The following article on 'Psychosis and the Three Refuges' is, for the most part, an account of recovery from periods of 'psychosis' in relation to a Buddhist practice. It was originally published in The Middle Way: Journal of the Buddhist Society.
Psychosis sounds scary. It is the name of a 2010 horror film based on a serial killer who “unleashes his blood lust”. The first thing people often ask, when I tell them I work with people who have psychosis is: “aren’t you scared?” So what can psychosis have to do with the Three Refuges (the Buddha, Dharma and Sangha)?
In psychiatry psychosis is sometimes used as a synonym for ‘severe mental disorder’ and according to the mental health charity, Mind, there is actually more chance of being killed by lightning than by someone with a mental illness. Most narrowly defined, psychosis is simply the presence of delusions and/or hallucinations.
Delusions, as understood in psychiatry, are beliefs that are clearly false and that indicate an abnormality in the affected person's content of thought. Hallucinations in psychosis are often auditory, hearing voices is a well known example. They can also be visual, and some people with psychosis experience strong smells or have sensations on or under the skin when nothing is actually there as far as other people are concerned.
Whilst some of us may have a greater predisposition, all of us can potentially experience psychosis. The British Psychological Society (2000) has estimated that around 10-15% of the general population experience what could be described as psychotic phenomena, and most are neither distressed, nor seek help. Studies have shown that all sorts of beliefs Western psychiatry might see as delusions (including beliefs in magic, aliens, telepathy and spiritualist beliefs) are actually extremely common in the general population (Peters et al. 1999).
Psychosis may be triggered by many things including stress, traumatic life events, drug use or even Buddhist practice. Buddhism traditionally that such experiences can arise in the practice of zazen. The Japanese term makyo, roughly “diabolic phenomenon” from “ma” (akuma), “devil” and kyo, “phenomenon, objective world” is used to describe such hallucinatory or delusional experiences in this practice. VanderKoor (1997) describes the example of Sara, who on a Buddhist meditation retreat had intense makyo. Following the retreat she was hospitalized and received antipsychotic medication.
Although I have a specific qualification in interventions for psychosis and around 7 years experience in working with others with these experiences, my most direct understanding comes not from training, work or study, but from personal first-hand experience of psychosis both within and without the mental health system.
My first experience of psychosis, when eighteen, was thought by psychiatrists to have been a reaction to stress and bereavement. In 1996 I began reading books on religion and Zen and believed that I was making a 'breakthrough'. My presentation quickly led to a psychiatric hospital admission. The following are extracts from my personal health records of the time:
In hospital I was further restrained and heavily medicated with antipsychotic injections by force. Fortunately the admission was brief and once discharged I stopped all medication after about 6 weeks. Since then over a number of years, at times of stress, I experienced brief psychotic symptoms. I chose not to disclose these symptoms to medical professionals at the time and navigated my way through, getting on with my life without subsequent compulsory psychiatric hospitalisations or forced injections.
During 1999-2000, whilst at university, I had a period of experiencing what a nurse described as “anxiety attacks”. The nurse recommended abdominal breathing. This worked for me and reminded me of the Zen books I had read over the previous few years, so I decided to try the practice of zazen (seated meditation). Later in 2002 I formally became a lay Buddhist at a Jukai ceremony and now consider the Three Refuges as vital to my personal recovery.
The Three Refuges are the Buddha (meaning both the historical Buddha and the Eternal Buddha Nature), the Dharma (the teaching of the Buddha and of our own Buddha Nature), and the Sangha (those who follow the Buddha and those who seek, long for and know the Eternal) (Schomberg, 1996).
The Three Refuges
Mindfulness was originally integrated into Western healthcare in the late 1970s by Kabat-Zinn; he describes mindfulness as: “paying attention in a particular way: on purpose, in the present moment and non-judgementally” (Kabat-Zinn, 1994 p.4). In healthcare the importance of presenting mindfulness as secular and distinct from Buddhism is frequently emphasised; psychologists now often present mindfulness as something from psychology or something that Kabat-Zinn ‘came up with’. In fact he was a student of Zen Master Seung Sahn (Streitfeld, 1991) and recent healthcare treatments such as Dialectical Behaviour Therapy (DBT; Linehan et al., 1991; Linehan et al., 1993) and Mindfulness-Based Cognitive Therapy (MBCT; Segal et al, 2002) also have a basis in adaptations of Buddhist teachings (Welch et al., 2006; Gilpin, 2006). The Dalai Lama has stated:
Studies are now beginning to support the use of Mindfulness practices drawn from Buddhism in the clinical treatment of psychosis (Abba, et al, 2006; Bach and Hayes, 2002; Chadwick, 2006; Gaudiano and Herbert, 2006). Paul Chadwick (2005; 2006), for example, is a clinical psychologist who has drawn on the teachings of Ajahn Sumedho (1992) and now advocates relating mindfully to unpleasant psychotic sensations; with a clear, open and gentle awareness of whatever is present.
Daishin Morgan, Abbot of Throssel Hole Buddhist Abbey in England, sees the therapeutic and enlightenment aims of meditation as on one continuum. He reminds us that whilst it is good to see some of the benefits of Buddhist practice made available to those who might not otherwise find them, the fundamental aim of Buddhist practice goes much further (Morgan, 2004).
