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The Approach Of Ancient Healing:
Psychotherapy In Buddhism
Bhikkhuni Khemanandi Huyen-Chau
POSTGRADUATE INSTITUTE OF PALI AND BUDDHIST STUDIES
THE APPROACH OF ANCIENT HEALING:
INDEX N0 2004/ MA/ 903
Over two and a half millennium years ago what the Buddha – The Supreme Enlightened Master- taught during a period of forty- five years has been studied in various aspects by a long line Buddhist patriarchies dawn generations of master-pupils lineage, so it is possible to find out in the canon the aspect of Buddhist psychotherapy takes shape.
Psychotherapy is the only form of therapy it is. If mental disorder arises in someone, it will be effectively solved by one's own mind of knowing and seeing one's own defilements with the good co-operation between oneself and the psychotherapist. That is the first important factor in the process of healing.
Mano pubaṅgamā dhammā
(Mind is the forerunner of all (evil) conditions.
Mano pubbaṅgamā dhammā
(Mind is the forerunner of all (good) conditions.
These two stanzas which are opening of the Dhammapada, were spoken by Gotama Buddha more than 2,500 years ago. They elucidate the crucial theme of Buddhist teaching, the human mind. The 'mano' here also signifies six-fold sense experience that is eye, ear, nose, tongue, body and mind episode. The happiness or suffering depends on the attitude of one's own mind: correct or incorect (yoniso-manasikāra vā ayoniso- manasikāra). If the mind understands in a good way, happiness arises. On the other hand if the mind interprets in a bad way, suffering is a consequent result and when the mind is out of control, at that time mental disorder takes place.
Further, the Buddha was the first one to point out a disparity between mental sickness and physical sickness. He says that
Dveme, bhikkhave, rogā Katamā dve? Kāyiko ca rogo cetasika rogo. Disanti, Bhikkhave, sattā kāyikaṃ rogena ekampi vassaṃ ārogyaṃ paṭijānamānā,…vassasataṃpi, bhiyyopi ārogyaṃ paṭijānamānā. Te, bhikkhave sattā, sudullabhā lokaṃpi ye cetasika rogena muhuttaṃpi ārogyaṃ paṭijānanti, aññatrā khīṇāsavehi. (AN, Catukka-Nipāta, Roga Sutta No.157)
"Monks, there are these two kinds of disease. What are they? They are bodily disease and mental disease. People are seen who say they have been physically healthy for one year, ...for more than one hundred years. But apart from those whose cankers are destroyed. (i.e the Saint or Arahants), beings who say that they have been mentally healthy for even a moment are rare in the world." (AN, Catukka-Nipāta, Roga Sutta No. 157).
The three cardinal causes of mental sickness could be discovered more than 2,000 years in Charaka Samita. They are: 1: rajas: defilements; 2: thamas: darkness or confusion; 3: satva: the imbalance of mind, bile, phlegm. With the technique of analysis of the mind contents, the mental cause have to be exposed either by the mental patient's knowing or seeing.
"It is worthy to note that nowadays, there are in Sri-Lanka a number of traditional mental hospitals, some of them are run by Buddhist monks." 
Psychotherapy is a combined word of Psychology and therapy according to Oxford Dictionary and Thesaurus, Psychology has two meanings: 1: Study of mind, 2: Mental characteristics. Therefore, Psychotherapy means treatment of mental disorders by the use of psychological method under some instructions of the Psychotherapist.
It is worthy to note that: "Freudian psychoanalysis works on the assumption that when the origin of a personal disorder is known its influence on unconscious motivation will automatically disappear." However, in reality it proves that there exist so many unsolvable cases.
The following is the limitation of the Western Psychotherapy:
II. Limitations of Psychotherapy:
There are five systems of psychotherapy that are being practiced and developed during the last two centuries in the Western world. They are:
1: Chemotherapy is the most popular and intensely used method of psychotherapy. Psychiatrists use chemicals or chemical compounds to create balance between the body and the mind of the mental patient.
2: Electroplexy is also a special therapy; only Psychiatrists can use it. The mental patients are given electric shocks of short duration from special electrical devices and they do not notice the psychology of mental patients.
3: Psychosurgery is the brain operation with a view to altering or normalizing certain behavior patterns of mental patients. This method is so dangerous to the risk of the mental patient that it has not been popular.
4: Behavior therapy: The behavioral scientists or social psychologists have used the advanced system of therapy in order to change or remove the symptoms of mental sickness so that normal behavior would be restored.
5: Psychoanalysis: According to Freud, Psychoanalysis is called depth psychology. Some techniques are used to help the mental patient to become aware of the causes of his mental sickness. It can be used to analyze experience and behavior of the depth consciousness of mental patients, especially with the discernment of the dreams and mental disorders that have the same character of neurotic symptoms.
It has been now proved that the diversity of mental life between so-called normality and neurotic is only a matter of degree. This invention based on The Freudian formal saying: "We are all somewhat hysterical". It sounds like an utterance of Buddhist introspection (Sabbe puthujjanā ummattakā) "All worldlings are prone to be mental illness." 
Psychoanalytic treatment has been proved to have three limitations such as: high cost, time-restriction and not good effect in many cases. In many cases the most it can do is to enable the subject to come to terms with himself and 'live with' his condition. The limited nature of its success is indicated by the need to resort to physical treatment for cases that have passed from neurosis to psychosis, such as electro convulsive therapy for acute depressive moods, insulin injections for the early stages of schizophrenia, frontal lobotomy for prolonged anxiety states and the use of the class of drugs known as tranquilizers which act upon the vegetative inter neurotic circuits of the brain. In contrast to the invention of Western psychiatry, Buddhist Psychotherapy is focused on a high level of the whole individual; since passion is the causal root of suffering it is required to lessen, and finally uproot passion. However passion is also the principal stimulating force of discretion, therefore the first step of the process must be the replacement of higher purpose for the impaction of the libido and their subsidiary things.
