CHAPTER
20

Zen and Mental Health

In This Chapter

The relationship between Zen practice and mental health presents some very interesting questions. In a way, isn’t Zen aimed at mental health? Especially with all the meditation and mindfulness being used in the mental health care field these days, what is the difference between those tools and Zen? What’s the difference between working with a therapist and working with a Zen teacher? Is there a time when you should get mental health care instead of practicing Zen?

I am not a mental health care professional, so what I offer here is from the point of view of a Zen teacher and practitioner. Quite a number of Zen or Buddhist teachers are also psychotherapists, psychologists, or psychiatrists, however, and they’ve written some good books about the intriguing relationship between Western Zen practice (which has been influenced by psychology) and mental health issues and treatment. These include Barry Magid’s Ordinary Mind: Exploring the Common Ground of Zen and Psychotherapy and Philip Martin’s The Zen Path Through Depression.

Zen Versus Mental Health Care

It may or may not have occurred to you that there is sometimes a tension between Zen and professional mental health care. By mental health care, I am referring to the treatment of psychological problems through therapy, medication, behavioral modification programs, and sometimes the formal diagnosis of mental illness. There are lots of people faced with issues like anxiety or depression who wonder whether they should opt for Zen or therapy. Others get involved in Zen and then wonder whether it can really address their mental health issues properly. From the point of view of a Zen teacher, it can also be tricky to decide when to refer someone to a mental health care professional.

POTENTIAL PITFALL

Beware of thinking you can find one solution that will fit all of your problems. It’s tempting, if you discover something that works well for you, to assume you can rely on it for support, answers, and resolution no matter what you’re faced with. Maybe you can rely on it almost all the time … but if you limit the resources you’re willing to use because you want to stick to one solution only, you may shortchange yourself.

Here I will illustrate some of the differences between formal Zen practice and mental health care, but also challenge the idea that using whatever tools you can find to relieve your suffering isn’t Zen. In a way, Zen and psychotherapy present a prime example of a Buddhist paradox: they aren’t the same, and they aren’t different. In this wonderful, complex world of ours, both of these statements can be true at the same time.

The Useful Dichotomy

It’s definitely useful to make a distinction between formal Zen practice—using the tools de-scribed in Part 2 of this book—and availing yourself of the resources available in the field of Western psychology. Generally speaking, both options involve some study of yourself and aim at reducing your suffering and increasing your happiness. Despite some apparent similarities, there are three main differences between Zen and mental health care.

First, there may be overlap in some of the methods used, but there are many tools used in psychology that are not used in Zen, and vice versa. The number of different types of therapies, medications, treatments, and approaches in modern psychology is so great and variable it’s difficult to summarize what is offered there that isn’t offered in Zen. Suffice it to say that Zen does not deal with medications, diagnoses, or triage for severe mental health crises. For the most part, Zen is going to assume you’re feeling well enough to cope in your daily life, and if you aren’t, it can’t offer you the tools that are regularly employed in the mental health field for helping you get your life back on track.

Second, and closely related, a Zen teacher receives vastly different training than a mental health professional. Someone who becomes licensed to practice psychotherapy or psychiatry has had a rigorous education in modern psychological methods. A Zen teacher, unless they are also trained in psychology, will be more or less clueless about those techniques and approaches. What they will know intimately is the Zen method, and their goal will be for you to learn that method and apply it yourself.

A Zen teacher, ideally, will also have significant insight into Zen teachings and into their own karma. They will have started out like you, applied Zen tools to their life, and obtained some measure of satisfaction. So when they guide you in Zen, they’re guiding you through a process they themselves have experienced. Still, their knowledge is specialized and doesn’t necessarily cover all the problems you might have (although the same could be said about a mental health professional).

Third, while both formal Zen practice and psychological treatment can help you become healthier and happier, which one you need the most can change at different times in your life, depending on your mind-state and conditions. It may seem ironic, with all the Zen emphasis on giving up attachments and seeing the emptiness of self, but it’s actually beneficial to have a strong sense of self when you engage Zen practice. It’s also good to have some healthy confidence in yourself and in life before you start challenging your delusions and narratives.

