Sunday, January 15, 2012

Rolling With the Crocodiles: Original Medicine and Mental Illness

A delightful print by artist Stephen Burt does not exaggerate.

Ten years ago -- and it seems like only a moment ago --  I wrote and published two or three small editions of an even smaller work entitled Original Medicine: The Vajrayana Buddhist Way of Healing (Tianjin: Expatriate Cloud Press, 2002, and others) This circulated all the places I wanted to see it circulate, and for a time -- circa 2004 -- was available as a free download on the Web.

A portion of Chapter Seven, "Original Medicine and Mental Illness," was excerpted and published on the Web five years ago. This became a popular post, and indirectly, became the reason why I happened to encounter certain noisy people who snap and bite to this very day. Still, it was only an excerpt, and to a certain extent out of context. I thought today we would publish the original chapter, as follows (previously published excerpt omitted):

In Tibetan medicine, mental illness is attributed to five causes: karma, excessive emotion, imbalance in the three nyes-pa, toxins, and demons or evil spirits. Mental illness can, in fact, be constructed and defined many ways, not all of which are entirely compatible with Tibetan paradigms. 

Unfortunately, many of the current Western definitions are in terms of social interaction and group acceptance. Current science has a detailed manual which carries all of the definitions our society is prepared to accept. To this number, I want to propose a revision that society may not be prepared to accept. I propose that all of the current definitions can be driven into one definition. This single definition is simply that mental illness is another, labeled manifestation of the three poisons. To the extent that we are still subject to the three poisons, I suppose we are all mentally ill.

Mental illness wreaks a toll on the body just as physical illness wreaks a toll on the mind. You cannot separate the two. You will find that certain manifestations of mental illness reveal biochemical abnormalities. I do not believe the latter precede or cause the former; rather, I believe such physical abnormalities are a symptomatic result.

While it may be possible to intervene in the physical process with powerful drugs -- seratonin uptake inhibitors are an example -- we may be running the same risks illustrated by our earlier example of antibiotics. Perhaps, in the future, we may find that such drugs will morph mental illness in unexpected ways, and we will regret that we did not look for another approach.

Just as an aside: some thirty years ago, I worked with the late Dr. Maximilian Fabrykant, M.D., a Swiss physician in the grand tradition. Dr. Fabrykant treated numerous survivors of the London Blitz, and those of German concentration camps. In result of his clinical experience, he came to the conclusion that all manifestations of mental illness could be managed nutritionally.

Original medicine can cure mental illness, but this cure is not particularly well suited to our age. When applied to physical illness, original medicine has a peaceful, almost contemplative character. When applied to mental illness, original medicine can appear rough, cruel, immoral, and in some cases, illegal. Note, for example, the Ayurvedic approach, which includes: 
"...persuading a person with good conduct to change to bad conduct, beating, isolation, terrorizing [the patient], consolation, exhilaration, and fear, occurrence of surprising events, and making the patient forget past events." [Vaidya Bhagwan Dash and Vaidya Laitesh Kashyap, Diagnosis and Treatment of Diseases in Ayurveda, Based on Ayurveda Saukhyam of Todaranahda. Part Three (New Delhi: Concept Publishing Co., 1980), p. 144] 
Note also the general Ayurvedic advice, "for the treatment of psychic ailments, mutually contradictory psychic dispositions should be created." [Ibid.]

When applied yo physical illness, original medicine can be individually managed. When applied to mental illness, original medicine usually requires the intervention of others. How such intervention is conducted becomes a stylistic issue.

A Hinayana practitioner may consider mental illness with great gentleness and forbearance, but do little else besides counsel the patient. A Mahayana practitioner may add somatic treatment to the counseling, or even engage in exorcism. A Vajrayana practitioner may, and in most cases will, actively inflame the poisons that cause the illness, and let them rage.