The libido – activated craving must give place to the mindfully directed incitement of the higher mind (Adhicitta). It is here that Buddhism presents a site of testimonial which Western psychotherapy has been unable to adjust suitably for its theories- the outlook of moral values.
Even depth psychology that is closer to Buddhism than to other sciences deals with the mind only to the dimension of transmuting hysterical misery into daily non- appeasement or unhappiness. It could not go beyond that to the superlative form of psychological maturity that is as deep as that of an arahant- the ideal of psychological superiority in Buddhism. Thus, Buddhism especially Abhidhamma- Buddhist psychology- pays much radical attention to the mind more than any other sciences of human mind.
III. Concept of man in Buddhism
Man is the most honorable creature in the whole world. One should consider all other men as one's own brothers, as the members of the same great family of humankind without any discrimination of race, caste or rank.
In the Vasala Sutta of Sutta Nipāta Pāli, It states that:
Na jaccā vasalo hoti, na jaccā hoti brāhmano
(It is not by mere birth one becomes an outcast or noble, but by one's action.)
Being reborn into a certain family, lineage or class or nation a man should not be looked down upon by another man. In another words, by mere birth it does not make man noble or ignoble but by three fold actions: bodily, verbal and mental actions. In Buddhist history there are various cases illustrated that. Devadatta was born of royal lineage and attained the five mundane higher powers (Abhiññā), but because of his jealousy towards the Buddha, he committed grievous crimes and was swallowed by the earth; Aṅgulimāla was a son of a minister who became a notorious robber but when he was transformed into a disciple of the Buddha, he became an arahant - the noblest stage! ...
Thus, man is the architect of one's own future or destiny. According to Buddhist psychological aspect, the disposition of man is conditioned and nourished by the action of mind (manas) and as a result the personality and destiny of man are also likewise decided by the mind. That has been illustrated in the two first stanzas of Dhammapada.
According to Buddhist doctrine, man is a psychophysical combination of mind and body (nāma- rūpa). Sensation (vedana), perception (saññā), mental formation (saṅkhāra) and consciousness (viññāṇa) are the non-physical factors in man collectively regarded as mind (nāma); whereas the four great primaries or elements (cattāri mahā bhūtāni) have their characteristics as extensions (earth- pathāvi), cohesion (water- āpo), heat (fire- tejo) and vibration (wind-vāyo). These are the physical factors in man collectively regarded as body (rūpa).
These five various groups (rūpā or material component on the one hand and vedanā, saññā, saṅkhāra and viññāṇa on the other) in which the psychophysical entity called man in analyzable are referred to in Buddhist texts as khandha (fivefold aggregate). It constitutes the basic so-called individual or personality.
Man must be skillful in his own welfare but at the same time he should cultivate his spiritual life. A locality where there is no chance for a person to develop his morality is not suitable to choose for one's living.
A man should have (kalyānamitta) a spiritual teacher to instruct him in the moral aspect, and should associate with and serve as his ideal. A locality where there is such a person to be found is a suitable to live in.
Association with the wise may prevent one from having mental disorders to some extent and make progress in the spiritual life. 
It should be also known that the distinction between the worldling and the arahants is clinging (upādāna). A worldling has been clinging to sensual and sexual desire, to his viewpoint as well as his own body; hence his fivefold clinging aggregate (pañcuppādānakkhandhā). Therefore he is subject to suffering (dukkha) mentally and physically. The paramount importance is eradication of these clingings (upādānā), in other words total absence of greed, hatred and ignorance.
IV. Concept of taṇhā in Buddhist Psychology and its modern parallels 
Psychology-analysis systematically expresses that there are two basic intuitions which hide behind the evident ego intuition and object intuition, namely, eros (the unifying intuition- positive wishes), the intuition that attempts for ever-closer union and thanatos (or the death with the destructive intuition- negative wishes) that results in the decay of what is living. The demonstration of the force of eros is named libido that comes from the Latin word for 'lust'. The Buddhist term for 'lust' is 'taṇhā'.
There are three kinds of 'taṇhā' that are (Kāma-taṇhā): craving for sense-delight, (bhava-taṇhā): craving for self-protection and (vibhava-taṇhā): craving for non-existence. Thus kāma-taṇhā as explained in Buddhism accords with the libido of Freudian Psychology.
The term libido is used to identify the presence of sexual thirst in man. Libido - sexual thirst is regarded as similar to the force of hunger, or the will to power, and other such tendencies among the self-leaning.
With the gradual advance of the libido theory, the term of sexuality became synonymous with the word love. Sigmund Freud says that the central part of what is meant by love consists in sexual love with sexual union as its purpose that is inseparable from this certain affectionate and friendly stimulus. The love for parents and children, friendship, love for humanity and even the devotion to abstract ideals are manifestations of the same instinctive root.
Craving for sense-delight as a demonstration of greed (lobha) and greed that is a fundamental root (mūla) rouses unhealthful state. The Buddhist psychological term of 'root' is called as motivation, motive, force, drive, rousing, instinct, inclination, etc.
The Buddhist concept of motivation is more intelligible easier to understand than the Western Psychology concept of man being born of sin.