The introspective Zen practices, particularly zazen, karma work, and cultivating insight, can be difficult or even harmful if your natural sense of self is incompletely formed, or has suffered a trauma. This can also be the case if you’re finding it difficult to engage with daily life because of anxiety, depression, or other psychological issues. In these cases, it’s not that Zen introspection doesn’t work, it’s that it isn’t what is most needed.

CONSIDER THIS

Nothing in this chapter is meant to discourage you from practicing Zen if you have mental health issues. Many Zen practitioners credit their Zen practice for their lasting freedom from despair, depression, anxiety, and other psychological problems. However, most of these people also made use of Western psychological techniques and treatments in order to support their life and practice through difficult times.

What is needed when you’re in a mentally or emotionally fragile or volatile state is healing, support, and stability. There are many ways to meet these needs, and it may well be that therapy or medication will be very beneficial for you. Healing wounds, encouraging self-esteem, putting boundaries around unhealthy behaviors, boosting confidence, and soothing anxiety are not really Zen’s areas of expertise. However, I should state very clearly that such things can happen in a Zen context.

Mindfulness can ease anxiety, precepts can stabilize your daily behavior, and various other Zen practices can be a source of strength and solace, such as chanting, walking meditation, scripture copying, working with a teacher, and participating in a sangha. It’s just that it will probably be up to you to monitor whether a practice is helping, and whether you’re getting enough help.

The False Dichotomy

The dichotomy between Zen and mental health care becomes false when you think of Zen in a larger sense than its set of formal practices. As described in Chapter 3, you can think of Zen practice at different levels, and at the most subtle and profound level it’s approaching each moment of your life with awareness and the intention to decrease suffering for yourself or others. How could taking care of your mental health not be part of your practice in this sense?

The sad thing is, people who face mental (or physical!) health challenges sometimes conclude that they can’t practice Zen after all. Sometimes there’s the perception that Zen is only for people with perfect mental health—people with robust egos and a sense of fearlessness when it comes to facing their delusions and embracing emptiness. This is not true at all. Zen is about being completely present and aware with your life just as it is.

It may be that your psychological condition means it’s not helpful for you to sit zazen. It may be that past emotional trauma causes you to dissociate when you are trying to let go of attachments, so you need to spend some time encouraging your emotions and celebrating your attachments. Because of your limitations you may feel disappointed or inadequate, as if the deep liberation and joy Zen offers will be forever beyond you. Amazingly, this does not have to be the case. All you have to do is make your mental health issues into practice. Facing, accepting, and working with mental health challenges requires an enormous amount of letting go, and it can result in profound insights into no-self.

ZEN WISDOM

“I had always depended on my practice of Buddhism to help me in difficult situations. But [when I found myself in a severe depression] it didn’t seem enough, or relevant to what I was going through …. But I had always believed in a spiritual practice that was about settling deeply into life, going into the depths if necessary. So I persisted, trying to find a way to connect this practice to what was happening with me …. My practice and path are Zen Buddhism. I found I was finally able to bring my depression into the vastness of my practice, and I learned that others can, too—whatever their own spiritual leanings.”

—Philip Martin, from The Zen Path Through Depression

Mental Health as Zen Practice

If you are facing mental health problems, you have some perfect opportunities for Zen practice. These may not be the opportunities you’d like, but engaging them wholeheartedly can result in deep transformation and liberation from suffering. Chances are, you’d rather sit peacefully in meditation until you experience transcendent insights about the nature of the universe (who wouldn’t?), but generally speaking it’s the difficult stuff that ends up challenging your sense of self and the way you cling to attachments.

Who Cares What People Think?

