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Today we have an unusual special for the “Not Today, Not Yesterday, Not Tomorrow”: we decided to talk about mental illness from a different angle, namely with Tibetan doctor Lobsang Gelek. Dr Lobsang has a bachelor’s degree in Buddhist Medicine Research and also owns the Garuda Clinic in Israel. Whether you can improve your mental health with the help of spiritual practices and why it is dangerous to meditate during the aggravation of a mental disorder – read in our new material.

– How does Buddhism define mental illnesses and their causes? Does Buddhism have a concept of mental disorders that differs from the Western medical paradigm?

– Tibetan medicine considers the causes of both mental and other diseases to be the same, those being the root cause of all our other sufferings: the so-called “three poisons” (These three poisons – ignorance, anger, and greed – are considered three obstacles or defects inherent in all human beings to one degree or another. The three poisons are symbolically represented in the centre of the Buddhist Bhavacakra (wheel of life), where the rooster, snake and pig symbolises greed, anger and delusion respectively): ignorance (i.e. not understanding that we do not have a permanent soul or ‘I’) and the passionate attachments generated by this ignorance or, conversely, anger and aversion.

These three poisons disturb the balance of the three physical bases of our body: wind, bile and mucus (The type of human constitution, classified by Tibetan medicine as “Wind”, “Mucus” and “Bile”, determines the symptomatology and dynamics of disease of internal organs). They both separately and together can cause illness. Mental illnesses mainly depend on the disorder of “wind”. Besides these elements, the appearance of mental disorders can be caused by grief, poison and demons (In Buddhism there are six worlds (Tib. rigs drug gi skye gnas), also “six spaces”, “six realities”, “six paths” – in Buddhism there are six possible rebirths in samsara. The six worlds are called “six paths of rebirths”, “six paths of suffering”, “six levels”, “six lower realities”).

Sanjadei Hural 2012, Oginsky datsan. The author of the photo is Daba Dabaev

– What practices or methods in Buddhism can help people with mental illnesses?

– There are many such practices. The best practice for calming the “wind” is basic meditation focusing on one’s own breathing. Buddha Shakyamuni taught this meditation to his disciples. The main thing here is complete concentration on the process of breathing. Significant importance is given to the pauses between inhalation and exhalation. You can start with a breathing cycle of 4 seconds exhalation, 2 seconds pause, 4 seconds inhalation, 2 seconds pause. Over time, as breathing becomes comfortable, you can increase the breath-holding duration to 6-3-6, 8-4-8, and so on.

It is recommended to concentrate your thoughts directly on the process of breathing. During inhalation, oxygen fills the lungs and dissolves there, enriching the blood. On exhalation the remaining air goes out, making room for a new breath.

Such breathing practice allows calming, balancing the “wind,” and bringing a positive effect in treating any mental illness.

– What aspects of the Buddhist teachings can be useful in understanding and treating depression, anxiety, and other disorders?

– In the modern world, constant stress also contributes to the arousal of “wind”. Life stresses, insomnia, and other factors lead to symptoms that Western medicine would interpret as mental disorders. For example, one manifestation of “wind” arousal is the appearance of groundless anxiety in a patient.

To calm the wind, the following recommendations should be followed: regular sleep, at least 8 hours (the Dalai Lama, for example, sleeps 9 hours), and the body should sleep between 22:00 and 5:00. During this time, all organs of the body replenish their energy. Every evening before bed, it is recommended to rub the temples, wrists, palms, feet, and sacrum with black sesame oil. It is recommended to consume nutritious foods, mutton soups, clarified butter called ghee. Before bedtime, you can drink a soothing decoction. An hour before bed, engage only in calm, pleasant for the soul activities.

Should not be in a draught. Feet, lower back and ears should always be kept warm. Warming of the sacrum and feet is recommended. In some cases, a course of moxa – deep heating of certain acupuncture points – is also prescribed.