The idea of craving for sense-delight as a pleasure tenet is much wider than the concept of pleasure formed in libido, and the therapy for the mental illness is much more deep-reaching and fundamental in Buddhism than in psychology; because psychology focuses on bringing a patient to his normal manners, while this normal person in Buddhist term is called a worldling (puthujjana). To some extent a worldling still has mental sickness until the arahantship is achieved as mentioned in the Aṅgutara-nikāya (AN, p. p 142-3) The Buddha says in this world there are beings who are free from bodily suffering on account of disease for a year... even a hundred years; but it is rarely to find out who can be free from mental disease even for one moment, except for those in whom the cankers (āsāva) are annihilated, namely, an arahant.
Commonly, the libido and the ego-intuition are said to run through 'the pleasure tenet' and the reality tenet respectively. The reality tenet expressed in this certain 'reality tenet' is alien to reality of the Buddhist concept. In Buddhism, this psychological reality is also a demonstration of craving (taṇhā).
According to final Freudian analysis, the reality tenet that is substituted for the pleasure tenet does not mean a dethronement of the pleasure tenet but only the preserving of it. An ephemeral delight, indefinite in its results, is given up, but only in order to acquire a convinced pleasure coming later.
The concept that ego - intuition demonstrates itself as self-protection, self-adoration, self-assurance, self-admiration, self-constant etc shows how far it searches pleasure and how far it is conditional on craving. In the certain aspect, it is only a form of craving named (bhava-taṇhā): craving for self-protection in Buddhism.
During two decades, Sigmund Freud developed several methods for reaching the unconscious that is similar to the concept of the unconscious in early Buddhism. It means the concept of sleeping predisposition (anusaya) and the concept of mental tendency (mano-saṅkhāra). Anusaya and mano-saṅkhāra like unconscious lie dormant in the deeper level of the mind and have an effect on manners of the worldlings (puthujjanā) without their comprehension. Thus, they become the parts of a feature of unconscious rousing. Nevertheless, the mano saṅkhāra have a broader scope extending through countless births which clinical psychology has not unveiled still. Among the seven anusaya (D.III p.254) vicikicchānusaya (anusaya of skeptical doubt) and avijjānusaya (anusaya of ignorance) stay beyond the range of psychology, of the remaining five anusayas, kāmarāgānusaya (anusaya of sensuous craving corresponds to the libido, paṭighānusaya (anusaya of antipathy), the thanatos, and diṭṭhānusaya (anusaya of wrong view or conjecture) and mānānusaya (anusaya of conceit), and bhavaragānusaya (anusaya of craving for existence), the ego.
The following is the comparisons of kilesa, anusaya and saṃjoyana.
The first three fetters in the above list represent the first defilement while the eighth and the ninth fetters represent the sixth defilement. Others are identical except the tenth defilement that is not found among the six basic passions, but is given as one of the ten passions enumerated by the Theravadins. 
The anusaya are so-called passions that lie dormant in a person's stream of consciousness (citta-santana) that is called bhavaṅga citta in Theravada and the Alāyavjñāṇa in the Yogācāra school. It is like a sleeping serpent existing from unknown time but it may cause the mental patient to act in an unreasonable manner.
Thus, every worldling has potential craving (taṇhā) or defilements (kilesa) the cardinal importance is how much one can be able to control oneself. The way to control oneself is nothing than mindfulness.
Mindfulness and awareness in every rousing of the mind is their target. If one can be able to detect at the first moment of every response of one's mind, which is very useful to one's own cultivation and one's purification of mind.
On the other hand if one fails to detect at the time of its rousing in one's mind, one can be carried away by verbal action and bodily action. Even in such a state if one is unable to control it, it means one becomes mental illness.
In other words response of mind or rousing of mind is called emotion.
V. Emotions - the root cause of mental disorders. 
On the superficial aspect, a near and prime cause of mental disorders is modern trading advancement that is ceaselessly stimulating and propagating desires which worldlings (puthujjanā) are unable to satisfy fully and become frustrated. However, according to Buddhist Psychology the worldling is identified by mental reactions of craving for states which are impermanent (aniccā), subject to suffering, devoid of reality and inherently impure. These one mistakenly assumes to be permanent, to engender happiness and endowed with self-existence.
One's yearning for them accompanied by mental cankers (āsava), defilements (kilesa) and psychological fetters (saṃyojana), in Buddhism are seen as the root causes of wrong action and consequent misery.
Accordingly in Buddhist Psychology mind is not just cognition. It embraces one's emotion as well as all unconscious mental-emotion reactive motifs. Emotions arise at the scene where mind and body encounter. It is the body's reaction to one's mind or reflections of one's mind in the body. For example, an antipathy thought will cause a process of energy in the body called anger. The body is getting prone to conflict.
Research has proved that robust emotions even cause fluctuation in the biochemistry of the body. The biochemical fluctuation exemplifies the visible aspect of emotion. Obviously, it is not usual to be conscious of all thought motifs, but it is beneficial to one if one can watch one's own emotions so that one can bring them into awareness.
Failing to watch one's own emotions and often being carried away by unwholesome emotions such as: greed (lobha) or sensuous desire (kāmacchanda), hatred (dosa) or ill-will (vyāpāda), laziness and apathy or sloth and torpor (thīna-middha), agitation and hesitation or restlessness and w6rry (uddhacca-kukkucca) and mistrust or doubt (vichikicchā). In other words one may be captured by one of these five hindrances (nivaraṇa) and one's mind becomes disorder!
The Buddha teaches in the Satipaṭṭhāna sutta of the Majjhimā Nikāya as follows:
Bhikkhave bhikkhu dhammesu dhammànupassī viharati?
1. Idha bhikkhave bhikkhu dhammesu dhammànupassī viharati pañcasu nīvaraṇesu. Kathaṃ ca bhikkhave bhikkhu dhammesu dhammànupassī viharati pañcasu nīvaraṇesu?
