I share and answer three questions from listeners about practicing with mental illness. I talk about when still, silent meditation might be unhelpful and propose alternative practices, and the Buddhist take on medication for mental illness. I also give an example of how to approach a particular condition as practice, even while you receive treatment for it from mental health professionals.
Practicing with Mental Illness
This episode is based on listener’s questions and focuses on practicing Buddhism and meditation when you suffer from mental illness. Fortunately, the three questions make it clear what the listener is experiencing, and therefore I don’t have to go into great detail about how I’m defining “mental illness.” In general, I think of it as mental or emotional pain or dysfunction that gets bad enough to significantly impact your daily life and functioning. However, I see all of us as falling somewhere on a spectrum between enjoying a stable, relative pleasant, resilient state of body and mind, and suffering from a debilitating, painful, diagnosable mental condition – and we move back and forth along that spectrum at different times in our lives.
It can be tricky, as a Zen teacher, to know what’s best when someone is experiencing mental or emotional difficulty. They may benefit from using the difficulty as fodder for spiritual practice, but they may also be struggling with a mental illness that might get the better of them if they don’t avail themselves of additional support. And all I’m qualified to do is guide your Zen practice – mental health professionals have all kinds of training, skills, and resources I don’t when it comes to coping with and recovering from mental illness.
However, hopefully you will never feel excluded from spiritual practice because you struggle with mental illness, to whatever degree. There are all kinds of ways Buddhism, Zen, and meditation can be helpful to you as part of a holistic approach to taking care of yourself.
When Silent Meditation Might Be the Wrong Thing
Ron writes: “In the last two days, the breath counting part of my sitting has been very easy. It’s as if the usual ‘noise’ of thoughts has been muted, even silent. Counting in various ways is easy at first, but when I lose my way, it’s just silent. Not drowsy, no falling unconscious from my seat, just silent. No thoughts to address, or even put away. Just silent.
This quiet and focus is unnerving because it’s so unexpected. It seems like this sensation just dropped on me; no drowsiness, nothing preparatory, just focus on breath, in and out. Total. And quiet. It came so suddenly, the silence so complete that I thought I was doing something wrong, that I was off in some solipsistic sleep-but-not-sleep. There seemed nothing to do but breathe in then out. I did not recognize the state as positive. I did not recognize noise the state at all.
[Ron writes a couple weeks later with an update] I now know that the ‘quiet’ I was experiencing was a symptom of profound depression. My wife was concerned, particularly when I spoke of suicide. She helped me get a 10 day stay with the VA. When I was in my funk, there was no train of thoughts. Nothing that I could recognize as thought at all. I suspect that the difficulty I’d run into was more than I could handle.
Ron, I’m glad you got some help! Indeed, doing zazen – or any kind of still, silent, introspective meditation – can sometimes be a very unhelpful thing for someone suffering from trauma, depression, or anxiety. You may just end up sinking into the pit your mind has created for you… That’s why it’s helpful to have a teacher you can talk to about your particular experience. Each person’s situation is different, and it’s helpful to be able to ask, “Does this sound right?”
If you don’t have a teacher to talk to (or even if you do), be very careful with meditation if you suffer from any kind of mental illness. Back off of your effort if the effects seem weird, disturbing, or if meditation seems to exacerbate your symptoms. And be sure not to overdo it – I’ve heard of people suddenly adopting a practice of sitting all by themselves for hours every day, and this is not recommended for anyone practicing without the guidance of a teacher, even if they’re not suffering from any kind of mental illness. You may have read a book describing how cool awakening experiences are and decide you’re going to try for one… but I can guarantee you’ll misunderstand what it’s all about without more guidance and context than that. But I digress…
If still, silent, introspective meditation is difficult given your mental/emotional state, or if you think its effects aren’t so good for your mental health, you can always sit for shorter periods – even a few minutes at a time can be beneficial. There are also other forms of meditation you can incorporate into your practice that are more accessible, less likely to trigger trauma, and that keep you more in touch with your body. These include walking meditation, where you take one step with each exhalation. It’s ideal to choose two points and walk back and forth between them, or to walk on a particular circuit, so you don’t have to think about where you’re going. Other more active forms of meditation include chanting or hand-copying texts. Traditionally you would chant or copy Buddhist verses or texts, but you could choose anything. These kinds of things let you get the benefits of meditation while grounding you physically in the here-and-now, so you’ll be less likely to get pulled into the unhealthy mental and emotional patterns that are causing you problems.
Buddhist Practice and Medication
Blondie writes: “I’ve been listening to your podcast over the last year as well as reading on Tibetan and Zen Buddhism. As I’ve been more comfortable lately with identifying as a Buddhist, I’ve been wondering about medication and mental illness. I’ve been diagnosed with major depressive disorder and severe anxiety for over 14 years and have been taking medication to help with these issues. Is it against any Buddhist practices or beliefs to take these medications? Would Buddhism allow me to better myself and not actually need these medications?
Great question, Blondie. You might get different answers from different Buddhist teachers on this, but I think my answer will be pretty typical. In general Buddhists have no problem whatsoever using medications that allow you to be mentally/emotionally healthy and stable. Given our teachings of no-self, we don’t conceive of any inherently real “you” that’s altered by the medication. In fact, it can be a powerful lesson in no-self watching your mental illness come and go and noticing how medication changes your experience. Who are we, anyway?!
Actually, I strongly recommend taking prescribed medications if they allow you to practice – that is, if they give you enough health and stability to function well and even have energy for and interest in meditation and other aspects of Buddhist practice. It would be irresponsible not to avail yourself of such support.