One way you can practice with mental illness, mild or severe, is to give up concern about what other people think. There are few things in this world that can make you feel as much shame as mental illness. When you are beset by anxiety attacks, paranoid delusions, paralyzing depression, a nervous breakdown, or something less dramatic, you may end up feeling like you have lost control and are weak, flawed, unreliable, unlikely to receive respect … the list goes on. It’s bad enough if you think these things yourself, but when you contemplate what people would think if they found out, it can be devastating. If they already know, you may feel the label of mental illness weighing heavily on you.

Letting go of caring about the opinions of others isn’t about rejecting your need for human warmth and support, it’s about refocusing your attention on your reality, without reference to others. This is essentially mindfulness practice. When you mindfully wash the dishes, you pay attention to your experience of the activity in and if itself, without thinking about what you are going to do next or whether this activity is worthy of your attention.

You can do the same thing with the activities that involve taking care of your mental health, such as attending therapy, trying to sit still through a wave of anxiety, or getting enough exercise to fight off depression. All of these things are part of your life as it is, and being completely present in them lets you appreciate them. Who cares what other people are doing? Who cares how their life compares to yours? Dwelling on comparisons and the opinions of others is the small self trying to build itself up into significance in the relative world. If you can see how opinions and standards have no inherent, enduring reality, this is an important spiritual insight.

Letting Go of Ideas

Another way to make mental health work part of your Zen practice is to let go of your ideas about who you are and who you would like to be. This is tough! Still, from the Zen point of view, all of those ideas are just creations of your mind that you have attached to your self-concept.

In Chapter 13 I explained how we all attach certain things to our self-concept in order to feel more substantial and real. Some of your favorite attachments are naturally going to be ideas about who you are and what you want to do in your life. These attachments simply cause dukkha, or the sense that things should not be like this. When you realize that the attachments are not necessary to your life, you can engage each moment without reference to them. You are free, appreciative, and attentive, even if you are facing situations that run counter to your stories about yourself.

POTENTIAL PITFALL

It’s also possible to incorporate mental illness into your self-concept, which means in some subtle way you will be invested in keeping that label. Assuming you would prefer mental health, it’s good to remember that the label “mental illness,” or the label of any particular diagnosis, is ultimately just a concept. It may be useful at times, but it has no inherent existence. You can let go of your attachment to it just as you can let go of anything else. This lets you embrace change if it comes, and reminds you that you are not defined by a label.

You probably don’t like the idea of having mental health issues, which can be very daunting and scary, so they are unlikely to be part of your self-concept. Therefore, if you are having psychological problems, you’re receiving a strong challenge to your sense of self. While this can be confusing and painful, it’s also a great opportunity. Life has deprived you of being able to say things like, “I am always clearheaded about things and can trust my perceptions.” You may no longer be able to say, “I can predict how I am going to react to things,” or “I have a stable, positive outlook on life.”

Can you let go of having a story to tell about yourself? Can you encounter each situation in a fresh, open way; do your best, and just see what happens? If you can, you’ve made significant headway in letting go of attachments.

Appreciating No-Self

If you can’t control your own mind, or can’t always trust your perceptions and thoughts to be true, where is your self-essence? Not in your mind, apparently. If you need to avail yourself of medication, treatment, or therapy that alters the way you think or behave, who are you? Are you really you only when you are without treatment?

Mental health issues can be a profound lesson in how the self is empty of any unchanging, independent essence, as discussed in Chapter 11. As you find yourself dependent on support or interventions from the “outside,” your sense of a separate, autonomous self can get whittled away. When you watch large swings in mood or outlook, your sense of a continuous, unchanging self that moves through time can be severely challenged. This is part of why mental illness can be so traumatic.

Zen practice can help just by putting all of this in context. Of course it hurts. Of course it’s disorienting. But it’s also okay. Mental health problems are irrelevant to your buddha-nature. When you are emotionally or mentally volatile or fragile, it isn’t the time to push yourself into a fuller experience of emptiness. You don’t need to; you are experiencing it personally already. Just being gently present with your day-to-day life will inform you.