Idha bhikkhave bhikkhu santaṃ và ajjhattaṃ kāmacchandaṃ 'atthi me ajjhattaṃ kāmacchando'ti pajānāti. Asantaṃ vā ajjhattaṃ kāmacchandaṃ 'natthi me ajjhattaṃ kāmacchando'ti pajānāti. Yathā ca anuppannassa kāmacchandassa uppādo hoti, tañca pajānāti. Yathā ca uppannassa kāmacchandassa pahānaṃ hoti, tañca pajānāti. Yathā ca pahīnassa kāmacchandassa āyatiṃ anuppādo hoti, tañca pajānāti.(1)
Santaṃ vā ajjhattaṃ byāpādaṃ 'atthi me ajjhattaṃ byāpādo'ti pajānāti. Asantaṃ và ajjhattaṃ byāpādaṃ 'natthi me ajjhattaṃ byāpādo'ti pajānāti. Yathā ca anuppannassa byāpādassa uppādo hoti, tañca pajānāti. Yathā ca uppannassa byāpādassa pahānaṃ hoti, tañca pajānāti. Yathā ca pahīnassa byāpādassa āyatiṃ anuppādo hoti, tañca pajānāti,(2)
Santaṃ và ajjhattaṃ thīnamiddhaṃ'atthi me ajjhattaṃ thīṇamiddhanti' pajānāti. Asantaṃ vā ajjhattaṃ thīnamiddhā 'natthi me ajjhattaṃ thīnamiddhanti, pajānāti. Yathā ca anuppannassa thīnamiddhassa uppādo hoti, tañca pajānāti. Yathā ca uppannassa thīnamiddhassa pahānaṃ hoti, tañca pajànàti. Yathā ca pahīnassa thīnamiddhassa āyatiṃ anuppādo hoti, tañca pajānāti.(3)
Santaṃ vā ajjhattaṃ uddhaccakukkuccaṃ 'atthi me ajjhattaṃ uddhaccakukkuccan'ti pajānāti. Asantaṃ vā ajjhattaṃ uddhaccakukkuccaṃ'natthi me ajjhattaṃ uddhaccakukkuccan'ti pajānāti. Yathā ca anuppannassa uddhaccakukkuccassa uppādo hoti, tañca pajānāti. Yathā ca uppannassa uddhaccakukkuccassa pahānaṃ hoti, tañca pajānāti. Yathā ca pahīnassa uddhaccakukkuccassa āyatiṃ anuppādo hoti, tañca pajānāti,(4)
Santaṃ vā ajjhattā vicikicchaṃ 'atthi me ajjhattaṃ vicikicchaṃ'atthi pajānāti. Asantaṃ vā ajjhattaṃ vicikicchaṃ'natthi me ajjhattā vicikicchan' ti pajānāti. Yathā ca anuppannāya vicikicchāya uppādo hoti, tañca pajānāti. Yathā ca uppannāya vicikkicāya pahānaṃ hoti tañca pajānāti. Yathā pahīnāya vicikicchāya āyatiṃ anuppādo hoti tañca pajānāti.
"And how, bhikkhu, does a bhikkhu abide contemplating mental objects as mental objects? Here a bhikkhu abides contemplating mental objects in terms of the five hindrances. And how does a bhikkhu abide contemplating mental objects as mental objects in terms of the five hindrances?
Here, there being sensual desire in him, a bhikkhu understands: 'There is sensual desire in me', or there being no sensual desire in him, he understands how there comes to be the arising of unarisen sensual desire, and how there comes to be the abandoning of arisen sensual desire, and how there comes to be the future non-arising of abandoned sensual desire.
'There being ill-will in him... There being sloth and torpor in him... There being restlessness and remorse in him...There being doubt in him, a bhikkhu understands: 'There is no doubt in me; or there being no doubt in him, he understands: 'There is no doubt in me', and he comes understands how he comes to be the arising of unarisen doubt, and how there comes to be the abandoning of arisen doubt, and how there comes to be the future of non-arising of abandoned doubt."
To note mindfully, and immediately, the arising of one of the hindrances, as recommended in the preceding text, is a simple but very effective method of countering these and any other defilements of the mind. By doing so, a brake is applied against the uninhibited continuance of unwholesome thoughts, and the watchfulness of mind against their recurrence is strengthened. This method is based on a simple psychological fact that is expressed by the commentators as follows:
"A good man and an evil thought cannot occur in combination. Therefore, at the time of knowing the sense desire (that was arising in the preceding moment) that sense desire no longer exists (but only the act of knowing)."
The five hindrances keep pushing, jabbing, knocking one down all the time until one's proper attention and fully understanding them.
The just arising and vanishing is according to conditions in the mind. If one patiently endures through the transient conditions then things change automatically on their own and one has the openness and charity of mind to act spontaneously, rather than reacting to conditions. With bare observation, with awareness, thing go on their own, one doesn't have to get rid of them because that begins, ends. Just be patient with them and allow thing takes their natural course into cessation.
The more one is identified with one's thinking, one's like and dislike, judgment, interpretation and proliferation of mind, which is to say the less present one is as the watching consciousness, the stronger the emotional energy will be, whether one is able to be aware of it or not.
The unhealthy emotional and motivational tracks become toughened by the incessant repetition of motifs of manners that escort their expression. A mannered shift at the level of overt expression of a person's emotion becomes needed in order to enfeeble or to root out the unhealthy emotion.
In Buddhism the problem of dukkha has a close relationship to the level of cognition and the nature of motivational and emotional effect on the individual's disposition. Gotama Buddha teaches that emancipation from the dilemma of human anguish is possible by a conversion at the level of understanding influences on motivation and emotion as well, shifting the total motifs of man's behavioral reactions and feelings.
