Depression is Not a Disease: Anxiety & Depression Workable via Meditation?

Via on Mar 24, 2008

After thousands of years-the rise of civilization, the history of philosophy and the mingling of religious traditions with modern science and psychology-our approach to pain can be summed up in four words: “Get rid of it.” Given that studies show happiness decreasing in first world societies around the globe, the approach doesn’t seem to be entirely working.
One might argue that our economy could collapse if people had to relate with their various pains-if they couldn’t reach for the nearest product guaranteed to alleviate their suffering. Got suffering? We are bombarded with the message that chemical imbalances in the brain are responsible for depression and anxiety-and that medications are the (profitable) solution for this flawed brain chemistry. The marketing slogan for a new antidepressant medication, Cymbalta, reads “Depression hurts but you don’t have to.” Sounds appealing. Psychiatry also buys into this conventional view-that external salvation can deliver wellness-something known as spiritual materialism in the Buddhist tradition.

Chögyam Trungpa wrote “The Lion’s Roar is the fearless proclamation that any state of mind including the emotions, is a workable situation…Chaos should be regarded as extremely good news.” (The Myth of Freedom, page 69). But we tend to regard emotional chaos as suffering, and our efforts to eradicate that suffering can create even more unnecessary confusion, even illness. Psychiatric medication could be used toward the proclamation of a Lion’s Roar-or it could be used to fortify the ego.

An important distinction here is between what we might call necessary suffering and unnecessary suffering. Necessary suffering is the facts of life that none of us can avoid: we all experience losses, illness, aging and death. We often experience disappointment. Unnecessary suffering includes the very real illnesses we inflict unwittingly on ourselves by repeating habitual patterns of judging, pushing away, managing or otherwise dominating our lived experiences (including our experiences of necessary suffering).

Why would anyone want to relate with pain directly, instead of avoiding it? Suffering is, after all, a nuisance obstructing our plans. But avoidance of pain, more often than not, seems to lead to more of the same. We have a choice: pay now or pay more later. One example that occurs frequently in my psychiatric clinic is insomnia. Many of my patients are hard-driving, successful overachievers whose ambition and success can not make room for addressing their insomnia. They are denying one of the facts of life: that their bodies are far from the efficient productivity machines they want them to be. Many of these patients have not slept well for decades before appearing in my office. They’ve used various strategies (caffeine, exercise, fixating on personal goals or peak experiences) to avoid fatigue and other obstacles, forcing their bodies to perform day in and out, without taking the rest we all require. Eventually this master/servant relationship with our body manifests as full-blown psychological disorders. At that point, significant treatment including medication may be necessary. But is it possible to live productive lives without accumulating stress in the body, and resultant unnecessary illness?

In my professional experience working with my patients as a psychiatrist, and in my personal experience as a meditator, I find that the self is much more expansive that what I was taught in my medical training. In fact, it seems the self is without any limit other than those we presuppose to exist. These limits mark the boundary we draw between what we regard as self and what we define as other. When we label any aspect of our experience as “other,” we are effectively saying, “I deny the limitless quality of reality.” The inherent tension between self and other accumulates as stress in the body, eventually leading to unnecessary illness. Take for example feeling anxious in a social setting. People in this situation have only two options: feel it and go toward it, or recoil from it and isolate from social situations. Thus life either expands or contracts depending on how one relates with social anxiety or any other painful experience. Put another way, uncomfortable experiences invite us to step through a door into our wholeness and our inherent wellness.

If we are to make the human journey toward wholeness and genuine unfabricated wellness, we must cultivate a daring willingness to proclaim as part of our reality whatever experiences arise, however unwelcomed they may be. Willingness to be with our experience is not a “yes, I approve of what is happening,” nor is it a “yes, I accept this because I am too weak to change it:” this is a much more direct yes that acknowledges what is without judgment or retreat. Each one of us is capable of indestructible wellness: a moment by moment fearless willingness to be with what is already true, what is happening.

Psychiatric medication, like any other human technology, can be used to build up our (erroneous and egoic) belief we can push away any part of reality that we regard as painful or uncomfortable. In this situation, any medications become yet another promise of external protection from pain. But given a different world-view, these same medications can help us to become ourselves, beyond our own preconceived limits. A psychiatry free of spiritual materialism could start by acknowledging the fundamental truth of our sometimes-painful human experience. This would stand in stark contrast to the prevalent view that psychiatric medications could (or should) allow a person to live a life free from the human condition. Suffering itself is the gate to wellness, not the obstacle.

A doctor and patient can use medications as a tool in the process of breaking out of our chronic habitual and behavioral strategies of avoiding our experience. This could begin with a good understanding about the differences between necessary and unnecessary suffering and what medications are for. Just as a broken bone needs a temporary cast in order to heal in proper alignment, medications can soften intense symptoms enough to catalyze the healing of deep wounds. We can learn to trust in our own basically good human nature, no matter our situation.