When to Turn to a Mental Health Professional

When is it time to avail yourself of professional mental health resources in addition to, or instead of, Zen practice? There is no hard-and-fast rule here, unfortunately. It never hurts to see whether therapy or mental health treatment might be helpful to you. It can be part of your Zen practice in the larger sense of the term.

CONSIDER THIS

There are a growing number of mental health professionals who also have experience with meditation, Buddhism, or Zen. You may want to seek one out if you have decided to seek therapy or treatment, because they will have some insight into what you are doing in your Zen practice. Some psychotherapists are long-term practitioners of Zen themselves and may be able to help you integrate your therapy with your Zen.

However, if your mental health issues are interfering with your functioning in daily life in a substantial way, you should seek help from a mental health professional. If your anxiety or depression is making it difficult to work, for example, or your neuroses are threatening your relationships, or you are actively contemplating suicide, it’s time to look beyond the traditional Zen tools for a solution.

It’s up to you to decide if and when you’ve reached the threshold of your psychological issues “interfering in a substantial way” with your daily life, but keep an eye out for an unwillingness to admit you have reached it. It takes humility and courage to acknowledge you’re facing problems you need help with—problems that may challenge your idea of yourself or even get you labeled with a psychological diagnosis. Getting help when you need it can be another important part of your Zen practice, requiring you to face the truth and embrace humility.

How Mental Health Care Complements Zen

Zen practice and Western mental health care both have strengths and weaknesses. Neither one is perfect and complete, and they can actually be quite complementary. Many of the shortcomings of Zen have to do with misunderstandings about what the practice really entails, or what Zen teachings really mean, but anything that is easily misunderstood is therefore imperfect.

One of the primary weaknesses of Zen, from the point of view of maintaining mental health, is that it doesn’t deal so well with emotions. It has the potential to do so, but because of all the emphasis on letting go, there’s a danger that you will try to let something go before you have fully acknowledged, processed, and embraced it. Zen doesn’t offer many explicit tools for exploring emotions, while psychology offers many of them.

You can certainly allow emotions to arise during your meditation, or attend to them with mindfulness, or explore them in karma work. Unfortunately, these methods can seem to imply that you should experience a certain dissociation from the emotions, rather than feeling them deeply and seeing how they are a part of you. While it is possible to do the latter in Zen practice, the process will probably be mostly self-guided. In contrast, some Western psychological methods are explicitly aimed at uncovering and experiencing your emotions, and the thoughts or memories underlying them, and can be very useful.

ZEN WISDOM

“Zen does not have all the answers to all the problems of the human condition. Psychoanalysts need not simply defer to Zen’s greater wisdom and longer history. Zen needs psychoanalysis as much as psychoanalysis needs Zen. In particular, Zen needs psychoanalysis to keep it emotionally honest.”

—Zen teacher and psychoanalyst Barry Magid, from Ending the Pursuit of Happiness: A Zen Guide

Another weakness of Zen is its inability to address the importance of your conditions. It encourages you to accept your life as it is and find liberation and joy right here, without searching around elsewhere for it. Ultimately this is possible to do, no matter your conditions. However, your conditions may be making it extremely difficult not to succumb to depression or anxiety, which don’t help you practice. Past or current trauma may have left you with significant psychological issues or barriers that upset your life and make it difficult to concentrate on acceptance or understanding. Your emotional issues may be exacerbated or triggered by current dysfunctional relationships.

Basically, sometimes it’s time to do something about the state of your life, and Zen isn’t necessarily going to encourage you into action. Western mental health care, on the other hand, is much more likely to address your conditions, particularly your psychological ones.

The kind of suffering Zen is really good at dealing with is subtle: the kind of unhappiness that people can have even when everything is going great. This is where psychological treatment tends to reach its limits. You might say that Zen takes over where Western psychology leaves off, addressing the deeper issues that some people would call spiritual. Still, the line between suffering that requires action and suffering that’s “just in your mind” is often unclear.