According to Buddhist terminology such a conversion is identified at Paññā-vimuṭṭi (emancipation through wisdom) and Ceto-vimuṭṭi (emancipation of mind) can be comprehended as the emancipation of a conversion in the emotional edification of disposition.
It is relevant to assume āsava (cankers) under the Buddhist psychology of emotions as it is plainly identified that they are mental phenomena which cause feelings of panic, irritability and annoyance (vighata parilaha) to anyone influenced by them.
There is the enumeration of four kinds of āsava (cankers) in the Pali canon: kāmāsava (those related with sensuality), bhavāsava (those related with eternal existence), diṭṭhāsava (those related with dogmatism or wrong view) and avijjāsava (those related with ignorance or confusion).
Buddhism pays very careful attention to the introspective observation of the stream of consciousness and experience in its healing of psychological phenomena. From pragmatic viewpoint Buddhism considers man's capacity to rectify what goes on in his flow of consciousness as a very dire step in redirecting his emotions and behavior.
Mental patients not only are unable to be mindful of the arising of emotional experience but also are carried away by its domination over their verbal and bodily expressions.
Vipassanā or Insight meditative training implies the development of mindfulness as regards all mental as well as physical processes in connection with one's daily activities.
Mindfulness in time is a good detector to sense the arising of unhealthy emotions such as longing and antipathy at their very inception thus their outwards flow can be stopped by practicing mindfulness (yāni sotāniṃ lokasmiṃ, sati tesaṃ nivaranaṃ).
Insight meditation in Theravada Buddhism is the most pragmatic observation of emotion at the time of its rising, existing and passing away. Such bare observation over the process of unhealthy emotions has the result of hindering them going beyond the boundaries of the mind and clearly showing themselves in overt deportment.
Selection not exhaustion is the Buddhist healing. Since its relation with emotion is controlled by ethical and practical point of view. Buddhism pays no notice of all diversity of emotional and motivational aspects of life but with the selective dealing of them to attain happiness and eliminate suffering of humanity. Thus Buddhist Psychotherapy has made a very significant contribution to human culture.
VI. The process of the ancient healing- psychotherapy.
Psychotherapy is a psychological process that helps to change the mental patient's illusion or hallucination. That is the concept of 'I' and 'mine', happiness and permanence. With the guidance of the psychotherapist, this process helps the mental patient gradually understand and accept the three cardinal aspects of all things: anicca (changing, impermanent), dukkha (suffering) and anatta (non -self); however such concepts have no meaning to the mental patient if these terms are used they may not responded to help. Their purpose is to be able to keep in their mind the concept of ego or self, but without suffering involved.
At the first session, the aims of mental patient and the psychotherapist are at variance. The psychotherapist should make the mental patient burst out his obsessive story and listen to him attentively without taking down notes in front of him.
The psychotherapist should ask the mental patient some questions concerning the change in some visible things or persons around him. Gradually the psychotherapist helps the mental patient to be aware of the law of change...
When the mental patient comes to accept the law of change (anicca), with the delicate guidance of the psychotherapist, the mental patient slowly realizes how much suffering there is in himself as well as in his near and dear ones.
The task of psychotherapy is one of reconciling the out-bursting emotions of the mental patient. It is hoped that the development of communication and relationship among the psychotherapist, mental patient and his family will bring him soon to the normal state.
2. The function of the psychotherapist
Those who would like to help others by this approach needs first of all to become familiar with the technique and have much personal experience in Insight Meditation so that their radiation of wisdom and compassion (karuṇa) will attract the attention of the mental patient.
Restoration of normalcy and mental health of the mental patients are the purpose of the psychotherapist. All worldlings have their own mental defilements such as greed, hatred, conceit...and for a long time they can control themselves; such person are not in the domain of psychotherapist but those who are unable to control their defilements and violently or unconsciously carried away by them in their verbal and bodily expressions are in their real domain.
The targets of the psychotherapist is to help the mental patient be capable of managing their own defilements and to be active as well as understand with an average level of self- awareness.
Making of cartharsis in the mental patients, the psychotherapist must not tell the carthasis of the mental patient to anyone and be a sensitive listener and base on that data to classify the temperament of mental patients such as:
Then, the psychotherapist should choose topics to converse according to their inclinations.
The psychotherapist at the beginning of developing communication has to show his empathy to the mental patient with a great enthusiasm to know his situation and soothe him from suffering due to sickness by forgiving and letting go and opening revaluation for him.
The psychotherapist is endowed with the understanding the four Noble Truths, and able to diagnose a sickness (Dukkha Sacca), designate its cause (Samudaya Sacca), say whether the sickness is curable (Nirodha Sacca) and trace the means of cure (Magga Sacca). Then, the psychotherapist should make the mental patient understand that every thing is subject to change therefore the mental patient's sickness also will be changed.
Good communication has to be set up in the triangular relationship among Psychotherapist (P), to mental patient (M) and his family (F): from P to M, from (M) to (P); from (P) to (F), and from (F) to (M), from (M) to (F) and from (F) to (P).
There are impediments that prevent the psychotherapist from understanding the patient. Passing of the mental patient's emotions on the psychotherapist is a distinctive obstacle that all psychotherapists have to face. For instance, the antipathy or lust or even sexual thirst that exist in the mental patient, may shift such emotions on to the psychotherapist.
Therefore the psychotherapist should ask the mental patient to keep the eyes closed during the time of conversation about thirty minutes. After a break for drinking some kind of beverage, he should suggest the mental patient do breathing exercise with him either sitting on a chair or lying on a bed without pillow: breathing in and out normally five times and then breathing deeply and keeping the breath in the chest for a while and breathing out strongly.