From the Vajrayana perspective, working with the three poisons inevitably involves a period when individual manifestation are permitted to flower so that they can be transformed or eradicated. In such cases, original medicine is anything but gentle, and may involve otherwise prohibited acts. According to one famous commentary, Bhavyakirti's Prakasika:
" 'Prohibited' means action in violation of the world. For example, to harm those who do injury to the Three Jewels; to steal the goods of the miser; to deprive the lustful person of a family; to cut the pride of the proud; to speak harshly to the envious. When one does such acts as those in violation of the world, and under the control of 'skill in the means,' he is not defiled, for by doing it under control of great compassion, there is no obscuration." [Quoted in Alex Wayman, Yoga of the Guhyasamajatantra (Delhi: Motilal Banarsidass, 1977) p 303. This is actually a commentary on a commentary.]
This statement gives us a clue to the methods involved in original medicine's approach to mental illness. Even in the sutras, we have an indication that there is an extreme methodology at work, as in this passage from the Vimalakirtinirdesha Sutra
"The Bodhisattva made his appearance at the fields of sports and in the casinos, but his aim was always to mature those people who were attached to games and gambling. To train living beings, he would appear at crossroads and on streetcorners. To demonstrate the evils of desire, he even entered the brothels. To establish drunkards in correct mindfulness, he entered all the taverns." [from memory]
Treating mental illness with original medicine requires an absolutely firm intention to relieve suffering, no matter the cost, followed by correct appraisal of the dominant poison, or combination of poisons, that is causing the palpable distress. This poison, or correctly, its manifestation, is then fed, much in the fashion that one feeds a fire with wood or gasoline. The treatment also involves extreme creativity of an almost deceitful character, much like the actor's skill.

In assessing mental illness, the condition of the body will indicate the condition of the mind. A person dominated by desire will display a rLung somatype. A person dominated by anger will display a mKhris-pa somatype. A person dominated by ignorance will display a bad-kan somatype. Beyond this, the specific manifestations of the illness may be revealed much as the bodily manifestations are revealed, involving certain hours, seasons, foods, and so forth, but they will be grossly overstated.

This is because, through the force of karma -- indeed, through the very powerful, composite forces of both cumulative and completing karma -- the patient has a close connection with the poison or poisons. The patient may embody the poison, and seem demonic.

The afflicted person has reached a crucial juncture in his or her own status as a human being. He has reached a crossroads, and stands at the brink of hell. If he adheres to the illness, he will be irretrievably blown into the consequences. For example: a mental patient dominated by anger may begin killing. Alternatively, he may regress into extreme anger's inward manifestation, severe depression, and commit suicide.  In either case, he will face the inevitable results of his actions. If, on the other hand, the illness is arrested, the patient will be relieved of such consequences. This obviously calls for healing of the highest order.

The purpose for feeding manifestations, for pouring gasoline on the fire, is threefold. First, in the external dimension, to demonstrate the futility of continuing along a particular path. Second, in the internal dimension, to exhaust the patient's resource for continuing along that path. Third, in the secret dimension, to provide an opportunity for recognition of the fundamental purity of mind.

The emotions spawned by the poisons are powerful. You can use this power for your purposes or against your purposes. For example: if you try to tightly control or even deny strong sexual desire, you could, perhaps, refrain from committing sexual acts but you would constantly be thinking about sex. If you try to bottle anger, it could blow, or turn inward. If you try to practice contrary acts without first eliminating the negative tendency you would find yourself in a tug of war. An example would be replacing greed with generosity before greed was eliminated.

Therefore, Vajrayana Buddhists believe the best way to deal with the issue is to accept the three poisons and what they produce for what they are not. As long as they are not pure, we are defiled. When they become pure, we are no longer defiled. This is a very subtle practice: simple to say but difficult to comprehend.

Dancing With Passions

People wrongly believe that the mentally ill are incapable of insight. This is not true in the sense that they are unable; rather, this is true only in the sense that they do not exercise insight that brings relief. I have found, and I firmly believe, that there are moments in every full-blown catharsis where profound insight is possible. For example: a person in the midst of extreme rage may suddenly cackle with laughter. We have the tendency to fear such moments, and to characterize the laughter as evil, or plain evidence of gross insanity. Nevertheless, there is a mechanism at work that has given us a window of opportunity. Emotions are rapidly changing and shifting, and we can use those shifting patterns to benefit by dancing with them.

Dancing with passion is inherently dangerous. You allow the psyche of the deranged person to become your reality, without check. You simply open yourself to the person, without defenses. The goal is to get inside a very uncomfortable and dirty place with a broom and dust mop. The broom sweeps with exaggerated mimicry of the illness. The dust mop gently polishes what is obscured. You are cleaning the tarnish from mirrors. You are polishing what is already stainless, but unrecognized. You are there to show the person the best of himself. You are imitating him so well, that he imitates you in response. This is a most difficult thing to do, because it involves absorbing his madness into your madness and extinguishing them both at the same time.

