Tricycle | Awake in the World

DESPITE TEN YEARS of dharma practice and five years of psychotherapy, Leslie was still miserable. To those who knew her casually, she did not seem depressed, but with her close friends and lovers she was impossibly demanding. Subject to brooding rages when she felt the least bit slighted, Leslie had alienated most of the people in her life who had wanted to be close to her. Unable to control her frustration when sensing a rejection, she would withdraw in anger, eat herself sick, and take to her bed. When her therapist recommended that she take the antidepressant Prozac she was insulted, feeling that such an action would violate her Buddhist precepts.

There is a story in the ancient Buddhist texts that relates how the King of Kosala once told the Buddha that unlike disciples of other religious systems who looked haggard, coarse, pale, and emaciated, his disciples appeared to be "joyful and elated, jubilant and exultant, enjoying the spiritual life, with faculties pleased, free from anxiety, serene, peaceful, and living with a gazelle's mind." The idea that the Buddha's teachings ought to be enough to bring about such a delightful mental state continues to be widespread in contemporary Buddhist circles. For many, Buddhist meditation has all of the trappings of an alternative psychotherapy, including the expectation that intensive practice should be enough to turn around any objectionable emotional experience. Yet the unspoken truth is that many experienced dharma students, like Leslie, have found that disabling feelings of depression, agitation, or anxiety persist despite a long commitment to Buddhist practice. This anguish is often compounded by a sense of guilt about such persistence and a sense of failure at not "making it" as a student of the dharma when afflicted in this way. This situation is analogous to that in which a devotee of natural healing is stricken with cancer, despite eating natural foods, exercising, meditating, and taking vitamins and herbs. As Treya Wilber pointed out in an article written before her early death from breast cancer, the idea that we should take responsibility for all of our illnesses has its limits.

"Why did you choose to give yourself cancer?" she reported many of her "New Age" friends asking her, provoking feelings of guilt and recrimination that echo much of what dharma students with depression often feel. More sensitive friends approached her with the slightly less obnoxious question "How are you choosing to use this cancer?" which, in her own words, allowed her to "feel empowered and supported and challenged in a positive way." With physical illness it is perhaps a bit easier to make this shift; with mental illness one's identification is often so great that it is extremely difficult to see mental pain as "not I," as symptomatic of treatable illness rather than evocative of the human condition.

Of course, the First Noble Truth asserts the universality of dukkha, suffering or, in a better translation, pervasive unsatisfactoriness. Is the hopelessness of depression, the pain of anxiety, or the discomfort of dysphoria (mild depression) simply a manifestation of dukkha, or do we do ourselves and the dharma a disservice to expect any kind of mental pain to dissolve once it becomes an object of meditative awareness? The great power of Buddhism lies in its assertion that all of the stuff of the neurotic mind can become fodder for enlightenment, that liberation of the mind is possible without resolution of all of the neuroses. Many Westerners feel an immediate relief in this view. They find they are accepted by their dharma teachers as they are and this attitude of unconditional acceptance and love is one that evokes deep appreciation and gratitude. This is a priceless contribution of Buddhist psychology—it offers the potential of transforming what often becomes a stalemate in psychotherapy, when the neurotic core is exposed but nothing can be done to eradicate it.

Medicine Buddha, Central Asia, twelfth century, gouache on cotton

Eden's situation typifies this. A writer whose crisis manifested in her twenty-ninth year, Eden suffered from an oppressive feeling of emptiness or hollowness for much of her adult life. Already a veteran of ten years of intensive psychotherapy, she understood that her feelings of numbness and yearning stemmed from emotional neglect in her youth. Her father, a cold and aloof physician, had avoided the children and retreated to a rarefied intellectual world of scientific research, while her mother was fiercely loving and protective but indiscriminate in her attention, praising Eden for anything and everything and leading her to distrust her mother's affection altogether. Eden was angry and demanding in her interpersonal relationships, impatient with any perceived flaw, with any inability of her partner to satisfy all of her needs. She had recognized the source of her problem through psychotherapy but had found no relief; she continued to idealize and then devalue her lovers and could not sustain an intimate relationship.

Eden's inner emptiness was a good example of what the psychoanalyst Michael Balint has called the regret of the basic fault. "The regret or mourning I have in mind is about the unalterable fact of a defect or fault in oneself which, in fact, had cast its shadow over one's whole life, and the unfortunate effects of which can never fully be made good. Though the fault may heal, its scar will remain forever; that is, some of its effects will always be demonstrable." No antidepressants were effective in Eden's case. In order for her to find some relief she had to confront directly her inner feeling of emptiness with the understanding that she was yearning for something that would no longer prove satisfying. Having missed a critical kind of attention relevant only to a child, she found that if someone tried to give her that as an adult, it felt oppressive and suffocating. Only through the tranquil stabilization of meditation could she stand the anxiety of this inner feeling of emptiness without reacting violently against it.

This illustrates the Buddhist approach. A person must find the courage and mental balance to confront the neurotic core or "basic fault" through the discipline of meditative awareness. In the Buddhist view, all of the elements of personality have the potential to become vehicles for enlightenment, all the waves of the mind are but an expression of the ocean of big mind. Mental illness is not an especially developed concept in Buddhist thought, except in an existential sense, where it is exquisitely developed. Buddhist texts speak of the two sicknesses: an internal sickness consisting of a belief in a permanent and eternal self and an external sickness consisting of a grasping for a real object. The focus, in Buddhist psychology, is always on the existential plight of the subjective ego, articulated especially well by Richard De Martino in the classic Zen Buddhism and Psychoanalysis (1960), co-written with Erich Fromm and D. T. Suzuki:

Object-dependent and object-conditioned, the ego is, further, object-obstructed. In the subjectivity in which it is aware of itself, the ego is at the same time separated and cut off from itself. It can never, as ego, contact, know or have itself in full and genuine individuality. Every such attempt removes it as an ever regressing subject from its own grasp, leaving simply some object semblance of itself. Continually elusive to itself, the ego has itself merely as object. Divided and dissociated in its centeredness, it is beyond its own reach, obstructed, removed and alienated from itself. Just in having itself, it does not have itself.

It is this existential longing for meaning or completed-ness and the inner feelings of emptiness, hollowness, isolation, fear, anxiety, or incompleteness that Buddhist psychology approaches most directly. Depression, as a critical entity, is rarely addressed. The fifty-two mental factors of the Abhidhamma (the psychological texts of traditional Buddhism), for example, list a compendium of afflictive emotions such as greed, hatred, conceit, envy, doubt, worry, restlessness, and avarice, but do not even include sadness except as a kind of unpleasant feeling that can tinge other mental states. Depression is not mentioned.