Western mental health professionals are now increasingly adopting mindfulness-, acceptance- and compassion-focused therapy approaches which ‘present concepts derived from Buddhist psychology as separate from the philosophical context from which they have emerged’ (p.18, Tirch et al. 2016). Research into the clinical utility of Buddhist-derived interventions (BDIs) has increased greatly over the last decade, and continues to grow:
‘...although clinical interest has predominantly focused on mindfulness meditation, there also has been an increase in the scientific investigation of interventions that integrate other Buddhist principles...’ (Shonin et al, 2014).
There are concerns over the rapidity at which mindfulness has been extracted from its traditional Buddhist setting and introduced into psychiatric treatment domains, and writing on innovations and advances in Cognitive Behaviour Therapy (CBT), Huxter (2007) has suggested that:
‘...attempts to distil and separate mindfulness from Buddhism run the risk of losing the skill knowledge and conceptual framework that this tradition offers... attempts to reinvent the wheel, without reference to earlier models are, perhaps a retrograde step’ (p.53, Huxter, 2007).
Although psychiatric nosology has continued in Europe since the mid-eighteenth century CE, definitions of mental health problems still remain subject to debate, with no definition accepted within Western psychiatry to specify the precise boundaries for the concept of mental disorder.
This article focuses upon buddhi vibhrama (impaired or deranged buddhi) as one of the defining features of mental health problems according to a traditional Buddhist Ayurvedic perspective. It also introduces the trilakṣaṇa (three marks of existence) which have an important place in addressing mental health problems as part of ‘cognitive therapy’ (vipassanā-paññā) in the practice of Buddhist Āyurvedic Counselling and Psychiatry (BĀCP).
According to premodern Buddhist and Āyurvedic texts mental health problems may arise as impairment, disturbance, loss, destruction, distortions or in other ways. In the Ayurvedic classical texts, mental health problems (in particular unmāda - a term often translated as mental disorder) are characterised as the impairment, disturbance, loss, destruction, distortions etc. of various mental processes or factors. Problems associated with buddhi (intellect) and smṛti (memory/mindfulness) are most frequently mentioned.
Buddhi (intellect) is the ability to understand correctly, it is the discriminative function, that which knows, and is one of the inner instruments of cognition. Buddhi vibhrama (impaired or deranged buddhi) is a condition wherein ‘perverted’ judgments are made.
Mental health problems are understood as conditions in which buddhi ‘loses its balance’ and buddhi vibhrama is specifically and directly associated with mental health problems from the Ayurvedic perspective.
Examples of disturbed buddhi are given in the classic Ayurvedic text, the Caraka Samhita:
‘If something eternal is viewed as ephemeral and something harmful, as useful and vice versa, this is indicative of the impairment of intellect. For the intellect normally views things as they are’ (CS.Sar.I.99).
What does it mean to clearly see things as they are?
The Ayurvedic classical text, the Caraka Samhita offers a clear answer to this in a very important passage. This passage in the classical Ayurvedic literature makes explicit reference to the Buddhist teaching of the three marks of existence (trilakṣaṇa) in what Wujastyk (2012) has described as ‘completely Buddhist terms... taken directly from the Buddhist meditational and doctrinal milieu’ (p.35, Wujastyk, 2012). Below two different transalations of the original Ayurvedic Sanskrit are given:
‘Any thing that has a cause constitutes misery [duḥkha (Pāli:dukkha)]; it is alien [anātman (Pāli:anattā)] and ephemeral [anitya (Pāli:aniccā)]. It is not produced by the Soul (Atman); but one has got a feeling of its ownership until one has got real knowledge to the effect that this is something different from him; and is not his own. As soon as one knows it, he gets rid of all (miseries)’ (CS.Sar.I.152-153).
‘Everything that has a cause is pain [duḥkha], not the self [anātman] and impermanent [anitya]. For that is not manufactured by the self. And in that arises ownership, as long as the true realization has not arisen by which the knower, having known “I am not this, this is not mine”, transcends everything’ (CS.Sar.I.152-153; p.41, Wujastyk, 2012).
