Diversity Practice Approach Buddhist Approach to PTSD November 2009 By Glenda Ruder currently working to obtain her master
's degree in Clinical Social Work at Highland's University in Albuquerque, NM. This paper was written in response to a Diversity Practice Approach assignment in a course entitled Advanced Multicultural Practice.
I have chosen to look at the theoretic approach of Buddhism; which is considered not only a religion but a philosophical approach as well. Throughout the paper I will be exploring how the Buddhist approach views mental illness particularly with the population of people affected by Post Traumatic Stress Disorder. Buddhism is a religion that was started by Siddhartha Gautama approximately 26 centuries ago in nowadays Nepal and northeastern India (O’Brien, 2009). Siddhartha Gautama was born a prince and was married at the age of 16. At this time he began to grow restless of the palace life and soon traveled outside of the palace walls. Every trip outside palace walls he recognized human suffering; such as: sickness, old age and death (A View on Buddhism, 2009). On his fourth trip, he saw a wandering monk who had given up everything he owned to seek an end to suffering. "I shall be like him." Siddhartha thought (Instilling Goodness School). From here Siddhartha studied with many different teachers. He mastered the art of meditation (the art of no-thingness), and meditative absorption (focusing on“the state of neither perception nor nonperception”) (A View on Buddhism, 2009). After mastering these two techniques he still did not feel that he was any closer to finding an end to suffering. Continuing on; Siddhartha came to a place called Bodhgaya in Northern India; while sitting under a Bodhi-tree he decided not to get up until he discovered the truth. A short time later, he became a fully enlightened Buddha (A
View on Buddhism, 2009). Siddhartha Gautama came to be known as “the Buddha” meaning the “awakened one” after experiencing a profound realization of the nature of life, death and existence (O’Brien, 2009). After this realization Buddha began sharing his teachings. The Buddha once summarized his entire teachings in one sentence: “I teach about suffering and the way to end it” (A View on Buddhism, 2009). His teachings were called the dharma, which he and his followers set out to spread throughout India. During his enlightenment; Buddha came to three truths in which his teachings were based off of. The first truth is that nothing is lost in the universe. This is a theory of all things being inter- connected; everything has purpose. A dead leaf turns into soil (Instilling Goodness School). The second universal truth of the Buddha is that everything is continuously changing. Life is like a river flowing on and on, ever-changing. It is smooth and gentle in some places, but later on snags and rocks crop up out of nowhere (Instilling Goodness School). Unexpected things continually happen and you cannot predict what will happen in life. The third universal truth explained by the Buddha is that there are continuous changes due to the law of cause and effect. This is the same law of cause and effect found in every modern science textbook (Instilling Goodness School). The idea of Karma is derived from this universal truth. Energy and things that you put into the universe are the origins for what comes to you in life. The Buddhist perspective perceives the mentally ill as those who become disconnected to their environment and the world around them. In order to heal mentally ill through the Buddhist perspective the issue needs to be looked at as a societal issue rather than an individual one. Emotional suffering and mental distress may be a universal experience, but the ways they manifest are unique from place to place (Duerr, 2009). A socially engaged Buddhist perspective
will lead us to inquire about our obligation to treat not only the person but also the environment that has contributed to the conditions that create suffering (Duerr, 2009). Healing mentally ill within the Buddhist perspective focuses on attention to the mind, body, and environment as opposed to medicinal based interventions. Thich Nhat Hanh writes in The Path of Compassion (1995):
Restoring mental health does not mean simply adjusting individuals to the modern world of rapid economic growth. The world is ill, and adating to an ill environment cannot bring real mental health….Psychiatric treatment requires environmental change and psychiatrists must participate in efforts to change the environment, but that is only half the task. The other half is help individuals be themselves, not by helping them adapt to an ill environment, but by providing them the strength to change it. To tranquilize them is not the Way. The explosion of bombs, the burning of napalm, the violent death of our neighbors and relatives, the pressure of time, noise, and pollution, the lonely crowds-these have all been created by the disruptive course of our economic growth. They are all sources of mental illness, and they must be ended.