This is an old solution that exhibits its power in extraordinary undertakings. In his magnificent translation of the I Ching, Richard Wilhelm wrote:
"In dealing with persons as intractable and as difficult to influence as a pig or a fish, the whole secret of success depends on finding the right way of approach. One must first rid oneself of all prejudice and, so to speak, let the psyche of the other person act on one without restraint. Then one will establish contact with him, understand and gain power over him. When a door has thus been opened, the force of one's personality will influence him." [The commentary on "Inner Truth."]
Let us take a real world example and see how this might work. Suppose you are married to someone who seems mentally unstable. She constantly criticizes you, berates you, even beats you, and then shifts into episodes of extreme tenderness and affection. You never know where you stand. You never know what to expect. These shifting moods have nothing to do with you. They are the manifestations of her illness.

You love this person and resolve to help her. You want to use original medicine, so you begin by producing the conditions that provoke the manifestations. When you accomplish this stage, you hold up a mirror.

When the person is angry, you are angry with her, not at her. You join her anger in an exaggerated way. If, for example, she comes home angry from a real or imagined insult, you adopt her view and take it to the extreme. She may be angry with a co-worker, so you become angry too. You throw a tantrum and direct all sorts of venom toward the co-worker. You hatch elaborate plots. You literally engorge yourself with the anger.

To take this subtly, suppose the person comes home and is angry with you. Again, you join her anger and display an even greater anger toward yourself. You strike yourself. You attempt to harm yourself. You scream at the top of your lungs that you hate yourself, and you tell her that her feelings toward you are justified. You are worthless. You are guilty of unimaginable crimes. You cannot be forgiven and you should not be forgiven.

Now, let us take the opposite. The person is very tender and loving, and even remorseful. Again, you join these emotions. You then exaggerate the emotions until they become transparent.

When you accomplish this stage, you hold up a mirror, and you become the person. You duplicate her illness and let her watch. For example: in the midst of your anger -- at the very pinnacle -- you suddenly stop and say, "What am I doing this for? This does not work! There must be something wrong! This must be mental illness! I have to change something!" You then work through "your" distress with her, and allow her to suggest ways to help you.

This is an extremely dangerous game, and you must play it well. Writing of a similar game, the great Chogyam Trungpa Rinpoche offered:
"The physician becomes wild, which is terrifying. We do not want to trust a wild doctor or surgeon. But we must." [Chogyam Trungpa, The Myth of Freedom (Boston: Shambhala, 1976)]
Once you start, you cannot just arbitrarily stop if the relationship becomes unpleasant. This is something that must be continued until a successful conclusion is reached. If you try to stop before the illness is resolved, both you and your patient will suffer irreparable harm. This is Vajrayana in action, and the implicit difficulty with Vajrayana is that it leaves no margin for error.

By making the patient's overt emotions your own, you are creating an opportunity for healing that her illness has otherwise prevented. You are letting her watch, in an uncomfortable and frequently challenging fashion, a magic show where she is the star. Her overwhelming self-absorption prevents her from breaking away. You are showing your thus captured audience of one what she looks like, and you are guiding her to understand where her actions will lead.

This approach demands total fearlessness, total acceptance, unconditional love, and absolute strength. To complicate the matter even further, these are qualities that you cannot cultivate, or adopt. You have to let them arise naturally. This approach demands that you must change along with your patient. The anger that she feels cannot be permitted to resonate with any anger that you may feel. The desire that she experiences cannot be allowed to find a resting-place in any desire you may experience. Her delusions cannot join your delusions. One of you must be sane, and that sanity must extend into the insanity you are joining.

The power of original medicine is more than sufficient to sustain you. Indeed, the power of original medicine is such that it can rescue a person from lower realms of existence. Even grave offenses, such as breaking ordination, or transgressing vows, can be mitigated through this power. The key is truthfulness. You must proceed from a clear intention to help others, and you cannot deceive yourself on this point.

Above I use the example of a husband and wife. I do this because treating mental illness with original medicine is not unlike entering a marriage. You marry a bundle of karma. Certain attractions and connections are present. Certain expectations may be present. Issues of trust and confidence are present. There are vows made, tested, and occasionally broken. There is an exchange of power present. There is, or should be, a deep and abiding love that is nonetheless subject to changing means of expression. The shared experiences are intimate. The analogies are endless.

