Buddhism and well-being: Implications for psychotherapy

Krishna Mohan (Ph.D., Makerere University, Kampala, Uganda)

Abstract

Well-being or happiness is much pursued by individuals and society in all cultures. Eastern and western cultures have understood well-being and evolved ways and means to promote well-being over the years. While psychotherapy seems to be in need of integration, psychotherapists increasingly employ Buddhist meditation. Research has shown that this has proven to be effective in treating certain aberrant conditions and in promotion of well-being. In the wake of this development it is safe to assume that Buddhism might be a rich source of inspiration to cater individual development. The paper examines the eastern, i.e. Buddhist and western perspective of well-being. Based on Mohan's (2003) field study on the Buddhist meditation when used along with psychotherapy in the Netherlands some implications are drawn for psychotherapy.

Introduction

Study of well-being is only given attention by psychology recently. Psychology in the past was preoccupied by illness and well-being was seriously neglected (Seligman & Ciskszentmihalyi, 2000). On the other hand human happiness and well-being are the central theme in eastern spiritual practices. Over the years, meditation and yoga moved from little known and much misunderstood esoterica to disciplines that are studied and practiced by millions of people in the West. Further, psychotherapists and researchers have been interested in their usefulness for clinical disorders and human wellness.

Well-being: Western perspectives

Since recorded history, philosophers considered happiness to be the highest good and an ultimate motivation for human functioning, but it is only recently that excellent reviews of the history and philosophy of happiness and well-being have begun to appear in psychological literature (Diener, 2000; Chekola, 1975; Culberson, 1977; Willson, 1967). While psychologists believe well-being is constructed out of three components - (1) Life-satisfaction, (2) Positive affect, and (3) Negative affect - the rating of well-being is irreducibly subjective, Furthermore, the meaning and content of the term fluctuate, depending on from what context and culture it is used. Presently, psychotherapy is criticized for its narrowness by focusing only on the disorders and for neglecting the promotion of well-being. The realization of the limitations of psychotherapy and awareness among psychotherapists to serve a broader need have become an issue. In the past, the spiritual dimension of human experience in mental health has not been given the attention that it deserves (Mohan, 2001). This trend is changing as Buddhist traditions find increasing acknowledgement in mainstream psychology. According to these traditions, healing is a restoring of the condition to wholeness or harmony (Carlson & Sield, 1989). In recent years there has been a burgeoning interest especially in the relationship between Buddhism and schools of psychotherapies among therapists, researchers, and spiritual practitioners. The nascent dialogue between the representatives of Buddhist meditation and psychotherapists belongs perhaps to the most illuminating developments, yielding crucial insights about human development, conceptions of selfhood, psychopathology, prevention, and cure (Engler, 1983; Rubin, 1991).

While there have been many attempts to describe psychological health in ideal terms which give us a list of qualities that help to develop a mature, healthy, fully functioning, self-actualizing person, it is important to examine definitions provided by some health psychologists who have, in their attempts to define a healthy individual, spelt out a list of specific characteristics, mostly based on research and observation, that could be associated with an individual who is psychologically healthy and experiences a state of well-being most of the time. In her analysis of many definitions Jahoda (1958) says positive mental health is based on the following: (1) Attitudes towards the self which includes accessibility of the self to consciousness, correct self-concept one's sense of identity and the acceptance of one's self; (2) Growth, development and self-actualization (3) Integration; (4) Autonomy; (5) Perception of reality; and (6) Environmental Mastery which include abilities to work, love and play adequate interpersonal relationships, meeting situational requirements, adaptation and adjustment, and efficiency in problem solving.

Seedhouse (1995) introspects that the term "well-being", as used in present day health promotion literature, is an extremely vague notion. While psychologists believe that well-being is constructed out of three components mentioned above, the author concludes that judging of well-being is irreducibly subjective. The meaning and content of the term are seen to fluctuate, depending on who is using it and why it is being used. In comprehensive reviews of the literature on subjective well-being, Diener (1984; Diener et al., 1999) repeatedly found that well-being has three hallmarks: life satisfaction, pleasant affect, and negative affect. Myers and Diener (1995), in their paper entitled "who is happy?", define high subjective well-being as frequent positive affect, infrequent negative affect and a global sense of satisfaction with life. Based on the above discussion an operational definition of well-being may include the following: Firstly, it may be understood as a scientific sounding term for what people usually mean by happiness. Secondly, it refers to what and how people think and feel about themselves, i.e. the cognitive and affective conclusions they reach when they evaluate their existence. Thirdly, it involves the individual's entire condition, i.e. psychological, social, and spiritual aspects of existence. And fourthly, well-being is a relative state of affairs - relative to the situation as well as to the value of the particular culture one belongs to.