This exercise is good for blood circulation and many functions of internal organs of the body. It is required to do for ten or fifteen times either after getting up or before bed time. If it is necessary it can be done twice a day.
The psychotherapist must practice patience on the mental patient, carefully and attentively listen to the bursting words of the mental patient and have capacity to detect the character of the mental patient by noticing on their facial reactions and bodily behaviors.
Moreover, the psychotherapist is able to get interpretation of the mental patient's dreams and find out its cause hidden in the unconscious.
This process of healing is the process of cooperation between the psychotherapist and the mental patient so the psychotherapist should ask the mental patient whether he wants to come again or not. If he agrees, the psychotherapist should give an exact appointment and good expectation about the mental patient's neat and clean appearance and polite behaviors.
3. The power of now 
No one in the world is totally free from pain and sorrow during one's life span. Isn't it important to learn how to get along with them rather than trying to get away them?
The suffering that the mental patient creates now is always some kind of non-acceptance, some sort of strongly unconscious resistance to what is. It is some sort of negative thinking or incorrect judgment. The intensity of the suffering relies on the level of non-acceptance or resistance to the present moment. Their mind always tries to search for a way to escape from the Now.
That is the main core of all kinds of mental disorders. Therefore, the simple principle is to accept whatever the moment comprises as if it is chosen already. Always get along with it not against it. Make it friendly. This will be the wonderful transformation for your whole life.
The pain-body is survived by the unconscious identification of the mental patient on any experience that produces with its own sort of energy, anything that creates further pain in whatever form: anger, destructiveness, hatred, grief, emotional drama, violence, and even illness. At the moment one observes it, sees it for what it is, and feels its energy field within oneself, one penetrates into it then the identification is broken. A higher dimension of consciousness has come in. One is the witness or the watcher of pain body. One has found out one's own inner strength. One has accessed the now.
In the Pali canon we find out several times the Buddha claims the importance of mindfulness in various cases: Mindfulness is only the way (ekāyano ayaṃ maggo) for the purification of beings (sattānaṃ visuddhiyā), for the overcoming of sorrow and lamentation (sokapariddevānaṃ samātikkhamāya), for disappearance of pain and grief (dukkha domanassānaṃ atthaṅgamāya) for reaching the Noble Path (ñāyassa adhigamāya), for the realization of Nibbāna (nibbānassa sacchikiriyāya).
Pāṭācāra on hearing the Buddha's calling her 'bhāgiṇi', this word was used in very time by the Buddha touched the right chord so that she immediately regained awareness and on listening to his teaching, she not only overcame her sorrow and lamentations but also was established in the fruition of Stream-entry.
Ven. Anuruddha was afflicted with a grave illness accompanied by painful physical sensations. He was however able to tolerate calmly these painful sensations. A group of monks inquired how he was able to do this. Ven. Anuruddha declared that he was practicing the four foundations of mindfulness.
At the beginning one practices mindfulness, one may not overcome pain, pain may not disappear; but with mindfulness one will be able to get along with the pain and accept it. Like that, if one's mind is not disturbed by physical pain, pain is virtually non-existent.
In Mahāsatipaṭṭhāna Sutta (DN, sutta 22), mindfulness on the body is taught in six ways or fourteen ways as follows:
- Mindfulness of breathing
Out of these six ways of developing mindfulness, mindfulness on the breathing process is of pragmatic therapeutic value. This way is easy to practice and easy to understand for the mental patient.
b. Application of mindfulness in sitting and lying
The following is the technique often used by Dr. H S S. Nissanka - the well-known psychotherapist of Sri-Lanka:
c. Application of walking in mindfulness
The psychotherapist should get the mental patient to walk on a plank of about 4 or 5 meters in length and about 10 centimeters in height. Gradually should increase the duration of time. This practice exercises much attention and bodily- balance. Those who have used medication for a long time will get much benefit from this kind of meditation (iriyapātha).
A well-educated lady, after using chemical medicine for a long time, her body got too fat and she became a mental patient. When instructed she has practiced this walking meditation, her weight gets lessened monthly and normalcy is restored
Other ways may not be suitable to the mental patient. In short, mindfulness on the body (kāyānupassanā) is the way for cooling down and achieving normality of physical manners of the mental patient concerned in order to restore mental health.
d. Symptoms: (Phenomena)
The psychotherapist can use Mindfulness meditation techniques in manifold ways. First of all, the approach is very patient-centered; the patient is allowed to be free and dignified to work with himself under the psychotherapist's guidance. This, of course is efficacious because of no confinement of psychotherapy to the hours when both meet together. The course of therapy is more one of the patient's seeing; knowing and accepting his mental processes and then allowing them ameliorate and improve in new motifs of thinking, saying and doing that are healthy for him. He was not able to be aware of what he had done in verbal and bodily action, so that was the main reason it led him to become a criminal.
A slightly disguised set of Satipaṭṭhāna techniques was utilized with a 23-year-old male patient who had been hospitalized for extreme frequent quarrels, fighting, and alcohol abuse, which had occasionally led to brief periods of loss of memory. This young man, who was married and had young children, had been very much touchy and explosive at home, often loosing his temper over petty things and striking out physically and running out of house for up to three days.
A typical thought in habitual motif was for him to go to a bar with friends for a few drinks during the evening and become intoxicated. In this condition he would often steal a car, get into a fight, or even threaten homicide, but he failed to have any memory of these acts the next day. He was hospitalized twice after such unlawful behavior.
During the first group and family therapy sessions, numerous identifiable marital problems became evident; these were the focii of the family therapy. Group and individual therapy revealed personal problems of expressing anger, projecting self- image, enmity toward women and extreme competitiveness with other men.
