The Role of Vipassana in Psychiatric Practice

by Dr. R.M.Chokhani

The following was presented as a paper at the Vipassana Seminar held at Dhamma Giri in 1986; it has been duly revised and updated.

One of the more widespread examples of modern adaptations of traditional consciousness-training practices is the Vipassana meditation technique, which has recently become popular among both the lay public and workers in the mental health field.

Vipassana is a Pāli word meaning "insight." It is a system of self-transformation by self-observation; the object is to eventually reach a state of calmness and balance of mind (Thray Sithu Sayagyi U Ba Khin, 1963) and live a life of altruism, beneficial for one and all (Goenka S.N., 1990).

Meditation as a practice of self-liberation was developed in different cultures by and for members of religious groups in the context of their cosmology. The teachings of Gotama the Buddha embody a psychological system as well as a cosmology (Kutz I., Borysenko J.J. & Benson H., 1985). Known as Abhidhamma, this is the most systematic and intricately laid out psychology - presenting a set of concepts for understanding mental activity and methods for healing mental disorders, which differ markedly from the outlook of contemporary psychotherapies (Goleman D., 1977).

The Abhidhamma Model of Mind

This model of mental activity is an "object relation" theory in the broadest sense: its basic dynamic is the ongoing relationship of mental states to sensory objects. "Sense objects" include percepts in the five main sensory modalities, plus thought or cognitive activity (which in this system is seen as a "sixth sense"). "Mental states" are in continuous change and flux: in this analysis, the rate of change of the smallest unit of mental states - a mind moment which is a moment of awareness - is incredibly fast, described as arising at the rate of millions in the time of a flash of lightning.

Each successive mental state is composed of a set of properties or mental factors which gives it its distinctive characteristics: there are fifty-two basic perceptual, cognitive and affective categories of these properties (Narada Thera, 1968). The basic dichotomy in this analysis of mental factors is that between pure, wholesome or healthy and impure, unwholesome or unhealthy mental properties. Just as in systemic desensitization, where tension is supplanted by its physiologic opposite, relaxation, healthy states are antagonistic to unhealthy ones, inhibiting them. Vipassana meditation aims to eradicate these unhealthy properties from the mind; the operational definition of mental health is their complete absence, as in the case of an arahant (saint) (Goleman D. 1977).

Mechanism and Psychological Effects

"Everything that arises in the mind is accompanied by physical sensation", said the Buddha; this interrelationship of mind and body is the key to the practice of Vipassana meditation. Vipassana trains the concentrated attention to follow the mechanics of mental processing with the base of physical sensations, in a detached fashion. This perspective of an observer allows the controlled release of mental contents like craving and aversion, past and future in a seemingly endless stream of memories, wishes, thoughts, conversations, scenes, desires, dreads, lusts. Thousands upon thousands of emotionally-driven pictures of every kind rise to the surface of the mind and pass away without provoking a reaction, while simultaneously anchoring one in concrete, contemporary reality (Fleischman P.R., 1986).

The mind is deconditioned with meditation altering the process of conditioning per se, so that it is no longer a prime determinant of future acts (Goleman D.,1977). A refinement of awareness occurs and one responds consciously to life situations thereby becoming free from limitations which were forged by mere reactions to them. One's life becomes characterized by increased awareness, reality-orientation, non-delusion, self-control and peace (Fleischman P.R.,1986). Such a person is able to make quick decisions, correct and sound judgment and concerted effort - mental capabilities which definitely contribute to success in contemporary life.

Vipassana, Health and Healers:
A Research Review

Considerable data is available, documenting the various biopsychosocial benefits that accrue from the practice of Vipassana meditation; it indicates the vast therapeutic potential that Vipassana has. For instance, many case report studies have been recorded, on the positive effects of Vipassana in different psychosomatic disorders, such as chronic pain, headaches, bronchial asthma, hypertension, peptic ulcer, psoriasis etc. and so also in different mental disorders including alcoholism and drug addiction. Beneficial effects of Vipassana have also been studied in special population groups such as students, prisoners, police personnel and individuals suffering from chronic pain and various other mental disorders.

However, healing - not the cure of disease, but the essential healing of human suffering - is the purpose of Vipassana. Suffering springs from ignorance of one's own true nature. Insight, truth - experiential truth - alone frees one (Fleischman P.R.,1991). "Know thyself," all wise persons have advised. Vipassana is a practical way to examine the reality of one's own mind and body, to uncover and solve whatever problems that lie hidden there, to develop unused potential and to channel it for one's own good and the good of others.