There is a common way to enter a marriage and a useful way. Chogyam Trungpa explained the latter on the occasion of officiating at my own wedding [Barnet, Vermont, 1971.] "Regardless of whether you are extending or renewing or creating a bond between you, a bond is going to exist," he said. "But to be useful, that bond has to be in the context of something that liberates, rather than confines. I am therefore suggesting that you take refuge together." The treatment of mental illness with original medicine should be approached exactly this way.

The transactional methods of intervention I have described can be applied in tandem with physical therapies. A person with extreme anger can, for example, be successfully treated with mKhris-pa therapies and gain a measure of relief. Nevertheless, you will find that the force of habitual tendencies will undermine physical therapies and thus the relief will be superficial. Physical treatment may also have unintended effect.

One example is provided by my close friend. I do not, as of this writing, know if she is a wisdom dakini here to help me, or a manifestation of the yakshas, here to test me. I do not know if I am holding a mirror for her, or she is holding a mirror for me. Our exchanges have been characterized by random violence and voluble emotion. Her symptoms change like a chameleon on a mirror. She is the greatest medical professor I ever had. During one extremely chaotic phase of her mental discomfort -- diagnosed, among other things, as bipolar disorder arising from a disturbance of the menses that involves the lymphatic system -- she proved so distraught that I immediately drove her from Las Vegas to Los Angeles and worked in tandem with with a gifted Chinese doctor. We both understood that her physical discomfort manifests in a liver, kidney, spleen nexus: she is fundamentally a compound rLung mKhris-pa somatype. He employed very aggressive needle therapy to this effect, and within the hour, the patient discharged a clot of old blood and necrotic tissue the size of a quarter dollar in diameter. Her demeanor immediately changed, and she was docile as a lamb for a day and a half. The next evening witness her usual rages and paranoia; these with special vigor, because she was feeling energetic due to the treatment.

Therapeutic Setting

Treating mental illness with original medicine involves a full time commitment. That is one reason why I say it is not well suited to this age. I do not see how it can be accomplished in a traditional doctor-patient setting. The only setting in which it has traditionally been accomplished is that of Vajrayana master and student. As one author proposes, here we have an immediate challenge because, "...many of the particular qualities of common western neuroses such as depression, dependency, and eternal adolescence, present obstacles to forming a healthy relationship to the vajra master." [Rigdzin Dorje, Dangerous Friend: The Teacher-Student Relationship in Vajrayana Buddhism (Boston: Shambhala, 2001) p. 56. Therefore, while to do this inter culturally is difficult enough, to do this cross-culturally requires another layer of real effort.

Another possibility exists in the relationship between a tantric practitioner and his or her consort. An illustration comes from the story of the great master Naropa, who, after a period of bliss, fell into a circumstance of discord with his consort. The traditional version is humorously gentle when it tells us, "he no longer listened to her and she no longer listened to him."

Actually, it would seem that they brawled shamelessly, and frequently. On one occasion, he asked her for a bowl of radishes and cream, and when she was recalcitrant, he went into a meditative state for several years. Upon quitting this state, he asked, "So, where are my radishes?" She replied, "Some yogi you are! All these years and you could not give up the idea of radishes!" Anyone who hears this story would have to agree that Naropa's consort was a practitioner of original medicine.

The fundamental setting for treating mental illness with original medicine is that of indestructible friendship. Such friendship is pricelessly rare, and frequently demands extreme hardship and personal sacrifice. One does not enter this sort of situation easily. Still, it is possible to develop such friendships. In my experience, you do not go looking for them, you just find them. A certain karmic imperative feeds the process.

This indestructible friendship is not necessarily bilateral at all times. Sometimes you have a unilateral friendship with yourself. In the beginning it should be the friendship you have with yourself. In this context, you are initially your own patient, and once you have that relationship enabled you can incorporate other beings. You can take the extreme of having yourself as your patient to the extreme of having every living being as your patient.

In this instance the meditation on the Healing Buddha might take a different form, with an extended preliminary meditation on the cultivation of loving kindness, and the candid acceptance of our own mental illness. We are willing to share this condition with others because we want to help them. We can then contemplate our mental constructs as being fundamentally pure, and relate these to the appearance of everything else. We can merge our minds with the mind of the Healing Buddha and let this now-uncontrived healing spaciousness be as it is. We can dissolve the very idea of the Healing Buddha and relax into the pure, blue sky. We can even stop that and believe we have no position at all. We are in a condition where everything we require is always available.

