Psychology and Health Enhancement
Padmal de Silva
As a way of personal development, Buddhism advocates certain steps which include behavioral change, contemplation and meditation, and wisdom. While the avowed religious goal is the attainment of Nibbâna, the Buddhist way of life has its own value and benefits irrespective of whether one pursues the Nibbâna ideal or not.
Buddhism and Health. In the context of psychological health and well-being. Buddhism offers concepts and practical strategies, and indeed an overall stance, which have relevance in several ways. First, there are specific, well-described ways for correcting, or the remediation of, problematic or maladaptive behaviors and emotional responses.
Second, Buddhism has relevance for prophylaxis, the prevention of psychological problems. The goal of prophylaxis is an important one in psychological health practice, and Buddhism offers specific steps which are recommended for the prevention of maladaptive behaviors and emotional responses. In addition, Buddhism also has an overall stance which embodies personal development and the cultivation of a mental attitude that is based on reducing the negative psychological forces of attachment and lust, malice and hatred, and ignorance and delusion. This overall stance provides an obvious framework for the promotion and enhancement of psychological health.
Numerous examples relevant to all of the above can be cited from the Early Buddhist texts, both in the original Tripitaka, and in the commentarial and expository literature, such as the works of Buddhaghosa. The value of some of these has come to be recognized in today’s professional and academic circles. For example, it is now well established that the practice of mindfulness meditation, a distinctively unique Buddhist development, can lead to various health-related benefits. These include the reduction of pain, the elimination of anxiety and the alleviation of some psychosomatic problems. There is also important current work on the use of this form of meditation as a way of preventing relapses in patients who have recovered from depression.
The Buddhist approach to the development of positive regard and loving kindness, and the corresponding reduction/elimination of anger/hatred, may be cited as another example of the Buddhist contribution to the promotion of positive psychological health. In one’s endeavors to develop loving kindness (metta), a gradual and hierarchical series of steps is recommended. This commences with goodwill towards oneself. One is advised to begin by suffusing oneself with loving kindness, in this way: « May I be without enmity, without ill-will, and untroubled. May I keep myself happy ». After this initial step, one is advised gradually to progress outwards, cultivating in succession thoughts of loving kindness towards someone respected and admired, a close and dear friend, a person towards whom one’s feelings are neutral, a hostile person or enemy, and finally all living beings.
The description of this process given in Buddhaghosa’s Visuddhimagga is remarkable in the details it provides on how this series of steps is to be handled. Of particular psychological interest is the discussion of how to develop loving kindness towards a hostile person. It is acknowledged that this is a difficult task, as thoughts of anger are likely to arise. Equally, offences committed by the person concerned may resurface in one’s memory. If, for these reasons, the efforts to develop feelings of loving kindness towards this person do not succeed, then one is advised to return to one of the previous stages, and repeatedly suffuse with loving kindness any person belonging to the three previous classes. And, immediately after emerging from the loving kindness developed in this way, one directs the thought towards the person who has aroused anger and enmity. It is said that, in this way, one can conquer feelings of antipathy, thus paving the way for genuine loving kindness.
This strategy is, as can be seen, very similar to the behavior therapeutic approach of graded exposure, with the added element of using the strategy of one mental state to modify an opposite or antagonistic one – much like the « reciprocal inhibition » approach of WoIpe to the reduction of phobic anxiety.
The Buddhist approach to the control of problematic lust and desire is a farther area worth highlighting. There are many discussions in the Early Buddhist literature which describe ways of meditating on, or being aware of and alert to, the aversive or unpleasant aspects of the stimuli that bind one and cause strong attachments and/or lust. The contemplation of asubhas, or the aversive – loathsome – properties of stimuli, is emphasized clearly in the literature. Examples include the contemplation on the repulsive and unattractive aspects of food, the aim being to develop the attitude that food is for essential nutriment, not for greed or gluttony. The aversive aspects of the human body are the subject of another meditative exercise, this being part of the wider meditation on the contemplation of the body.