Sometimes Zen practitioners can feel a little bit like they’ve failed when they turn their attention toward improving their conditions instead of just accepting them, but this is creating a false duality that isn’t actually the truth of Zen. The acceptance and the doing are not opposed to each other. The most effective doing happens when you’ve accepted the way things are, and sometimes you aren’t really accepting something unless you start doing something about it.

When to Be Careful with Zen

Again, I am not a mental health professional, and there are books available that are written by such professionals on how Zen or Buddhism relates to depression, anxiety, and other psychological issues. However, in a book like this one, which tries to be comprehensive, it’s worth mentioning a few kinds of mental health issues that require you to be careful with Zen tools.

This is not an exhaustive list, but some of the issues that come up most frequently for Zen practitioners are dealing with an incompletely developed sense of self, depression, and posttraumatic stress. This is not to say you shouldn’t practice Zen if you are experiencing, or have experienced, any of these things. It’s just that you should be aware that not all Zen tools and teachings will be helpful to you all the time, and reaching outside traditional Zen for additional support may be very useful.

Strengthening the Self

I was once deeply touched when I heard the Dalai Lama at a public lecture, when he said that in order to practice Buddhism you need a strong sense of self. This seemed so radical to me! Weren’t we trying to get rid of the self? Wouldn’t a strong sense of self just be an obstacle to practice? And yet, I had an intuition that what the Dalai Lama said was true, and it gave me hope because I definitely had not gotten free of a deep conviction that I existed, concretely and very significantly.

What is a strong sense of self? It is a well-developed self-concept, complete with stable narratives about who you are, what’s yours, what you like and don’t like, and what you want. It is a sense of a clear boundary between yourself and the rest of the world. It is a belief that you have some measure of control over the things you identify as self, and confidence that you can move about in the world effectively and autonomously. It is a conviction that you have a self-essence that continues through time, and that you own enough territory in this world to figure in its ongoing drama.

This list could go on, but suffice it to say that a strong sense of self lets you navigate successfully in the world, protecting your self-interests and trying to gain what you desire.

It takes time and maturity for human beings to develop a strong sense of self, and there are many ways its development can be undermined. In particular, abuse, trauma, and seriously dysfunctional relationships can confuse boundaries and result in an unstable or tentative sense of self. Some mental illnesses with genetic or physical components contribute to this. The weaknesses in your sense of self can be subtle or substantial, but in either case what you need is some of the nurturing support, encouragement, and validation that children require in order to grow up confident and strong. This may mean that you need to spend some time and energy on pursuing things that make you feel good, loved, successful, and whole.

If your sense of self is underdeveloped, it may not be helpful for you to attend austere Zen meditation retreats and spend hours contemplating how you don’t really exist, or how everything changes and nothing can ultimately be depended on. You’re welcome to try these practices, but watch carefully what effect they have on you, and check in with a teacher if you can. It may also be wise to form a relationship with a mental health professional who can help monitor and build up your psychological strength and sense of self.

CONSIDER THIS

When trying to judge how much intensive Zen practice to do when you’re feeling fragile or volatile, think of the metaphor offered by the Buddha. He explained that in practice you want to keep yourself tuned like a lute. If a lute string is too loose, it won’t make a beautiful sound. If it’s too tight, it will break. What you’re looking for is the “just right” place in the middle, and it takes constant adjusting to stay in tune. Too much intensive practice can be like tightening the lute string too much. You don’t want to break; you want to make beautiful music with your life.

When Zen asks you to let go of searching for happiness and validation from outside things, it’s assuming that you have already done plenty of this. It assumes you have a vital and energetic relationship with life, and a strong determination to take care of yourself. Zen uses that very self-interest—your desire to be happy and free from suffering—to motivate you to explore the true nature of human existence and suffering. It asks you to see how you are naturally good, worthy of being loved, successful, and whole, and to see that therefore you don’t have to depend on outside things for happiness.