All people need healing, most particularly healers. "Physician heal thyself," is a well-known phrase. Freud and Jung insisted that analysts be analysed. The very vulnerability and compassion that sets the healer on a lifelong journey to heal, coupled with the constant exposure to human suffering, requires a treatment of its own. Vipassana is acceptable and relevant to healers of diverse disciplines because it is free of dogma, experientially based and focused on human suffering and relief. With its practice, healers are able to deepen their autonomy and self-knowledge, at the same time augmenting their ability to be a professional anchor to others in the tumult of their lives. Vipassana is verily the path of all healing, including self-healing and other-healing (Fleischman P.R., 1991).

We find that most of the empirical research has been concerned with looking at the physiological and/or behavioural measures related to the use of Vipassana meditation as a self-regulation strategy. Attention also needs to be paid to the classical perspective of Vipassana - phenomenological aspects of meditation-induced altered states of consciousness.

Model for Clinical Application

The clinical utility of Vipassana meditation is more likely to be in terms of providing a general psychologic pattern of positive mental states rather than a response to any particular presenting problem. Generally, the conventional psychotherapies are generated as treatments for the latter. All the same, the author has been using a cognitive therapeutic technique, derived from the system of Vipassana meditation, as a supplementary treatment and has found it to be effective for stress management and reduction of fears and phobias.

It should be noted that the therapist must be well-conversant with the technique of Vipassana meditation and a mature meditator himself. Speaking in Vipassana parlance, the patient observes his respiration (Anapana meditation), while the therapist practises mett± (loving-kindness meditation).

Before commencing the formal therapy, the therapist explains to the patient its potential benefits, particularly relaxation. This helps reduce the latter's apprehension and enables him to cooperate and participate actively in the treatment. In addition, it is necessary to ensure that the physical environment is one that will facilitate relaxation; the room should be quiet and free from interruptions, and the patient's couch should be reasonably comfortable.

The patient is asked to lie comfortably on the couch, close his eyes and observe the flow of respiration by concentrating on the area of the upper lip just below the nostrils - whether in-breath or out-breath, deep or shallow, fast or slow; natural breath, bare breath and only breath. When his mind wanders, the patient is instructed to passively disregard the intrusion and repeatedly focus his attention on his breath, without getting upset or disturbed about the drift of his mind.

Two things happen. One - his mind gets concentrated on the flow of respiration. Two - he becomes aware of the relationship between his mental states and the flow of respiration: that whenever there is agitation in the mind - anger, hatred, fear, passion, etc. - the natural flow of respiration gets affected and disturbed. He thus learns to simply observe and remain alert, vigilant and equanimous.

The patient is advised to continue practising the technique on his own, twice daily, in the morning and in the evening, each session lasting for about thirty minutes. The therapist reviews the progress of his patient from time to time, simultaneously counselling and motivating him to undertake a regular ten-day Vipassana meditation course. The patient is thus encouraged to continue to strive for his personal autonomy, that is, to take personal responsibility in his own health and well-being.

Conclusion

It is my contention that this technique shortens the total duration of treatment and helps the patient cope better in the community by providing a general pattern of stress-responsivity less likely to trigger specific over-learned maladaptive responses, whether psychological or somatic. Moreover, there is a change in the patient's internal state, whereby his attention is focused, his perceptual and motor systems function optimally and his anxiety is minimized. This happens in spite of, and while meeting, a great variation in the external environmental demand by virtue of self-regulating and developing one's internal capacities with Vipassana meditation.

Multicentered controlled clinical trials of this technique with sophisticated experimental designs would help us to study its value and limitations in the prevention and treatment of various psychiatric disorders. Also, it needs to be clarified as to which patient with what clinical problem will benefit from Vipassana meditation as the treatment of choice vis-a-vis other self-regulation strategies, viz., biofeedback, hypnosis, progressive relaxation, etc.

References

Fleischman P.R. (1986), The Therapeutic Action of Vipassana and Why I Sit, Buddhist Publication Society, Kandy, Sri Lanka.

Goleman D. (1977), Meditation and Consciousness: An Asian Approach to Mental Health, Am.J.Psychother.30:41-54.

Kutz I., Borysenko J.J. & Benson H. (1985), Meditation and Psychotherapy, Am.J.Psychiatry, Vol.142, No. 1:1-8.

Narada Thera (1986), A Manual of Abhidhamma, Buddhist Publication Society, Kandy, Sri Lanka.

Surya N.C. (1979), Personal Autonomy and Instrumental Accuracy, in "Psychotherapeutic Processes," editors: M. Kapur, V.N. Murthy, K. Satyavathi and R.L. Kapur, N.I.M.H.A.N.S., Bangalore, India:1-19.

Thray Sithu Sayagyi U Ba Khin (1963), "The Essentials of Buddha Dhamma in Meditative Practice," this Journal 31-35.

Wolpe J. (1958), Psychotherapy by Reciprocal Inhibition, Stanford University Press, Palo Alto, California, USA.