The Buddhist emphasis on anicca, or impermanence, can also be seen as a potential contribution to the promotion of psychological health. The anicca perspective helps one to recognize, and bear in mind, the essential transient ness of phenomena. Nothing is permanent or everlasting. The firm grasping of the inevitable impermanence of things -including people – helps to create a perspective where one can handle losses of all kinds, including bereavement, without undue devastation, and with a sense of equanimity. This leaves little room for abnormal or pathological grief reactions.
The Four Sublime Attitudes The development of the four sublime states – or sublime attitudes (brahma-viharas) – is considered a major part of one’s personal development in Buddhism. The states are metta (loving kindness), which has already been referred to; karuna (compassion); mudita (sympathetic joy); and upekkha (equanimity). These key Buddhist concepts are worthy of a close study, as they reflect a major aspect of the psychology of Buddhism. These, when developed, can transform one’s overall attitude to one’s fellow-beings, and contribute significantly to one’s own psychological well-being.
Loving kindness is free of lustful attachment. Its manifestation is the feeling of love and friendliness, and the removal of hatred. Compassion is an emotion conducive to the removal of pain or suffering of others. It refers to feelings for those in distress. Sympathetic joy refers to rejoicing at others’ happiness, success and prosperity. Absence of envy and jealousy are said to be its essence. It is worth noting that both karuna and mudita involve, and are marked by a strong sense of empathy. One feels for others and with others, in their distress and in their joy; not simply as an outsider but also through a perspective of sharing the distress or the joy. This is an area of Buddhist psychology which requires more elucidation and analysis, as it has, potentially, a major contribution to make to a human psychology of well-being.
The fourth sublime attitude, upekkha refers to the development of a neutral, stable and balanced attitude which enables one to remain calm and unruffled, unaffected by attraction or repulsion, and not subject to elation or depression. It is also marked by impartiality or lack of bias in one’s dealings with others. In the hectic and competitive present-day world, such an attitude can have a substantial bearing on whether one succumbs to the upheavals around one, or succeeds in remaining calm and stable despite the changes around one and remain calm and stable.
Hindrances to Development
In Buddhist psychology, it is stated that one’s efforts at psychological development are hindered by various negative factors. Various discussions of these are found in both Canonical and commentarial texts, including the Samannaphala Sutta of the Digha Nikaya. Five main barriers or hindrances (nivaranas) to psychological progress are: (a) sensory desire; (b) malice, or ill-will; (c) sloth and torpor; (d) restlessness and worry; and (e) skeptical doubt, or perplexity. These are described as hindering one’s efforts in a spell of meditation, and – more generally –hindering one’s personal/spiritual development.
If a man is filled with sensory desire, he will, being full of craving for that object of his desire, be attached to it. Even if spoken to rudely by that individual, or harassed or beaten, he will bear it all. In that way, sense desire is like being in debt.
Ill-will is compared to suffering from a bilious disease which makes everything, even honey and sugar, taste bitter. One feels irritation and harassment even at those who wish him well. Getting over this ill-will is like being cured of the illness, and one can appreciate the taste of honey and sugar. He is able to appreciate the value of advice, and respond positively.
Sloth and torpor (i.e. mental and physical laziness or inertia) is compared to being in prison. The person is trapped in his passive, inactive state. Overcoming sloth and torpor is likened to being set free from prison. Restlessness and worry (i.e. the mood fluctuating between phases of over excitement, with a flurry of thoughts, and a low state of unease, guilt or worry) is compared to being a slave, having no independence.
Finally, skeptical doubt or perplexity is likened to the state of a traveler in a hazardous territory where he gets anxious and nervous at the slightest noise or sound. He will go a few steps and then stop. He may even turn back completely. The overcoming of skeptical doubt is compared to a strong man, in company and well prepared, who walks through a difficult territory and reaches his destination.