But this is about seeing the true nature of your relationship to the world, not about withdrawing from the world out of fear or despair. Zen is about seeing the true nature of the self, not destroying it. When your self is destroyed, you have nothing to work with. It is your vehicle for life and practice, so it needs to be taken care of with loving attention.

Fighting Depression

Another mental health challenge that requires you to be careful with Zen practice is depression. In a strange way, depression can make you feel like you are acting out Zen practices and teachings, but with a negative result. The Zen teaching on emptiness can resonate with you because everything seems pointless and hollow. Giving up self-attachments can seem like a nonissue because you can’t care about anything. Sitting still and alone on a cushion meditating can seem preferable to dealing with the world. And yet, all that happens is you sink deeper and deeper into the dullness and torpor of depression. But then, who cares?

What you need when you’re depressed, and what Zen is unlikely to give you, is a nudge to get you moving. You need active encouragement to engage with life, to exercise, to take care of yourself, and to do whatever you can to jolt yourself out of your depression. Depending on the seriousness of your condition, you may need medication to provide that jolt. Many successful Zen practitioners have availed themselves of this tool and found that it allowed them to do Zen practice. The Zen tools of introspection can just make your depression worse if all you can see when you are meditating is how bleak everything is.

Fortunately, there are Zen tools that can be helpful even when you are depressed. Mindful activity in the form of walking meditation, bowing, chanting, or simple physical work can pull your attention out of depressive loops. Practices like metta—sending wishes of loving kindness to others—can shift your attention away from the state of your mind. However, nothing beats finding something to do that you enjoy, even if your capacity to enjoy it is somewhat compromised. Try getting a massage, going on a hike, reading a mystery, or painting a picture—activities outside of traditional Zen practice, but which can help you connect with life again.

Dealing with Trauma

Living with the effects of trauma is another effort that requires taking some care with Zen. You can end up triggered into an extreme emotional, psychological, or physical reaction through Zen practice, and then find yourself in a situation where the people around you don’t know how to help you. Of course, this is true wherever you go, not just in Zen practice settings; but you may assume that because Zen teachers encounter all kinds of emotions and experiences in their students, they will understand yours. However, they may not recognize your experience for what it is (a reaction due to past—or current—trauma), or may not recognize its seriousness (there’s a huge difference between feeling anxious, for example, and a full-blown panic attack).

In addition, in the context of Zen practice it may be seen as positive to experience stress or negative emotions as you face and process your karma; but if you are dealing with the effects of trauma, it’s easy for the stress and negative emotions to become too overpowering. It may be difficult for you to handle the feelings and still go about your daily life, let alone examine them more closely while hoping to gain some insight into them.

Introspective Zen tools can sometimes increase the chances of being triggered into an overpowering emotional response. This is especially true of long, silent meditation retreats. If you are dealing with trauma and are interested in meditation and retreats, however, you shouldn’t necessarily refrain from doing them. Just do so carefully and thoughtfully, and preferably with the assistance and feedback of a mental health professional and a Zen teacher. Be honest with both of them about your history and symptoms. They can help you monitor what is helpful, and how much is too much.

ZEN WISDOM

“Putting words like Zen, trauma, and spiritual together … seems at first glance to be a stretch, yet the experience of trauma survivors is often singularly spiritual. Moreover, the experience of recovery from a traumatic experience has a darkside and a lightside. Trauma recovery is cyclical, often a lifelong process, much as the yin and yang of Dao. A traumatic experience both touches and invites our essential, true nature.”

—Zen Teacher Harvey Daiho Hilbert, Vietnam veteran and clinical social worker with other survivors of trauma, from The Zen of Trauma

In the meantime, seeking support and guidance from a professional who understands the effects of trauma can be very useful. It can be an immense relief just to know you aren’t alone and that your experiences are typical reactions to trauma. There are also tools, medications, and techniques available to help you manage symptoms and reactions. As mentioned earlier, if you think of Zen practice as approaching life with awareness and an intention to relieve suffering, dealing with the effects of trauma is Zen practice, too.

The Least You Need to Know