Post Traumatic Stress Disorder (PTSD) is defined as severe recurrent emotional anxiety reactions that originate from an intense and traumatic experience. A trauma occurs when there is a combination of sensory and emotional overload that cannot be processed and integrated into the psyche. A war scenario provides many intense visual, auditory and contextual stimuli that are completely foreign to the average person, as does sexual abuse, rape or witnessing a car accident (Strong, 2009). PTSD is a significant health risk for many that are afflicted by it in the United States. Because the symptoms of anxiety and PTSD are a result of internal thoughts that bring about physiological change, it is important to seek out the type of therapy that will foster an improvement in health. Using Buddhist-styled therapy, one, can learn to approach and embrace the challenges in life and manage the thoughts while understanding that challenges and suffering are normal and that life’s circumstances will only improve (Cadena, 2008).
Buddhist- centered therapy focuses to provide a comprehensive approach to mental healthcare (Cadena, 2008). In the Buddhist religion members are encouraged to seek encouragement from a Buddhist monk. In order to correlate this method into a therapeutic approach; those effected by PTSD are asked to seek guidance and advice from their therapist when they are feeling anxious. Through initiating communication with a guidance counselor, the feelings of anxiety are often alleviated. The focus of the Buddhist-styled therapy is to not only encourage through the principles of Buddhism but to encourage initiation of care by selfmotivation (Cadena, 2008). Another important aspect of Buddhist-styled therapy is beginning to understand the world around you using the universal truths of Buddhism. The components of this are: the understanding that nothing is lost in the universe, life in constantly changing, and the belief of cause and effect. The understanding of how these truths relate to suffering will allow them to understand how the environment is ever evolving. This can help provide hope and encouragement (Cadena, 2008). The understanding of Buddhist theory can facilitate growth and help someone work through the struggles of their experiences. Buddhist Psychotherapy or Mindfulness Meditation Therapy can be defined as the direct application of mindfulness to an emotional complex to facilitate transformation and resolution (Strong, 2009). This is another form of a Buddhist approach; however, rather than focusing on the understanding of Buddhist theory it focuses on inner awareness. Learning to be present during situations even through times when traumatic images are triggered. Presence is one of the most important components of sensitive listening as when we are listening to a friend who is suffering. In this same way, learning to be fully present for our emotional suffering is highly therapeutic and is perhaps one of the major contributions to the healing process (Strong, 2009).
Another aspect of this is focusing on our emotional suffering that prevents us from being fully present at a given time. Meditation is a tool used to bring mindfulness and awareness to the individuals personal suffering. The main purpose of Mindfulness Meditative Therapy is to separate the flashback of images they experience with the emotions or anxiety that they feel during these experiences. This allows the person to slowly break down these experiences which enables them to slowly digest this information which will allow them to work through these emotions. Someone afflicted by PTSD are flooded with traumatic memories. These memories may be photographic or may include abstract elements of color, shape and movement in something resembling a surrealistic collage. The emotional reactions that are formed from these memories are referred to as the Structural Theory of Emotions.
An intense emotion is likely to be encoded in intense colors such as red and orange and the imagery is likely to be large and close in the person’s inner visual field, whereas neutral emotions are likely encoded in neutral colors such as pale blue or white and appear small and far away. It is by becoming aware of this internal structure of the imagery that encodes the emotional energy of the trauma that we can explore the possibility of changing the imagery and thus changing the emotional intensity of a traumatic memory. This concept is developed to an art in the therapeutic modality called Neuro-Linguistic Programming, or NLP. Just as language is made of words that represent internal experience, imagery represents the natural language of the mind – the mind thinks in pictures and uses inner imagery to organize experience and memory (Strong, 2009).