At the same time, of course, medications have side effects and many people prefer to function without them if they can. The only way you can know whether Buddhist practice can allow you to function without meds is to try… but very carefully. No dramatic changes in meds, no expectations, and hopefully with the close guidance of a sympathetic psychiatrist. I have, indeed, heard of some people who have learned to manage their depression and/or anxiety without meds (or with fewer/less meds) through Buddhist practice, but it can take a long time (think many years).
Also, it’s important to know that, typically, practice doesn’t stop your symptoms from arising. If you struggle with anxiety, you’ll still probably experience anxious thoughts and physical sensations. If you live with depression, you’ll still probably find yourself, at times, sliding towards numbness or despair. Practice can help you recognize your symptoms and relate to them in a new way. Most practitioners describe feeling less identified with their thoughts and feelings, and better able to endure them until they pass without making them worse. My own teacher had to take medication for depression earlier in life but has managed it without medication for many years. She says she has had to accept the fact that she’ll probably always tend toward depression. She stays on the lookout for symptoms and is sure to take care of herself in practical ways – getting exercise, maintaining social connections – as well as practicing Zen.
Practicing with Emotional Overwhelm
Linnea writes: “I suffer from mental health issues. A lot of it I have found ways to deal with – I have a psychiatric doctor who cares for me, and I definitely believe in a sound balance between medical care and spiritual/religious practice – but there’s one thing that gives me great pain, and no matter what I do it doesn’t get any better. I wonder if you might have any advice to offer?
The problem is twofold I think. One, I feel a great need for order and structure and get extremely stressed and filled with anguish that things are not in order. Two, I get extremely stressed from trying to make decisions. Stressed to the point of ending up curled up like a shaking ball of pain in my bed just for trying to decide what household chores I should do next. It sounds silly and idiotic but this makes life unbearable. The problem is in my head, in reality my home is in a rather good order and I don’t have a lot of things but for me it feels like wherever I look there is something that needs to be fixed and things that I don’t know what to do with. I really, really try to relax and let go but I just can’t. I might meditate and it feels good but then I look around and try to decide what to do after the meditation and it’s like my brain begins to boil.
I have four children and a loving husband. They deserve a mother and wife that’s not hiding most of her time under a blanket because she can’t decide where to put things.”
Linnea, I’m glad to hear you have the support of a mental health professional, because as you probably know I’m not qualified to offer any advice on mental health issues. (Whatever I might say about how to mitigate or deal with your issues really shouldn’t carry any more weight than what a friend, family member, or acquaintance might tell you.)
That said, practices such as Buddhism can make all the difference as you go about taking care of your life in whatever ways you need to. We’re invited to let go of all of our ideas about ourselves – who we should be, what it means if we suffer from mental health issues, what it means if we need to take medication, what others think of us, etc. Rather than trying to figure out and hold on to a fixed idea of self (capable, rational, good, dependable, strong, etc.), we practice being fully present with what is. This is the teaching of no-self in action; it’s pretty easy to accept the idea that you have no inherently-existing, independent self-nature in an abstract sense, but to have to face that reality personally, on a daily basis, is another thing entirely. But it’s a powerful learning experience if we can embrace it.
Practice also invites us to question our other assumptions. What do we think will happen if we let things get out of control? There’s usually a lot of fear behind our attachment to order – we’re afraid everything will disintegrate without our effort, that we’ll be swallowed up in chaos and lose everything we love. Simply recognizing our sense of fear and overwhelm can help. It doesn’t matter whether or not we “should” feel overwhelmed by our responsibilities (we often try to talk ourselves out of our feelings or judge ourselves) – we feel what we feel.
I love order, too, and when I feel overwhelmed I find myself flying into irrational rages at small setbacks (like sleeves caught on doorknobs). I used to judge that and try to make it go away, but now I put my hand on my heart and recognize that I’m feeling stressed, overwhelmed, alone, put-upon, out-of-control, resentful, and scared. Wow. I don’t know why, but just connecting with my truth like that relieves some of the pressure, and I send my poor scared self some compassion. Sure, my life is relatively easy and there’s no excuse for my melt-down, but there it is. Sometimes there’s no explaining our reactions… this is what Buddhists call “our karma.” If we don’t accept it just as it is, we can’t really start working with it.
Practice can also involve creativity, cultivating faith, and experimentation. For example, we have a lot of work to do taking care of lives, but usually, if we experiment with letting go just a little, we find that the universe supports us more than we might expect. Maybe the hubby will take out the trash when we forget, or maybe we’ll find out our friends really want to help and have just been waiting for us to ask. We can try making a list of the things we need to do, and then letting ourselves calmly do the first thing on the list – forgetting about the rest of the things we could be doing, even though we might have picked the wrong thing and all hell will break loose when we’re not looking (!) – and we usually find we’re just as smart and efficient when we take one thing at a time as when we constantly second-guess ourselves. If we try to endure the sense that we’re losing control for a while, we may find that something we thought was essential really isn’t.
It’s our practice of mindful awareness that allows us to observe our lives more carefully and learn from them. For example, I usually feel like I’m going as fast as a can but can never get anywhere near caught up with everything I have to do. Some ways back, however, I was in bed with pneumonia for over a week and was struck with how the world didn’t actually fall apart. Quite a few of my absolutely critical projects revealed themselves as optional from another point of view. And although I vastly prefer order, I actually feel a little proud of myself when I see a little area of chaos in my life I’m able to tolerate. My Sangha members tease me about being super organized and attached to everything being in straight lines, but certain areas of my house – particularly my kitchen table and my working office – are quite messy. I’d prefer they weren’t, but the fact that I can function pretty happily with them the way they are is something of a personal triumph! (Only a real lover of order would understand!)