Within the Buddhist tradition, at an advanced stage of mindfulness practice (satipaṭṭhāna) insight (vipassanā) into the three marks of existence (trilakṣaṇa; Pāli:tilakkhaṇa) is purposefully developed:
sabbe saṅkhārā aniccā (all saṅkhāras (conditioned things) are impermanent)
sabbe saṅkhārā dukkha (all saṅkhāras are unsatisfactory)
sabbe dhammā anattā (all dharmas (conditioned or unconditioned things) are not self)
According to Ayurveda, the term prajñāparādha (violation of good judgement) can be defined in terms of impairment in buddhi (intellect), dhṛti (constancy/patience/steadfastness) and smṛti (memory/mindfulness). Prajñāparādha is closely connected with avidyā (ignorance) and foundational for the arising of mental health problems. From the Buddhist perspective avidyā is essentially ignorance of (a failure to grasp directly) the three marks of existence:
‘Perceiving permanence in the impermanent [aniccā],
perceiving pleasure in what is suffering [dukkha],
perceiving a self in what is non-self [anattā],
and perceiving attractiveness in what is unattractive,
beings resort to wrong views,
their minds deranged [khitta-citta],
their perception twisted [vi-saññino]’ (AN.IV.49).
Reference to the three marks of existence (trilakṣaṇa) in classical Ayurvedic medical texts in association with mental health problems, suggests that whilst this understanding of mental health problems is informed by the Buddha’s wisdom, knowledge of the three marks of existence need not be restricted or confined uniquely to Buddhism. A recent study in Australia focused on ‘putting Buddhist understanding back into mindfulness training’ found that an understanding of the trilakṣaṇa (three marks of existence) contributed to improving well-being and reducing distress among both Buddhists and non-Buddhists cross-culturally (Jarukasemthawee, 2015).
Buddhist Āyurvedic Counselling and Psychiatry (BĀCP), is a new subject in Buddhist studies, developed and introduced by Prof. Sumanapala Galmangoda in Sri Lanka at the Nāgānanda International Institute for Buddhist Studies (NIIBS) in Manelwatta, Kelaniya. Prof. Sumanapala Galmangoda (Royal Pandit, Senior Professor and Director, Postgraduate Institute of Pāli and Buddhist Studies, University of Kelaniya) is an Āyurvedic doctor, specialist in Buddhist Abhidhamma and a respected authority on the ‘traditional cultural approaches’ to promoting mental well-being which have been practiced in South-East Asia for centuries and continue to be valued (p.15, WHO, 2009; p.39, WHO, 2012).
BĀCP encompasses both Anusāsanī (instruction, teaching, advice, counselling - which can include therapeutic application of sīla (behavioural therapy), Samatha-samādhi (mental therapy) and Vipassanā-paññā (cognitive therapy)) and yukthivyapāsraya (logic-based physio-pharmacological therapies). The strong theoretical basis of Buddhist Āyurvedic Counselling and Psychiatry (BĀCP) makes it more than the sum of its parts. In practice it is a complex psycho-physical intervention and combines different treatment methods.
Buddhi vibhrama is impaired or deranged intellect, it is a condition in which distorted judgments are made due to a distorted view of how things are. This is a defining part of mental health problems, but also something we are all subject to.
Both the classical Ayurvedic texts and Buddhist texts agree that buddhi vibhrama can be identified in ‘perceiving permanence in the impermanent’, ‘perceiving pleasure in what is suffering’, and ‘perceiving a self in what is non-self’.
Buddhist Āyurvedic Counselling and Psychiatry (BĀCP) includes cognitive therapy (vipassanā-paññā) as one of its holistic therapeutic approaches. This entails developing awareness of the trilakṣaṇa (three marks of existence) as a therapeutic intervention. Research in Australia found that an understanding of the trilakṣaṇa (three marks of existence) can contribute to improving well-being and reducing distress among both Buddhists and non-Buddhists cross-culturally. Manasa Ayurveda therapists are now introducing BĀCP in the UK and developing an understanding of the three marks of existence is an important part of their therapeutic programmes.