The Structural Theory of Emotions relates to this approach with the belief that if the structure of the flashing images can be changed you may be able to heal the emotional reactions to the images. However, for this to work effectively the imagery must arise experientially from the emotional felt sense, rather than be created through deliberate visualization (Strong, 2009). In order for this to be possible one must work through these images and emotions connected to them on their own through their own inner experience. This healing cannot come from external sources. There is no attempt to interpret what arises, only to experience fully and know
completely whatever arises (Strong, 2009). This process strives to break down the emotional aspects of the experiences so eventually they will be able to work through their traumatic experiences; rather than taking it in all at once and becoming overwhelmed by it. The second phase of Mindfulness Meditation Therapy is focused on establishing Mindfulness Based Relationship. This happens when one presents non-reactivity and allows the imagery into their present awareness rather than disassociation. There are different techniques in order to come to this result. One technique includes watching the imagery as if projected on a screen is one technique (Strong, 2009). Once a client begins to experience a state of a Mindfulness Based Relationship they will be able to recognize the specific content of the various images they may be visually experiencing. This will bring about the prevention of disassociation or anxiety when experiencing these images.
The Mindfulness Based Relationship is an essential part of the transformation process for many reasons, the primary reason being that it allows the compacted emotional complex to unfold into more manageable parts. At another level, the MBR allows the client to fundamentally change the way that he relates to his inner emotional experience and he begins to break free from seeing himself as a victim of the emotional trauma. This in itself is an essential requirement for change (Strong, 2009).
Mindfulness Meditation Theory helps the client work through the effects of their traumatic experience by exposing them to their fear. They do this in repeatedly and various ways in order to prevent the client from being over whelmed. This exposure desensitization effect is regarded by most schools of psychotherapy as an essential part of overcoming PTSD and Mindfulness Meditation Therapy provides a very subtle and effective way of doing this (Strong, 2009). The Buddhist theory approach would require the client to be open minded and willing to look inside themselves to work through the trauma that they have experienced. If a client would
have to be self-motivated for this approach if they were not the clinician would not be able to engage them. The clinician would give them the tools they would need throughout the process; however, as in any approach you need a willing client. A clinician would assess the clients’ progress when they had mastered each step. In the first approach I discussed the client would be ready to move on when they had recognized and understood the three universal truths in Buddhism. When they were able to recognize that they weren’t necessarily victims, according to this theory, however things that happen in life are not on a personal level rather on a universal one. With Mindfulness Meditation Theory the client would be able to move on when they possess the ability to sit with the recurrent images and are present with them. Goal setting within both approaches would be working towards the next steps in the theory; to master each one. You would end services with the client after they were able to process the trauma that they experienced and they no longer had anxiety or emotional reaction to it. You would evaluate this through observation and subjective recollections of how the client was feeling when they were experiencing the flash backs. I think that in order to use this approach in practice you would really have to believe in the theory behind it. Before using this approach you would have to identify what your own beliefs are regarding it. Many clinicians use pieces of different theories in practice; however, I think that this is a theory you would have to use fully in order to see results. The main basis of this theory is for each individual to be self-motivated. In order to help someone with PTSD process their trauma you would have to remain objective. In every theory this is important, however, because this theory is so focused on the idea that ‘things happen for a reason’ it is really important to be aware of counter transference and your own past experiences
not effecting the work that you are doing with these clients. Mostly focusing the energy on their experiences, understanding of the 3 Buddhist truths and how they fit together in order for them to be able to work through their experience; and find greater meaning for these experiences in order to move past them. You would need to keep the client focused and facilitate their understanding of the basis of these approaches.
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Duerr, Maria. (May 19 2009). Impossible Choices- Buddhism and Mental Illness. Medical Ethics. Retrieved on October 31, 2009. http://www.scribd.com/doc/15621451/ Impossible-ChoicesBuddhism-and_mental-Illness
O’Brien, Barbara (2009). What is Buddhism? An Introduction to Buddhism. Retreived on October 31, 2009. http://buddhism.about.com/od/basicbuddhistteachings/a/ basicshub.htm.
Strong, Peter. (August 26, 2009). Mindfulness Psychotherapy for Post-Traumatic Stress Disorder (PTSD) in Boulder, Colorado. Retrieved on October 31, 2009.
A View on Buddhism. (August 24 2007). Retrieved on October 31, 2009. http://www.viewonbuddhism.org/buddha.html
Instilling Goodness School. Following the Buddha’s Footsteps. Retreived on October 31, 2009. http://online.sfsu.edu/~rone/Buddhism/Footsteps.htm