Koshin Schomberg (1996a), Abbot of North Cascades Buddhist Priory in the USA, teaches that, in Buddhist training, difficulty in accepting the full religious implications of meditation can be an obstacle: Buddhism is a religion, and requires us to have real faith. This faith is not a matter of professed creed or belief. It is the faith that there is That which is a true Refuge and that we can find this Refuge through meditation and training.
In my own life, this practice is more than just a technique for changing my relationship to unpleasant experiences; zazen is directly taking Refuge in the Buddha.
Whilst I was in hospital with psychosis, I was convinced that the world and all that relates to it had ceased to exist – nothing was real. All that remained was an illusion, placed there by the devil to keep me bonded to false reality and ultimately in hell. I also believed that various people including my family were in fact this devil in disguise attempting to keep me in bondage.
After looking at a landscape painting on the hospital wall for some time, I had a sudden belief that it was a window into the true reality beyond the devil’s illusion – a window into heaven. In order to show trust in God, I stood upright and allowed myself to fall backwards hoping to land in the heavenly reality shown in the painting. As I allowed myself to fall backwards my head hit the edge of a table. I lay on the floor, my head now bleeding. “Look at the blood” said the nursing staff around me, “What blood?” I answered, defying what I believed were the devil’s attempts to bind me.
Knowing what is real and what is not can be especially difficult when experiencing psychosis. For me, taking Refuge in the Dharma, the Buddhist teachings (which reject both extremes of eternalism and nihilism), provides a source of stability and confidence. In particular the teaching of the Buddhist precepts; beginning with “Cease from evil”, provides an anchor in the midst of the changing conditions of daily life, and an essential guide to action no matter what may happen (or appear to happen). Even within psychosis the Dharma, and in particular the teaching of the precepts, provides an anchor.
Buddhism is more than mindfulness with bells, gongs and incense, but it is no cure for psychosis. At the completion of my final exams at university I had been practicing zazen for a while, but nevertheless became psychotic again, believing that I was being spied on by government agents:
When I was out I noticed that someone looked at me and touched their ear. This was a message that they had an ear piece and were listening to me. In a pub, believing I was being listened to by government agents, I began reading from my passport; hoping this would help give me protection:
As I read this I looked across the pub and could see that a woman was touching her ear looking at me and smiling. I then knew that she could hear me through an ear piece and was a spy. There was also a television on in the pub, the news was on and I could see that there was a riot in another part of the country. This riot was connected to the things that were happening to me and it became clear that I was now on a secret government mission. The woman’s smile was a signal that I would indeed have "assistance and protection as may be necessary" on this mission...
Around this time I had a number of other unusual experiences and then decided that it may be beneficial to practice zazen (something I had not done for a while). So I sat down in my room, but attempting to practice whilst in this psychotic state was like getting hit by a mental tsunami. For a moment I saw just how incredibly unsettled my mind was and this was very disturbing. This disturbance inspired me to check out my recent experiences, with a Buddhist Monk in a local Zen temple. My intention was to ask the Monk what his opinion was of these beliefs and experiences. On my way to the temple I had various further experiences such as receiving messages from inanimate objects. I also felt elated and believed that this could be a spiritual experience. I intended to share all this with the monk in the temple.
When I entered the temple I was invited to join meditation. We first read a scripture together but when it was time to move I stayed put. I was then told that meditation was over and was offered a cup of tea.
Responding to my unusual perceptions and experiences, I began to act in a chaotic way in the temple, and was eventually asked to leave. On my way out I explained that I had come to find out if the monk thought I should see a psychiatrist and he said that he thought I should. Being advised by the monk to see a psychiatrist challenged my psychotic beliefs and helped to bring me back down to earth. Fortunately this challenge gave me enough insight to move in the direction of recovery without actually seeking medication or hospitalisation at the time. In the next few weeks, having completed my exams, I attended my graduation ceremony and returned to my parents’ home for a while.
For many, in the face of an unsatisfactory mental health system, it can be tempting to seek alternatives in Buddhism. Taking Refuge in the Sangha means trusting in and seeking the advice of those who follow the Buddha. Over 2000 years before Florence Nightingale, who is seen as the founder of the nursing profession, Buddhist teachings set forth the qualities of a good nurse in the Anguttara Nikaya. The Buddha stated: "Whoever, O monks, would nurse me, he should nurse the sick" and Buddhism has begun to enrich contemporary Western nursing.
Even so, Buddhist centres which are not set up as treatment clinics or hospitals cannot be expected to function as such and in relation to psychosis the most essential role of the Sangha may indeed be to continue pointing those in need in the direction of professional healthcare providers.
Psychosis and the Three Refuges
In reality, unlike the movies, psychosis is not about “unleashing blood lust”, in fact sometimes it is not scary at all, but it can be deeply disturbing for both those who directly experience it and their families. One does not need to be a Buddhist to practice mindfulness, and it may be helpful to people in getting grounded and letting go of disturbing sensations or thoughts; however, Buddhism goes much deeper and I believe that not only mindfulness, but the Buddha, Dharma and Sangha have been essential to my staying well after psychosis.
Finally, the Three Refuges do not offer a miracle cure for psychosis which can be rolled out through the healthcare system in a secularised form. There are perhaps as many routes to recovery as there are people.
Aldridge, M.A. (2011) Psychosis and the three treasures, The Middle Way: Journal of the Buddhist Society, 86:3