Since it did not appear that this man would be quick at receiving the usual mindfulness approach, a softened version was tried. He used to get angry but later denied getting angry and then expressed the denial explosively. Later the young man said that he did many things he was unable to understand.
e. Methods of treatment (Cittānupassanā and Dhammānupassanā)
It was suggested that he attempt to look at and label the emotions he experienced during the next few days. He tried that suggestion and reported that what he felt most of the time was fear (of people or sometimes of nothing he could identify) and psychological pain. He was instructed to keep watching and naming emotions.
After some weeks, he began to see anger arising in certain interpersonal situations. He was also able to experience his feelings of irritability and to see what events produced them. Most important, he began to be aware that he did not express anger and often was not aware of it until it had overwhelmed him. He was taught to express in words his anger in order to give an outlet as he experienced it, and to view anger as something all people normally feel.
This seemed to free him for progress in psychotherapy. He stopped seeing his problem as alcoholism and spoke of alcohol intoxication as another way of trying to hide from his anger. Soon he stopped mentioning alcohol at all.
Other mindfulness techniques were then used with this man, particularly thought contemplation, which made him aware of his ineffective and inaccurate self-image. This helped him to start correcting misunderstandings about male-female relationships.
At the end of eight weeks of this treatment, he took a job. Ten months later, he was still functioning effectively at home and at work, with no recurrences of drinking, fighting and loss of memory. This mindfulness techniques utilized here constituted one part of an overall therapy program which proved to be effective.
A few months after this case history was published, the man again behaved capriciously. Even at the request of his family and friends, he refused to seek help and continued to encounter more problems, cardinally with his family and his job. He finally fired a rifle through the window of a house; seriously injuring a woman he did not know while apparently trying to injure his wife. At this writing, he is confined awaiting lawsuit.
This case is isolated but striking example of a person who did not continue to develop after terminating therapy, but in stead slowly lost the benefits he gained. The psychotherapeutic gains achieved through the use of this technique, like most other forms of therapy, can wear away gradually over time if the patient ceases to practice mindfulness and stop developing.
The above- mentioned case shows that this mental patient is so influenced by external stimulus as well as his sudden emotion that he had acted like a puppet without knowing or seeing the result of his verbal and bodily actions. According to Buddhist Psychological terms, he used violent agitation (uddhacca) to cover his latent defilement (kilesa) of anger (dosa). When he comes to see it and know it, it disappears by itself.
Worldlings often long for something new, unusual, attractive... and get bored and neglect daily activities; but when something happens out of order they are unable to work well, confined in one place, restricted and have to depend on others. At that time they come to know how precious and noble life is!
When he is in prison he comes to know the value of freedom, when his leg is broken he comes to know the value of strong legs, when he struggles with sleep he comes to know the value of sound sleep, when he is unable to swallow he comes to know the value of mindful eating…
In the case of the mental patients, their defilements are so veiled by ignorance and overwhelmed by craving that they act abnormally which lead them to either a tragic and traumatic crisis or a horrible and terrible situation.
Since all 'worldlings' are deranged, what we are concerned with in energetic psychology is the degree of derangement and its underlying causes. This is the case also in Buddhist psychology.
In this world the human mind moves selectively, grasping this rejecting that, due to individual preferences of habit and previous self-conditioning. The consciousness predominating factor known to Buddhism as Avijjā (nescience), Moha (confusion or ignorance) or Vipallāsa (misapprehension) is essentially a condition of mental disorder, a hallucinatory state. The Pali axiom "Sabbe puthujjanā ummattakā." (All worldlings are deranged), identifies that the entire object of Buddhism is to implement mental therapy to a condition which accedes to this rule and is in reality nothing but a state of universal delusion.
* * *
Therefore, the process of healing is to get the mental patient to know and see his own emotion (kilesa) by labeling whatever is happening in his body and mind: postures, sensations in his body and feelings, emotion in his mind with bare observation and non-identification.
In other words, what was unconscious, unknowing unseeing before becomes conscious, knowing and seeing. Thus, mindfulness is practiced at random – labeling whatever is happening at the present moment in his daily activities and his working mind.
With the technique of fourfold mindfulness: on the body, on the feeling, in the mind and in the dhamma, slowly and gradually the mental patient can recognize by oneself and then on seeing and knowing his own defilements, the mental disorders will be cured and restored soon.
The cardinal importance is maintenance of constant mindfulness, calmness and clearness in all threefold actions: mental, verbal and bodily. The length of time and intensity of mindfulness one can be with them will determine one's control of oneself. With the conscientious practice of the above technique relapses have no room to appear.
The power of mindfulness 
The healing begins when the mental patients come to know how to observe their own mind, how often they behave like unrestrained disputants steadily opposing each other and denying listening to the other side's arguments because of their lack of courage to accept their practical, moral or intellectual reasoning. If they continue to look into more carefully their mind more carefully, their thoughts or judgments, they will have to recognize that many of them are just the product of habit, led by prejudices of intellect or emotion, by their pet liking or disliking, by laziness or selfishness by unsound or cursory attentions.
It will convince one the urgent need for methodical mental culture. It is in daily life little heedlessness in thought, words and deeds going on for many years of one's life, that is mostly responsible for untidiness and confusion in one's mind. This heedlessness creates the trouble and allows it to continue.
The dark and untidy corners of the mind are the hideaways of one's most dangerous enemies and one can be attacked unconsciously and much too often defeated by them. That dusky domain peopled by unsatisfied thirst and repressed jealousy, by hesitation, whim and many shady figures shapes a background for uprising passions such as lust, antipathy and confusion.