We can invent this condition or it can be invented for us. On one illustrative occasion, I was intoxicated and sobbing on the telephone with someone I barely knew -- nothing is served by concealing or minimizing one's humanity. As it happened, this was a young girl of no obvious distinction. I had spoken with her maybe two or three times previously, and barely knew her. There was no particular relationship between us, as she was merely interpreting a family argument (language difficulties!).

Reaching the height of useless emotion, I appealed to her for help, and she replied, "Just put down the phone, walk outside, look up at the center of the sky, then come back and talk to me. I will wait for you." With these words, I remembered the continuity of my teacher's mind, and I did as she asked. 

That was original medicine, and she was a master practitioner.

If you set out to engage someone's mental illness, using the methods I have described, you cannot afford to make assumptions about your own sanity and you cannot make assumptions about theirs. You have to erase any notions of a distinction between you. More accurately, you have to trust original medicine enough to let distinctions dissolve of their own accord.

While I have fluently empathized with people occupying high social positions -- powerful political figures, and wealthy cultural celebrities --- most of the people I see could be labeled as gangsters, prostitutes, policemen, soldiers, priests, habitual drunkards, drug addicts, dissatisfied wives, murderers, cast-off husbands, cult practitioners, and individuals living a socially marginal existence. This could be a fertile field for cultivating distinctions, but that field would be a minefield. Sometimes I hear terrible things, even frightening things, but I enter each worldview as it presents itself. I am always reminded of the marvelous admission by Kyabje Kunzang Dorje Rinpoche: "Among my greatest Lamas I include a butcher, a prostitute, and a bandit."

Sometimes the experience is extraordinarily painful. While this presents a opportunity to recreationally interact with all the things we may have been in the past, or might be in the future, it does not lessen the shock of uselessness arising from that interaction. There is seemingly a karmic connection between us, and sometimes that forces us to question ourselves very deeply. We wonder what, in the past, gives rise to a connection with so many widely different personalities from so many walks of life.

There can be only one answer. All that we have been follows us.

The thing is to stay focused on this business. If you go about speculating on the nuances, you will lose the thread of what you are trying to accomplish. If you find yourself repeatedly drawn into such speculation, a useful counteragent is to cultivate the belief that you are meeting people for the first time. You therefore strive to engender a connection that is wholesome and beneficial.

An important precaution is in order at this point. While you dance with passions, and embrace passions, you cannot permit yourself to work out your own problems at someone else's expense. Nothing I have written thus far should be construed to permit or condone this event.

You can use the practice of original medicine to instruct yourself, but in the case of treating someone else's mental illness, you cannot use the interaction to treat yourself as well.

This is a fine point. By joining your wife's anger, you certainly learn something about your own anger. To an even finer point, it may be that the patient you treat is actually treating you. However, you cannot join her anger with the intention to resolve your anger. This would be like pouring water into an already overflowing container. The mere presence of anger is going to take up all the available space.

If you want to resolve your own anger, it would be better to get unreasonably angry with a perfect stranger. You would quickly see the futility and the result, you would be exhausted, and you would want to abandon anger as rapidly as possible.

In any event, joining anger for selfish purposes is a non-meritorious action and you will face the compound result of your anger and your failure of compassionate intention.

The successful treatment of mental illness with original medicine ultimately depends on the patient, not the skill of the practitioner. The only "skill" is patience. You can use three corners to describe a square, and wait for the patient to discover the fourth corner.

To be candid, some people are so obscured and deluded that you can only pray for them. You should therefore select candidates for transactional methods with extreme care. This is, of course, unless you are utterly fearless, in which case you can take on all comers. In either event, you are establishing a bond and where that leads depends on your perception. The people you treat will leave you, perhaps in conditions of great bitterness and recrimination, attended by all sorts of controversy. Yet, if your intentions are pure, the havoc that treatment produced in both your lives will ultimately have a beneficial result. If your intentions were otherwise, tacitly or implicitly, the results will be problematic.


I wrote the above in the summer of 2002. May it be auspicious.

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1 reader comments:

Anonymous said...

"May it be auspicious..." I rephrase optative-pluperfectly as "Might have been auspicous" i.e., had I read it in the autumn of 2002, when I acquired a new [di-]staff member of my household. I should have given her her marching orders after the first time I called the police.

I should have known better, and next time remember _caveat humptor_.


A former Stoodwok resident