, malleable, wieldy, steady,
and attained to
imperturbability…”
The trained and healthy mind is clear, not
cluttered, and remains undisturbed by the ups and downs of circumstances in the
outside world. It is soft, yielding and malleable, like a metal that has been
melt and is ready to be cast.
These descriptions of the healthy mind as a
trained mind are very evocative and appealing. And some of the adjectives used
are very similar to how a healthy brain is described by neurologists these
days. For example, the terms malleable and wieldy sound very
similar to the idea of plasticity of the brain, which is considered a desirable
characteristic.
This is not just me trying to cherry-pick
Buddhist texts to match them with our modern scientific insights. There is
growing amount of evidence to back up that the Buddhist path of practice,
especially contemplative practices such as meditation and mindfulness, have
considerable effects on physical and mental health.[9] Although only twenty years
ago, Buddhist meditation was still considered a mystical practice and
considered by many scientists on par with hugging trees and consulting crystal
balls, in the present day, mainstream science has recognized and appreciated
the huge positive effects that Buddhist mindfulness and meditation has.
Review studies have shown that meditation
positively affects our brain structure, as can be measured in brain waves.
Certain parts of the brain increase, and blood flow and connections in the
brain improve. Furthermore, when you practice meditation, you become more aware
of your default mode network, that is the patterns of thinking and feeling that
are the background noise in the mind, and are less negatively affected by those
patterns.
Not only mental health improves. Meditation
has been proven to decrease blood pressure and make the heart rhythm more
stable. Studies have also shown that it improves the immune system, and the
most recent studies have now conclusively established that it affects the part
of the chromosomes known as the telomeres, thereby slowing down the aging
process.
Although such scientific studies were not
available to the Buddha and his disciples in ancient India, it is surprising
how often the Buddhist texts talk about mental health, concentration and
physical comfort in the same passages, and how the Buddha connected health with
the highest aim of his Teaching, that is Nirvana.
Now that we have established how meditation
plays a central role in becoming truly healthy in a holistic sense, I cannot
resist to cite one of my favorite quotes about meditation, from the American
news anchor Dan Harris:
“Meditation is going to join the pantheon of
no brainers like exercise, brushing your teeth and taking the meds that your
doctor prescribes to you.“[10]
And to close, let’s read the Milindapañhā:
“Whatever medicines are found in the
world—many and varied—none are equal to the Dhamma.”[11]
[1] “Health
and Well-Being”, World Health Organization, https://www.who.int/data/gho/data/major-themes/health-and-well-being,
accessed on 9 December 2022
[2] "The Healing Medicine of
the Dhamma" (Miln 5), translated from the Pali by Andrew
Olendzki. Access to Insight (BCBS Edition), 2 November 2013
[3] Paonil,
W., & Sringernyuang, L. (2002). Buddhist perspectives on health and healing. The
Chulalongkorn Journal of Buddhist Studies, 1(2), 59-79.
[4] Ratanakul,
P. (1999). Buddhism, health, disease, and Thai culture. A
cross-cultural dialogue on health care ethics. 17-33.
[5] A.III.145.
[6]
Translations here from พระพรหมคุณาภรณ์ (ป. อ. ปยุตฺโต), พจนานุกรมพุทธศาสตร์ ฉบับประมวลธรรม, พิมพ์ครั้งที่ 13, (กรุงเทพมหานคร : บริษัท เอส. อาร์.
พริ้นติ้ง แมส โปรดักส์ จ ากัด, 2548)
[7]
Quoted in Paonil and Sringernyuang (2002).
[8] E.g.
A. i. 164
[9] As
for example summarized in “How Does Meditation Change the Brain? - Instant
Egghead #54”, Scientific American, https://www.youtube.com/watch?v=q0DMYs4b2Yw,
accessed on 9 December 2022.
[10] “Dan
Harris: Hack Your Brain’s Default Mode With Meditation”, Big Think, https://bigthink.com/videos/dan-harris-hack-your-brains-default-mode-with-meditation/,
accessed on 9 December 2022.
[11] Milindapañhā
335, translated by Olendzki at
https://www.accesstoinsight.org/tipitaka/kn/miln/miln.5x.olen.html.
