Does the Dharma Have a Role in Recovering From Mental Health Problems? – A Personal Perspective

By Joanne Clark

Some years ago, I was having a major anxiety attack during a Dalai Lama teaching, something that often happens to me when in the presence of high lamas. I was sitting in the first or second row, really struggling, and suddenly His Holiness looked straight at me and said forcibly, waving his arms, “Everything is changing changing changing.”

When he said that, I saw my anxiety shift a little. I saw a little gap. As anyone who has suffered from trauma-related anxiety will know, even the littlest shift is a big deal. Those experience appear very solid, very impenetrable. Things seem permanent in trauma, but they aren’t and remembering that can be grounding. A black mood might seem to last forever, but it doesn’t. That was a big teaching for me, one that is relevant still.

I think when we talk about how Buddhist teachings can help with mental illness, we sometimes gloss over the basic teachings and their great worth and profundity. We hear a teaching while we’re in a good mood, sitting comfortably on our cushion, and think we really understand it and so we can move on from it. But these basic teachings take on new meaning when we can bring them to mind with conviction during trouble. We think impermanence is an easy concept. However, realizing subtle impermanence is an important part of the Buddhist path and not so easy. And to see or remember even gross impermanence when we are in the grips of a strong emotion, is not easy. However, that practice, coupled with the practice of patience, can be transformative in the context of mental illnesses such as depression, anxiety and PTSD.

So when I talk about how Dharma has helped me recover my mental health, I am not talking about pujas or grimly meditating my way through trouble. I am not talking about easy fixes or miracles, repeating “no-self, no-self”. I am talking about attitudes and approaches to my suffering that have been helpful. Dharma is unique as a religion in that there is never one approach to a problem. Every problem can be viewed from many angles. From Buddhist perspectives on impermanence, Dhukha and no-self, to investigating the interdependence of a situation, to cultivating compassion and love, to practices of generosity and observing ethical vows, to prayers of faith and devotion, to mantras that settle and protect the mind, to viewing karma and this lifetime in the context of many lifetimes, to studying and understanding the many categories of afflictions, and much more, there are a multitude of understandings to be applied to suffering—the first and foremost of the Buddha’s teachings. These can help with mental illness, these can be a tool in the toolbox.

© Christopher Michel, Ladakh | (CC BY-NC 2.0)

However, this does not mean that mental health professionals should be eliminated from the tool box! When an individual is suffering with serious mental health issues, these must be resolved within a culturally familiar and appropriate context, which for most will be Western mental health facilities. Dharma centres in the West are simply not facilitated to address these problems and, in many cases, they are struggling to maintain healthy communities themselves and can be toxic environments to vulnerable individuals. Michele Haslam demonstrates this forcibly in a recent series of YouTube videos posted on this blogsite. In addition, some Buddhist practices are dangerous for vulnerable individuals—for example, trying to meditate one’s way out of complex trauma or severe depression is very risky and rarely helpful.

From my experience, out of those Buddhist practices and perspectives that are safe, those relating to altruism are by far the most helpful for anyone struggling with mental health problems. Cultivating kindness, generosity and compassion—practicing honesty and other ethical restraints—restraining harmful anger– are hugely helpful, even if one is able to do them only very little. In the early, dark years of my trauma, I was fortunate to be given an opportunity to live with my aging mother. She needed me—and I desperately needed to be needed. Though she didn’t need much help in those early days, simply getting dressed and showing up for her was one of my main practices.

Over time, I was able to extend that to volunteer work with Hospice and later helping with my mother’s dementia which became more and more demanding. I also worked in later years in crisis as a mental health clinician. During a time when my internal experiences were threatening to overtake me, maintaining an outlook that had some degree of focus on other’s welfare was helpful in grounding me and helping me feel less worthless. Sometimes, early on, my practice would be as simple as smiling at someone on the street, thinking that I could at least make someone’s day a little brighter. Every prayer in the Dharma is directed towards helping others and truly, the person who benefits most from cultivating such an outlook is the person saying the prayer. This is what I learned.

During those early years, when I first stumbled away from my last Dharma Centre, I spent years trying to find a puja or mantra or meditation technique or single thought or prayer or conversion experience that would fix me. I had learned that there was a puja for this illness, a puja for that obstacle, but I hadn’t grasped the full depth of the Dharma and what it could offer. It took me years to fully understand that interdependence, that great treasure of the Buddha, means that there is a rich complexity to reality and single answers just don’t do it. Not only that, but the practice of viewing every problem from many angles is hugely helpful itself in the journey to mental health. It strengthens and grounds the mind and loosens mental rigidity. As His Holiness frequently says:

Use our intelligence maximum way, and in that way transform our emotions.The 14th Dalai Lama

None of this is particularly Buddhist. Scientists certainly understand interdependence and impermanence—they certainly use their intelligence in superior ways to solve problems. My experience, while studying for a degree in mental health counselling, was that there is a definite overlap between Western psychotherapies and the teachings of the Buddha. For example, Cognitive Behavioural Therapy (CBT) is the Western mental health intervention consistently shown to be most effective in clinical trials—and its premise that most of our mental health problems are caused by exaggerated and distorted thinking is very similar to Buddhist perspectives.