The approach of understanding happiness and well-being differs from eastern and western perspectives. Eastern approaches are grounded in introspection and arduous self-examination. In contrast to western psychologies that rely more on observation of behavior, the eastern view of life is understood as full of suffering and frustration. The means that eastern approaches recommend to overcome distress are discipline and self-control.

Well-being: Buddhist perspectives

Indian thought is one of the influential philosophies in the world. Buddhist thought of well-being is taken as a representative of an eastern perspective. Buddhism represents a view of personality and describes methods for its growth into a particular form of perception. Abhidhamma, a psychological account of Buddhism was developed based on the insights of Buddha in the fifth century B.C.E. Abhidhamma contains an ideal type of the perfected personality around which its analysis of the working of the mind is oriented. The basic method Abhidhamma offers for studying the mind's multitudinous changes is introspection, a close and systematic observation of one's own experience. Mental factors "kamma" according to Abhidharmma are the key for happiness and well-being. Kamma is the principle that every deed is motivated by underlying mental states. The following is derived from various sources on Buddhist psychology (e.g., Hall & Lindsey, 1978; Kwee & Holdstock, 1996, Watson,1998; www.accesstoinsight.org ; the terms in parentheses below are in Pali, a language the Buddhist canonical texts are written in).

The theory of well-being according to Abhidhamma is that the mental factors are the one which lead to happiness and suffering. The Abhidhamma distinguishes between mental factors that are kusula - pure, wholesome, or healthy - and akusula - impure, unwholesome or unhealthy. Most of the perceptual, cognitive, and affective mental factors fit into either the healthy or unhealthy category. Delusion - which is perceptual is the central unhealthy factor in Abhidhamma - is seen as being basically ignorance, the primary root of human suffering. Delusion (moha) is defined as a cloudiness of mind that leads to misperception of the object of awareness. It is this misperception of true nature of things, without bias or prejudice of any kind, is the core of all unhealthy mental states. Delusion leads to "false views" or misdiscernment (ditthi). According to Buddhism, if a person's mind is dominated by false views, whatever he might do or aspire could only "lead him to an undesirable, unpleasant, and disagreeable state, to woe and suffering".

Another important unhealthy mental factor is perplexity (vicikiccha) that denotes the inability to decide or make a correct judgment. Other unhealthy cognitive factors are shamelessness (ahirika) and remorselessness (anottappa); these factors allow a person to disregard the opinions of others and one's own internalized standards. In fact these factors make the person commit evil acts without compunction, and so he is apt to misbehave. Egoism (mana) is another important unhealthy cognitive factor where the self-interest causes a person to view objects solely in terms of fulfilling their own desires or needs. According to Abhidhamma the concatenation of these three factors in a single moment - shamelessness, remorselessness, and selfishness - is undoubtedly often the basis for much human evil.

The affective unhealthy factors include agitation (uddhacca) and worry (kukkucca), states of distractedness, remorse, and rumination. These factors create a state of anxiety, the central feature of most mental disorders. Clinging is considered to be an important unhealthy factor. Greed (lobha), avarice (macchariya), and envy (issa) are related factors to clinging. Aversion or hatred (dosa) is the negative side of attachment. According to Abhidhamma, greed and aversion are found in all negative mental states and always combine with delusion. Contraction (thina) and torpor (middha) are the final unhealthy factors. These factors lend a rigid inflexibility to mental states. To sum up, if a person's spirit is predominately dominated by unhealthy factors his mind as well as the body is prone to sluggishness.

Contrary to unhealthy factor, healthy factors determine well-being of the person and also promote well-being. The means in Abhidhamma for attaining a healthy mental state is to replace the unhealthy factors with healthy factors. It is interesting to note that for each negative factor there is a corresponding positive factor that override it. Insight (panna) is the central healthy factor in Abhidhamma. Insight is the opposite of delusion. Insight is the sense of "clear perception of the object as it really is," suppresses delusion, the fundamental unhealthy factor. Healthy and unhealthy factors can not coexist in a single mental state: where there is clarity, there cannot be delusion; where there is delusion in any degree can there be no clarity.

Abhidhamma places lot of importance on mindfulness (sati), besides insight for healthy mental state. Mindfulness and insight are responsible for other healthy factors to develop concomitantly. The presence of these two healthy factors is sufficient to suppress all unhealthy factors. To have a healthy mental state requires a certain circumstance to arise. The twin cognitive factors of modesty (hiri), which inhibits shamelessness, and discretion (ottappa), the opposite of remorselessness, come to mind only when there is a thought of an evil act. Further, modesty and discretion are always connected with rectitude (cittujukata), the attitude of correct judgment. Confidence (saddha), a sureness based on correct perception is another important health factor. According to Abhidhamma the group of healthy mental factors - modesty, discretion, rectitude, and confidence - act together to produce virtuous behaviors as judged both by personal and social standards.

