To Provide Compassionate Care for the sick & terminally ill and create a supportive, nurturing environment for people to consciously face their illness and/or end-of-life journeys.
Can antidepressants help or hinder waking up?
Many psychiatrists who work with SSRIs think that, in ways that are still mysterious, the medication can “reset the thermostat,” reprogramming the mind to experience joy or ease. “Sometimes it can reset the setting,” says San Francisco psychiatrist Seymour Boorstein, “and the patient can go off Prozac.” My friend “Annie” says, “Paxil trained my mind to be happy. I learned the behaviors of a happy person and then after I went off the medication I could sustain that happiness because I had acquired a set of new behaviors like smiling, asking people about themselves, spending time with friends, and so on.”
There is nothing inherently antispiritual in this process. “What is serotonin?” asks Tarrant. “It, too, is a piece of the original light. For some people it comes in the form of serotonin; for others in the form of a smile. There is more than one way to move neurotransmitters around - meditation can do it; having someone hug you does it, too.”
Says Fleischman: “I feel emboldened to say that Vipassana meditation changes your neurotransmission.”
All of this leads to what may be the ultimate question: Can a depressed person be enlightened? Or—alternately—can an enlightened person be depressed? On this matter I found much difference of opinion.
“No,” says Fleischman unhesitatingly. “The goal—nibbana—is total purification, which means no negativity, no anger, no hatred, no sexual feeling, no upset, no depression, no rage. That’s the definition of a Buddha, someone who has attained that.”
But even to some practitioners this state of mind sounds suspiciously like the flat affect attributed to too much Prozac. We are all said to have the Buddha nature, yet the iconographic Buddha, austere and remote as those serenely beautiful Southeast Asian statues, does not seem like any relative of mine. Clearly, one’s view of enlightenment informs how one thinks about depression.
“When you experience the first kensho,” says Bodhin Kjolhede, abbot of the Rochester Zen Center in New York state, “this enlightenment experience does not clean up the basic afflictions. It does not eliminate greed and anger and emotional habits. Even when people have had fairly deep experiences of awakening, they still have tendencies or afflictions or habit energies with amazing staying power. But our relationship to them changes.
“Depression is one of those things. After enlightenment you can still be depressed, but it’s not as disruptive or frightening because you see it as transient and insubstantial, like all phenomena.”
A proverb for our times: Before enlightenment, take Prozac and talk to your shrink; after enlightenment, take Prozac and talk to your shrink. Perhaps it is only when we think the mind is something, that a mental state is something (paranoia or anxiety disorder, let’s say), that enlightenment itself is something, that we get into difficulty. “If you’re taking Zoloft,” says Tarrant, “what you do is to attend, to take notice. How much does it lift your depression? Does it stop your thinking from being clear? Does it reduce your passion for life? Does it make you a little bit manic?”
Just as it is naive to imagine meditation as a panacea for all psychological ills, perhaps it is a Western prejudice to insist that an enlightened master should be the picture of what we consider perfect mental health. Gelek Rinpoche tells a story about a very high lama in Tibet who suffered from a serious mental illness—probably bipolar illness or schizophrenia—and periodically behaved bizarrely. His mental illness did not seem to impair his spiritual status.
“The idea of complete psychological adjustment is foreign to the chaotic nature of life,” says Tarrant. “The possibility of reaching out into a deeper dimension is there even if we are psychologically unhappy. There is a movement within Buddhism that says, 'There are all these hindrances to my achieving clarity. I need to detach from my desires and aversions so I can cease to suffer.’ A lot of people thought this was sort of boring—not true to life, not quite human—and along came Mahayana, and it said, 'Right in the midst of what you see as the problems of life you’ll find your enlightenment.’”
Perhaps the Buddha was in the grips of a deep depression when he walked away from his castle and family to join the ragged sadhus, swinging bipolarly (a modern shrink might observe) between severe austerities and vertiginous indulgences. Would a psychiatrist armed with a DSM manual and a Hamilton rating scale have diagnosed depression or at least chronic dysthymic personality? Is it possible to see in Shakyamuni’s behavior hints of the warning signs in medical pamphlets—”Have you lost interest in life? Experienced changes in appetite or sleep patterns? Stopped socializing with friends?” Was Buddha the sixth century B.C.E. equivalent of the depressed housewife who refuses to get dressed, comb her hair, or cook a meal?
So determined was the thirty-five-year-old ex-prince that he finally sat down under a pipal tree one day near the city of Gaya in northern India, vowing not to get up, until he’d found the answer.
The Buddha did not have the Prozac option, of course, or even the psychotherapy option, so he invented something radically new. He didn’t just follow someone else’s program. Perhaps if he’d had Prozac, his drive to heal himself wouldn’t have been so urgent, and he might have been happy and gone back to his palace, and we wouldn’t have had Buddhism. Then again, maybe he wasn’t depressed as we know depression. Perhaps there was then—and always will be—a distinction between a spiritual crisis and a psychological crisis.
Judith Hooper is the author of a book about the brain, The 3-Pound Universe (J. P. Tarcher) and Would the Buddha Wear a Walkman? (Simon & Schuster/Fireside). Her articles have appeared in Atlantic Monthly, The New York Times Book Review, and other publications. Illustrations by Henrik Drescher.