In fact, the practice that I learned from years of Buddhist study, the practice of testing my beliefs against reality, is similar to that taken by CBT therapists. These therapists do not use meditation or Tantric pujas to assist individuals in recognizing and understanding how their thinking is distorted and exaggerated (though mindfulness is used in conjunction with CBT in some instances). Principally these therapists have their clients engage in “practice” through worksheets where they explore the causes of their distress in the context of what are called “core beliefs” and investigate how those beliefs relate to expectations of how life should be and how those expectations “trigger” thoughts and reactions to events. Similar to Buddhist practice, the goal is to practice daily in introspective awareness in the context of measuring one’s thoughts, beliefs and expectations against reality.

One stark example of how these CBT practices and interventions overlap with the Dharma can be found in Aaron Beck’s powerful text: Prisoners of Hate: The Cognitive Basis of Hostility and Violence. In this investigation, Beck, who is the founder of CBT, concurs with the Buddhist view that strong anger disturbs the mind such that a large percentage of an angry individual’s perception is exaggerated and unrealistic. He also concurs with the Buddhist view that the one who suffers most from strong habits of anger is the angry person.

On the other hand, when we speak about anger, that too has to be seen from many angles and dimensions. As HH Dalai Lama has often explained, there are uses for the energy of anger that are not necessarily harmful and can be directed towards compassionate ends. With proper introspection and compassionate motivation, there are healthy uses for anger. And certainly, in cases of recovering from trauma and abuse, feelings of anger have to be given space and validation for proper healing to occur.

So, it seems that for any Buddhist struggling with mental health difficulties, it would be easy to find Western therapists who would share similar perspectives on reality and mental health. There is no need to go it alone, no need to abandon one’s religion and no need to seek help from those who are unqualified, such as those at a local Dharma centre. For myself, giving up on Buddhism, which had become such a deep, integral part of myself, would have diminished my self-respect and added further trauma onto trauma. Seeking help through the Dharma and honouring my vows was a means by which I could honour myself and my own wisdom in committing to such a rich tradition. I decided that no lama failing in ethical restraint, no corrupt Dharma centre, was going to undermine that deep part of myself. This became a source of pride and dignity, important factors on the path to recovery.

In this context, Shantideva’s discussion of “self-confidence” versus “self-importance” in the Bodhicharyavatara, has been one of many inspiring passages I have returned to again and again:

Therefore with a steady mind
I shall overcome all falls,
For if I am defeated by a fall,
My wish to vanquish the three realms will become a joke.

I will conquer everything
And nothing at all shall conquer me!
I, a child of the lion-like Conquerer,
Should remain self-confident in that way.Shantideva

This perspective really helped me avoid going down that path of seeing no-self wrongly, that path of self-denigration and loss of self-worth—familiar troubles in trauma-related struggles and depression. His Holiness will often hold his fist to his heart when speaking forcibly about the strong determination needed for the bodhisattva path and when teaching on no-self, he will say reassuringly, “The self is there.” His message is always that while our view of the self is unrealistic and we cannot find such a self under critical examination, a strong sense of conventional self is nonetheless needed to traverse the Bodhisattva path—what Shantideva calls self-confidence. Within that perspective, practices such as Lojong can be transformative and helpful. Without that perspective, Lojong and teachings on “no-self” can easily become just further means to beat oneself up.

It is concerning that perspectives are being taught in some dysfunctional Dharma Centres that risk diminishing students’ self-worth. I have heard some lamas state that the “ego must be crushed.” Another lama has claimed that “beatings aid enlightenment.” Such perspectives leave individuals particularly vulnerable to mental health problems. This is also a cross-cultural phenomenon. For example, self-hatred is a common experience in Western cultures but not common in Asian cultures. In this context, there is a greater likelihood that Asian teachers might teach the wisdom of no-self in less than skilful ways, ways that undermine students’ self-confidence and sense of self worth.

In Western psychology, they use what they call Bibliotherapy to help individuals. In this, regular reading of stories or texts becomes a form of therapy. CBT has its own bibliotherapy, where individuals read CBT perspectives on a regular basis. For myself, such an approach has been very helpful, as I find my favourite and most inspiring passages from Shantideva and elsewhere and reread them frequently and bring them to mind at critical moments. I find that reading something is not such a big deal—but applying it in a difficult situation is sometimes a very big deal. One more tool in the toolbox.

These are just a few examples of how my commitment to the Dharma has helped me heal over the past decades from trauma, psychosis and despair. In my experience working as a crisis clinician and struggling with my own problems, mental health is not regained through simply finding the correct therapy model—or the correct daily Buddhist practice. It is not one thing or the other, not a distinct day when we can say, “Done.” It is gained day by day, hour by hour, maybe over a lifetime, through a multi-dimensional approach, one that includes social and community supports and the close guidance of a professional as well as therapeutic and sometimes medical interventions. In this multi-dimensional and realistic context, Buddhist perspectives can be healing and empowering.