These defilements often take refuge and find support in the unrestrained dusky domain of the mind. Usually one tries to ignore it and to depend on the nullifying energies of one's surface mind. But the only sound psychological therapy is to face it – with mindfulness. Nothing more challenging is needed than to acquire the practice of directing bare and pure attention to these elementary thoughts as often as possible. The simple fact should be known that two thoughts are unable to coexist at the same time: if the clear light of mindfulness is present, there is no room for mental dusk.
When maintained mindfulness has safeguarded a firm foothold in one's mind, one may replace those elementary thoughts, moods and emotions by purposeful beneficial thoughts. This procedure of bare and pure attention is very basic and efficient; the challenge is only the constancy in utilizing it.
It is said that prevention is better than treatment; therefore all of us should train ourselves according to what the Buddha teaches Bāhiya of the Bark- cloth as follows:
"Yato kho te, bāhiya, diṭṭhe diṭṭhamattaṃ bhavissati,
"In the seen will be merely what is seen; in the heard will be merely what is heard; in the sensed will be merely what is sensed; in the cognized will be what is cognized..."
At the first hearing, it sounds very simple; but when it is in the application of one's daily activities, it requires the long process of self- cultivation and self- purification.
The discourses of the Buddha contain numerous features of modern psychotherapeutic processes: asking, questioning, having discussion, giving explanation and counseling, etc.
In any cases, this psychotherapeutic process does not seem to apply equally to physically ill laymen. However, the enlightener's physical illness was cured quickly by the power of Dhamma as mentioned in Samyutta Nikāya. There are three sermons on The Factors of Enlightenment concerning the Elder Kassapa The Great, The Elder Moggallāna The Great and The Elder Cunda The Great respectively.
In the first two cases, The Elder Kassapa and The Elder Moggallāna were ill, suffering grievously sick; The Lord Buddha reminds his two close disciples respectively about the seven factors of enlightenment. After listening to these sermons their serious sickness disappeared, thus both could recover by reflecting the power of the factors of enlightenment.
In the third sermon, the Lord was ill at that time, suffering grievously sick The Elder Cunda came to see the Buddha, the Buddha spoke thus" May the factors of enlightenment become clear to you, O Cunda."
After the Elder Cunda recited this discourse, the Lord Buddha's illness too was cured. The Buddhist like to receive treatment by requesting monks to recite sermons and in some cases, it shows beneficial results.
Nowadays this way often followed by Buddhists; when someone in the family gets ill without knowing its cause, they often request Buddhist monks or nuns to recite Paritta sutta. In some cases it shows very useful results. In many Buddhist countries, there is a custom to recite Aṅgulimala sutta to pray for the good of the expectant mother as well as her baby.
It is worthy to know that there are a number of unbearable diseases when the patient is on the verge of death or leads the life of unbearable sickness. In such situations they make strong determination to better their practice till death or they will die in Dhamma or their illness will be healed. With some instructions of Mahasi Sayadaw or his outstanding disciples, many patients with strong mindfulness practised very ardently, their illnesses subsequently were healed.
These cases are described in detail in the book of Dhamma Therapy by Mahasi Sayadaw and his disciple Ven. U. Paṇḍita with the well-known book- In This Very Life and so many cases I had seen at the Santisukha Meditation Centre - Mingaladon Township in Myanmar conducted by the eldest noble disciple of Mahasi Sayadaw - Ven. U. Kosalla and his outstanding disciple- Ven. U. Tejaniya. It may not be mentioned here because of the limitation of this study.
1. Canonical Texts
Chaṭṭha Sangayana CD ROM, by Vipassana Research Institute - India
Angutta Nikāya (AN), trans & edited by Nyanaponika Thera & Bhik. Bodhi (Vistaar Publication, New Delhi)
Digha Nikāya (DN), trans. Maurice Walshe (Wisdom Publication, Boston)
Majjhima Nikāya (MN), trans. Bhik. Nanamoli & Bhik. Bodhi (Wisdom Publication, Boston)
Samyutta Nikāya (SN), trans. Bhik. Bodhi (Wisdom Publication, Boston)
The Udāna & The Itivuttaka, trans. Ireland John D (Kandy, BPS, 1997)
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Anandamaitreyya Ven. B, Buddhism Lectures and Essays (Colombo10, Samayawardhana, 1993)
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 S.III, p.p2-3, A II p.p142-3, Vbh.Ap.186
 Buddhist Psychotherapy by H S S.Nissanka
 Dimension of Buddhist Thought by Francis Story
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 Buddhism Lectures and Essays by Ven. B. Maittreyya
 Encyclopaedia Vol IV
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 Encyclopaedia, Vol V
 Dimension of Buddhist Thought by Francis Story
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 Recent Researches in Buddhist studies, ed. Kuala Lumpur Dhammajoti
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 The Power of Now by Eckhart Tolle, Published by Hodder& Stoughton
 The Power of Now by Eckhart Tolle, Published by Hodder & Stoughton
 The Way of Mindfulness by Bhikkhu Soma
 SN - Anuruddha Samyutta. Sutta 10
 The Four Foundation Of Mindfulness by Sayadaw U. Silananda
 Buddhism In Psychotherapy by Seymour Boorstein and Olaf G. Deatherage
 Dimension of Buddhist Thought by Francis Story
 Vibhanga Atthakatha
 Dimension Of Buddhist Thought by Francis Story
 The Power of Mindfulness by Nyanaponika
 The Udāna & The Itivuttaka (trans by John D. Ireland)
Sincere thanks to Bhikkhuni
Khemanandi for making this digital version available
(Binh Anson, 12-2004)
to English Index]
last updated: 10-01-2005