Will Van Derveer, M.D. is a psychiatrist in private practice in Boulder, Colorado. He practices and studies meditation with Dr. Reggie Ray in the lineage of Chögyam Trungpa: willvanderveer@yahoo.com, 303.260.9685.

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48 Responses to “Depression is Not a Disease: Anxiety & Depression Workable via Meditation?”

  1. [...] For more: shambhala.org, or read the full article on Meditation as an antidote to depression and anxiety here. [...]

  2. Amy Kenney says:

    I appreciate any attention that can be brought to this topic but I have concern with the title of this article. My hope is that readers will read past the title to delve into the subject of a serious and common problem. The education of lifestyle changes/patterns for those who may be predisposed to depression & to those who are going through stressful events could become an education tool used in mainstream society. Thank you for your thoughtful insight & common sense approach to a sometimes dangerously serious subject.

  3. David Lewis says:

    Thank you for your thoughtful essay. I wonder what you think of the genetic component of despression and/or bipolar illness? I ask because my father, brother, sister and I all suffer(ed)from one or both. I believe his difficulties with depression contributed mightily to my brother’s death at age 47; and that my father’s depression underlay his abusive behavior. It seems that the genetic and environmental causes and conditions that led to these mental problems become so intertwined that it is near-impossible to break the tangle without medication, therapy and meditation. I would appreciate your ideas and would love to be able to speak with you in more detail. Yours in Buddhadharma, David Lewis

  4. John Joseph says:

    I am the first of the males in my family to have broken from the claws of bi-polar disorder and depression. I spent years in psychotherapy and refused to take medications and many years in meditation. The key, is to know that your mind is a container of thoughts that you can control and change. I agree that the bio-chemical aspect of depression is often too powerful for some people to overcome, but there are other ways out of this mental prison as illustrated in this fine article.

  5. Sam says:

    Very insightful information. We can’t avoid our true nature forever. Suffering is inevitable, but wellness is attainable when one’s perspective of reality is expandable. Medication can be a helpful tool towards wellness, but it will not end our suffering for good.

  6. Dhruva Nath Timsina says:

    i firmly beleive in mind game and meditation can actually help in healing illness and thinking can do work, may be its the mind controlling things in avoiding illness.

  7. Evan Ravitz says:

    Anxiety & Depression have a reason: Society has been going the wrong way for a long time. Meditation and being responsible for one's personal "policy" is the yin: getting real responsibility for national policy is the missing yang.

    The major finding of the major "Citizens and Politics" study was that we're not apathetic but feel "impotent" about affecting politics. A voice is not enough, nor is voting for candidates. Best example: here, Rep. Mark Udall voted AGAINST the first bailout to get elected. Now safely a Senator for 6 yrs, he recently voted FOR the 2nd bailout. We need a direct vote on OUR policy or it's not ours, it's the people who contributed the most: the financial industry.

    The most evolved project for a hybrid direct/representative democracy is led by former Sen. Mike Gravel. Registered voters can now vote to ratify the National Initiative for Democracy at http://Vote.org, much as citizens ratified the Constitution at the Conventions when the Legislatures wouldn't!

  8. Shelli says:

    As un-PC as it might be in this day and age, I agree – to a point – with the author’s premise. The fact that talk therapy is at least if not more effective than medication when it comes to most garden-variety depression seems to bear this out.

    HOWEVER, I certainly hope that Dr. Van Derveer is NOT suggesting that psychiatrists and patients can reasonably expect to find success in this same approach with brain disorders that have already been demonstrated to be firmly physical/medical in nature. Schizophrenia, bipoloar disorder, and acute brain trauma will not cure themselves regardless of how firm the patient’s understanding of the nature of suffering might be, any more than one could reasonably expect a firm grip on reality and a meditation practice to fix a broken arm or cure cancer.

    • Stephanie Potter says:

      Talk therapy, without transformation, simply imbeds the depression. Meditation Instructors and Psychotherapists can be equally abusive when it comes to sharing the journey of unraveling the learned behaviors.

  9. Nathan Smith ndsmith says:

    The boundary between the conscious mind and the physical brain is not well understood. In most cases, it seems, an ‘all of the above’ strategy is most promising. Of course, the greater issue of medical/heath industry and societal norms and beliefs plays a decisive role in how we actually understand the mind-body relationship. Like some of the other comments, I agree that it would be foolish to throw out our newly acquired, helpful and accurate understanding of brain chemistry and psychiatry in order to promote one possible method of improving mental health.