Lamas of the Oginsky datsan on Mount Alkhanai. The author of the photo is Daba Dabaev

– In what context can Buddhist practices be harmful or insufficiently effective for those suffering from mental disorders?

– It is not recommended for people with aroused “wind”, or in other words, individuals with unstable mental states, to recite mantras or perform other meditations: such practices agitate the “wind” and can aggravate the condition.

– What basic principles of Buddhism can be applied in the practical treatment of mental disorders?

– First and foremost, one should remember the principle of moderation. Any extremity in Buddhism is considered incorrect. The cause of many illnesses lies precisely in the tendency towards extremes in one’s life. Scientific research over the past decades has also shown that the Buddhist practice of developing altruism and compassion has a strong effect in treating many diseases, not only mental ones.

– Can understanding karma in Buddhism influence the perception and treatment of mental illnesses?

– The word “karma” translates as “action”. All actions of our body, speech, and mind leave a “karmic trace” in our psyche, which is not realised but is a factor that pulls us towards similar good or bad actions, and therefore sooner or later involves us in situations where karmic potencies are realised in a pleasant or unpleasant way. In Christian culture this is often seen as God’s punishment or reward, but in Buddhism it is seen as an automatically operating process of cause and effect. The entire structure of our thoughts, inclinations, attachments are karmically conditioned, and understanding this can be an important tool for a diagnosis like psychoanalysis. Such diagnostics allow for selecting means to address mental issues – compensating for negative karma, be it through meditations or performing virtuous actions such as saving animals destined for slaughter or giving alms. But, of course, not all mental illnesses fall into this category.

– What roles do consciousness and self-awareness play in understanding and treating mental disorders from a Buddhist perspective?

– As mentioned earlier, in Buddhism, our psyche is considered the deepest cause of illnesses. Since all Buddhist practices are aimed at purifying the mind, including consciousness from the “three poisons”, working with consciousness is considered extremely important for mental health. Often, understanding the cause of illness becomes the cause of recovery. No living being wants to suffer if shown the path to healing. Therefore, the task of a Buddhist physician (healer) is to recognise and point out the causes of illness to the patient.

Sagaalgan khural 2012. Oginsky datsan. The author of the photo is Daba Dabaev

– What Buddhist concepts might be useful for those who work with people with mental illness, such as psychotherapists or psychiatrists?

– In Buddhism, the main method is to combine wisdom and altruistic compassion in all actions. Ultimate wisdom is understood as realising the reality of non-self, while worldly wisdom in our case is professionalism of the physician. Compassion is developed through the entire Buddhist practice. As the great bodhisattva Shantideva said:

May I be the doctor and the medicine,

And may I be the nurse

For all sick beings in the world

Until everyone is healed

May a rain of food and drink descend

To clear away the pain of thirst and hunger,

And during the eon of famine

May I myself change into food and drink

May I become an inexhaustible treasure

For those who are poor and destitute.

May I turn into all things they could need,

And may these be placed close beside them.

Without and sense of loss or attachment,

I shall give up my body and enjoyments

As well as all my virtues of the three times

For the sake of benefitting all

(Shantideva “Bodhisattva-caryāvatāra”).

– How can meditation practices be incorporated into an overall approach to treating and supporting people with mental health problems?

– This is a difficult question – as we have already mentioned, meditation can exacerbate mental disorders. Although a professional Buddhist physician may sometimes prescribe a specific meditative practice, in general, the safest option is perhaps only breathing meditation, which can help cope with stress, anger, or fear episodes.

Read more on the topic: “Similar thoughts occur to everyone suffering from depression: if life is unbearable, so why suffer?”.

“For six years I was treated for the wrong diagnosis. And at 27, I was diagnosed with borderline personality disorder”.

“The whole psychiatric ward is Polish-speaking. It’s like being in a bird house: everyone is singing the same song and you’re chirping about your own”.

“I’m even grateful to fate that I got to the hospital because I was in a place where I could get help. If it had happened on the street, I would have died”.