In summary, the cluster of unhealthy factors formed by greed, avarice, envy, and aversion are opposed by the healthy factors of nonattachment (alobha), nonaversion (adosa), impartiality (tatramjjhata), and compusure (passadhi), which reflect the physical and mental tranquility that arises from diminishing feelings of attachment. One important aspect of these four healthy factors allow one to accept things as they are, but also to make whatever changes seem appropriate, the hallmark of well-being according to Abhidhamma. Body and mind are seen as interconnected in Abhidhamma. While every factor affects both body and mind, the final set of health factors are the only ones explicitly described as having both a physical and a psychological factor. These are buoyancy (ahuta), pliancy (muduta), adaptability (kammannata) and proficiency (pagunnata). Abhidhamma states that when these factors arise a person thinks and acts with a natural looseness and ease, performing at the peak of his/her skills. Further, these factors make one able to adapt physically and mentally to changing conditions, meeting whatever challenges may arise. Well-being is equated with the integration of personality. Besides, 'the steady mind of well-being' is characterized by calm and poise in all situations. Other features are: being friendly, not bearing ill-will for any one, compassion, forgiveness, being free from attachment and egoism and being balanced in both pleasure and pain.

From the above account it is clear that there exist differences about the concept of well-being in the West and the East, in that the conceptualizations made in the West revolve around the ability to satisfy one's needs, avoidance of frustrations and stress, and exercising certain amounts of control on the environment such that it enhances the satisfaction of personal and social needs. In the eastern tradition control over the senses is thought to be essential to well-being. The emphasis is on the maintenance of balance between extremes of satisfaction and denial (implying that needs need not be totally denied) and the adoption of a path of moderation or middle path. Further since frustrations, failure, successes and joys are considered inevitable in one's life, the essence of well-being lies in not being overwhelmed by either. While in the West the idea is to have control or exploit the environment, since it is thought that environment provides the inputs that lead to need satisfaction, in the eastern spiritual thought the concept of 'being in tune' with the environment is encouraged to experience well-being.

Research on Buddhist meditation and psychotherapy

Numerous Buddhist ideas and concepts have relevance to psychotherapy. Insight into the real nature of things leads to the subsiding of one's previous understanding of the world. There are three empirical marks of existence that are essential to Buddhism. The first is dukkha or suffering. Life is suffering, because of its impermanence and basic emptiness or no-self-ness. Anatta is the experience that there is no essential and enduring self or ego. This emerges from breaking down the process of awareness and finding that the ego is neither a part of awareness nor the sum of the parts of awareness. The other relevant experience in Buddhism is anicca, the impermanence of everything. Buddhists hypothesize that movement is characteristic of existence. Everything is changing or in a flux. The idea of a fixed or permanent ego or self is perceived as an illusion that is created in an attempt to cope with the ever-flowing flux of reality. There is no self. The emphasis on empiricism makes Buddhism especially apt to be connected with cognitive behavioral approaches to psychotherapy and behavior change (see e.g. Kwee & Taams, 2002).

In the framework of Buddhism emotional disorders are most often understood as caused by the pursuit of a lifestyle contrary to the inherent disposition of the person and contrary to one's spiritual destiny. In severe disorders, energy, i.e. the highest spiritual aspect (manas), is believed to withdraw from the five khandhas or aggregates of attachment. These constitute the entirety of what is called 'personality'. These are (1) mind-body, (2) perceptions, (3) feelings/emotions, (4) mental formations, and (5) consciousness. Less severe psychological disorders are generally understood in terms of a discordance of the five aggregates. Depending on the presence or retreat of certain aggregates, the person experiences a change in consciousness. Psychological imbalances, brought about by the person's mind, require a basic restructuring of consciousness contents (or self-talk).

Meditation is the core technique in Buddhism. Psychotherapy may be critical to expose and reduce a person's neurotic or aggressive tendencies, but more is needed in order to deal with a person's sense of 'dis-ease' due to life itself. Most often, it is the fear of experiencing life's vicissitudes that causes suffering. Through meditation and self-examination, a person is assisted in going beyond the usual goals of psychotherapy. The essential element of meditation is that it "takes actual qualities of mind and cultivates them internally so that the person's powers of observation are increased" (Rubin, 1996, p.172).