These hindrances are common, and are experienced by everyone. In meditation, these are seen as the major hindrances to one’s progress. In the wider context of one’s day-to-day life, again one is affected and held back by these. They are, in a very real sense, hindrances to psychological health. Overcoming these is a significant step in achieving psychological development, not just in a spiritual sense, but also in the sense of general psychological health and well-being.
As an example, it is worth noting here the steps recommended in the texts for overcoming the hindrance of sense desire. It is stated that there are six things conducive to this. These are:
(a) Learning how to meditate on impure, or loathsome (asubha) objects. We have already discussed this in brief in an earlier paragraph.
(b) Devoting oneself to the meditation on such aversive stimuli (asubha-bhavana). This includes focusing on the aversive aspects of the human body.
(c) Guarding the sense doors.
(d) Moderation in eating.
(e) Noble friendship. The reference here is to such friends who have experience and who can be a model and help the person.
(f) Suitable conversation. It is said that one should engage in conversations that deal with the overcoming of sensory desire, and more generally in conversations that are suitable to advance one’s progress in personal development.
An important topic that needs to be addressed at this point is that of the Buddhist ideal, which was mentioned in passing in an earlier paragraph. The attainment of Nibbana means that the person has reached the ultimate state of personal development – that of the Arahant state (‘the worthy one’). An Arahant is one who has conquered the negative, maladaptive factors called the asavas (influxes or « biases »).
These are the bias of sensual desire, the bias for permanent existence, the bias of dogmatic views, and the bias of ignorance. Those who have destroyed and conquered these asavas, it is said, are free from « mental disease ». The implication of this and similar references is that those who have not attained personal development to this high degree are not immune from psychological ill-health. This does not mean, however, that short of this « perfect » or « worthy » state, there can be no psychological health or well-being.
Indeed, the overall stance of Buddhism extols virtues at all levels, and recognizes their benefits. Buddhist texts speak about the life of a good or righteous householder who is someone who leads a lay life, with duties and obligations. He has not renounced ordinary life for the purpose of seeking arahant-hood. He practices virtuous living, engages in contemplative meditation as he can, desists from gross misconduct, discharges his duties and responsibilities diligently, and develops a benevolent attitude to the world and to those around him. This life is described as « harmonious living » or « righteous living » (sammacariya, dhammacariya). Such a person displays a clear dimension of mental and physical health. Thus Buddhism does not take the position that only those who have renounced a lay life can achieve psychological well-being. Indeed, much of Buddhist ethics is based on the value placed on a harmonious lay life.
Positive Concepts of Mental Health
In his book “An Introduction to Buddhist Psychology”, Padmasiri de Silva has provided a discussion on the positive concepts of psychological health, and attempted to provide an account of the Buddhist contribution to each of these. The positive concepts he lists are: reality orientation, attitude towards the self, self-knowledge, voluntary control and autonomy, ability to form sensitive and satisfying relationships, and body-mind integration.
With regard to attitude towards the self, it is pointed out that the shedding of the delusory belief about the self as a permanent soul or reality, can lead to a transformation that promotes psychological well-being. This transformation is not simply an intellectual change, but also an experiential one achieved through the practice of Vipassanâ (or insight-oriented) meditation.
With regard to self-knowledge, regular practice of mindfulness enables deep and penetrating awareness, not affected by distorting conceptual and intellectual baggage.
As for the ability to form sensitive and satisfying relationships with others, it is argued that greater self-knowledge enables the formation of better relationships. Instead of forming relationships based on greed, domination, dependence and power, one forms productive relationships of care, friendship, trust and compassion.
Such relationships minimize conflicts and the negative psychological sequelae that these conflicts bring both to the individual and to the relationship itself. We know, from present-day clinical practice, the role of dysfunctional relationships in the genesis of psychological distress, maladaptive response patterns, and significant depression, among others