Mental Health in Early Buddhism

 

Lonqquan Great Compassion Monastery

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 Most health experts agree that just treating patients’ illness is an outdated approach to health care.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 19^th-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]

 

 

 

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[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.