Over the years reviews have appeared on various types of meditation (e.g. Shapiro, 1994; Walsh, 1999; Rubin, 1996; Epstein, 1995; Watson, 1998; Kloppenborg, 2000; Mohan, 2000, 2001). Some studies have even shown that apart from having a bearing on well-being, meditation has been effective in treating various psychological disorders (Murphy & Donovan, 1997; Kabat-Zinn, 2003). Since the fifties, various studies have been conducted to examine the efficacy of meditation in such conditions as stress, behavioral coping, self control, anxiety disorders, heart disease, hypertension, substance abuse, psoriasis, and eating disorders by claiming meditation's efficacy in alleviating these conditions (Andresen, 2000). With regard to the clinical effects of specific techniques, Segal, Williams, and Teasdale (2002) have provided an overview on the usefulness of mindfulness meditation and its usefulness as a preventive program in major depression. Hayes (2002) argues for more research that focuses on the development of theory in meditation, an aspect that is presently lacking. Constructive understanding as espoused by the Society for Constructivism in the Human Sciences might well be able to offer a comprehensive meta-paradigm to account for Buddhist meditation's practice and research in conjunction with psychotherapy (e.g., Kwee & Taams, 2002).

In past three decades research on Buddhist meditation accrued impressive results; see e.g. Kabat-Zinn (2003) on outcome in various conditions and Teasdale (2000) on relapse prevention in depression. Buddhist meditation, whether called Vipassana, Chan, Zen, or Dzogchen (in Tibetan), is based on what the Buddha taught 2500 years ago. Mindfulness is its common basic ground. These techniques have been employed by the respondents with clients foremost because of the beneficial effects experienced in self application.

Field study

In a recent field study using in-depth interviews (n =10) on Buddhist meditation when used along with psychotherapy in the Netherlands, Mohan (2003) found that meditative practices are generally considered to be effective as an adjunct in the treatment of almost any disorder met by professional psychotherapists (mostly psychologists). Meditation has also made the therapists more open toward clients and more attentive to their problems. It seems that meditation is helpful for both therapists and clients, but in the latter case, only if clients show a receptiveness for this type of intervention. Although the study could not determine through the respondents' answers which clients with which specific disorders would benefit the most from Buddhist practices, there is a consensus that meditation is helpful as a preventive measure. Buddhist meditation as a technique of awareness can be systematically integrated in any form of psychotherapy.

The study has also thrown some light on the problems using Buddhist meditation in the context of psychotherapy. Therapists feel that problems like fully understanding Buddhist psychology, explaining this to clients, and assessing the outcomes of the therapy when used along with psychotherapy are the hurdles they encounter. Nevertheless, they expressed optimism about the future of Buddhist practices and opined that these techniques could be developed further to meet the clients' specific needs. They note that in the near future Buddhist meditation might well become an accepted part of and in the long run become merged with mainstream psychotherapy. This study highlights several issues for further consideration: (1) the benefits of Buddhist meditation in a psychotherapeutic context; (2) the dissemination of meditation as an adjunct to psychotherapy; (3) the need for systematic training in Buddhist psychology and techniques; (4) the need for assessment tools; and (5) the hope for an integration of Buddhism and psychotherapy in promoting well-being.

Conclusion and implications

Longing for well-being or happiness is present in all cultures. Western psychology understands well-being from a hedonistic and individual need satisfaction. Buddhist psychology looks at it from a 'middle path' and regards societal needs as important as individual needs. Both Buddhist and western ways of living have evolved their own approaches to attain optimum well-being or happiness and to alleviate suffering. The Buddhist perspective of life is rooted in spirituality and seems to be broader than a sole scientific fundament. To alleviate suffering, the emphasis is to reduce afflictive desires, practice meditation, and follow a spiritual path. From a western psychological perspective, promotion of well-being is achieved through a greater control over one's self and the environment. Both perspectives and approaches have their value to their own cultures and if harmoniously combined could complement each other and enrich individual and societal well-being. As globalization is becoming a reality, the insights from the Buddhist wisdom of synthesis and enlightenment and the western analytical and scientific approach might provide the much needed understanding of (promoting) well-being. In the recent years mental health professionals are open to Buddhist practices, while western psychology is gaining popularity and applied in the east for modern day problems. Serious attempts are underway to bridge the gap between Buddhist wisdom and western savvy. This include the recent developments to integrate Buddhist spiritual practices with evidence-based mental health interventions (Mikulas, 2002) and a plea to develop a curriculum leading to a Master's degree in 'Clinical Meditation Studies' (Kwee, Ishii, & Sakairi, 2001). Its aim is not psychotherapy per se, but to energize therapists to help clients grow, to stimulate therapists to alleviate their own existential-emotional suffering, and to further states beyond pure emotion - including glimpses of 'enlightenment' - in the society at large. Keeping in view the call for integration, Mohan's (2003) preliminary findings confirm the need for the development of such a new mental health profession.

© Krishna Mohan (Ph.D., Makerere University, Kampala, Uganda)

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ACKNOWLEDGMENT

I dedicate this work to the late Prof. Ria Kloppenborg from Utrecht University, the Netherlands, who inspired me to do research in Buddhism and Psychotherapy.

3.8. Well Being. Integrating Eastern Knowledge in Western Culture and Western Knowledge in Eastern Culture

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