    As a philosopher, I am always puzzled by claims like “the self is without any limit other than those we presuppose to exist. These limits mark the boundary we draw between what we regard as self and what we define as other.” It seems patently false that the self is without limits. I understand that a good Buddhist is supposed to believe that “I” am “you,” but the philosopher in me recoils. In the case of mind-body interaction, clearly one of the difficulties is that the “other,” i.e., the chemistry of the brain, is also the “self.” Perhaps this is a paradigm case, and not a special case. Not sure about how that works, though.

  10. Interesting article, and partially true.

    Unfortunately, it is much more complicated than Dr. Van Derveer makes it seem.

    All mental illness, from anxiety to schizophrenia is integral in nature, meaning that there is a body/brain component (brain chemicals, genetics, etc), a psyche component (the subjective experience of the illness, as well as the role it plays in shaping our consciousness, etc), a cultural component (attachment issues, intersubjective issues such as "secondary gain," meaning the perks that come with being ill, like attention and care from loved ones, etc), and a social component (generally this will be a stigma, like in-patient treatment or criminality, etc). Neglecting to account for any of these issues leaves only a partial accounting of the illness.

    Without doubt, some of what Dr. Van Derveer says about spiritual materialism is true, especially in the medical model in which he was trained. However, I would prefer to see a therapist follow a different lead in this area. A good therapist might ask us to look at what the illness needs from us, what role is it trying to play in our spiritual lives, our evolution as individuals?

    If we take our depression or anxiety (and I am diagnosed with social anxiety disorder) as a teacher, what can we learn about our lives? Even this approach is not fully integral as outlined above, but it is a far more productive way in to the parts of ourselves that are not yet whole and healthy.

    If we take our "suffering" as a teacher, we can get that indestructible wholeness Dr. Van Derveer mentions in his article. But that wellness will come because we no longer resist the pain that depression or anxiety brings, not because we have overcome what for many is a biological illness. Pain x Resistance = Suffering. Remove the resistance, and the suffering goes down to zero.

  11. redvoid says:

    I have never had a prescription medication or antibiotics in my life for any condition physical or mental. I have beat every illness with my natural immunity, rest & nutrition (what EVERYONE had to do until 50 years ago). I also have had severe bouts of depression for the last 20 years that caused major negative consequences in my life, including loss of jobs, friends and group associations. When I started looking for psychologists, I was shocked at how readily they wanted to prescribe all kinds of medications without running any medical tests. I think there is a tendency for Americans to conflate Medicine and Doctors (a for profit industry) with Pure Science (a non-profit search for absolute scientific truth) and they have very little in common. Prescribing drugs without running tests is NOT good science, but it is good business. The US has over 30 Million People on antidepressants, of which at least 43% have not ever been tested even verbally by a Psychiatrist, much less had their neurotransmitter levels measured in a lab. They all just want that shiny new pill they saw advertised on TV (which is illegal in the EU and should be here to advertise prescription medications) to fix all their problems. Its pretty obvious that most antidepressant use in the US is over prescribed, marketing influenced, escapist, and NOT therapeutic and its Pharmaceutical companies getting rich off of our consumerist appetites and lack of regulation. I applaud Dr Vanderveer for paying more attention to healing than to profits, and calling out "spiritual materialism" for what it is.

  12. [...] you feel depressed, when you feel bad, it is sometimes for no reason at [...]

  13. Michell says:

    this article has been written in a very impressive way. Depression is a mental disorder its not a disease. Its a deep sadness you feel when your life is sucky. It is a very common factor in drug addiction, so common, in fact, that a large percentage of those who are addicted to drugs and alcohol also exhibit symptoms of depression, whether in its mild form or to the extreme as bipolar disorder or manic depression. Some Drug Addiction treatment centers deals with both depression and drug addiction.

  14. I was raised in a Buddhist tradition that does not view depression as a disease. That's not to say it's not extremely serious, fundamental to the human condition, or that there's predisposition in some or many cases.

    That said, "everything is workable" is a practice, not mere philosophy or "scientific" conjecture or or pharmaceutical take two pills and see me in the morning "medicine."

  15. Misleading how? It's the Buddhist view. This article does straddle, or address, two streams of thought—psychiatry and Dharma.

  16. We're not just talking about "mental illness" or clinical depression, here, but the sort of depression we all experience, frequently.

  17. I would argue that I (related to you, Aunty) have experience depression, and meditation and Buddhist study have not only helped, but have systematically undermined my tendency toward depression. All meditation is not created equal—I'm not sure what exactly you practiced, or how often, or how seriously day to day…it would be helpful to know more.

    Saying "I practiced meditation and suffering didn't go away" does not accurately reflect the Buddhist teachings that suffering is ground zero of human existence. Meditation isn't a drug.

  18. The title is mine, and I take responsibility for it, and happily stand behind it. I did discuss said title with the author in the original discussion which led to said article—it was not made the title because it was more catchy, but because it was more clear—and, clearly, conducive to dialogue!

    Apologies to the experienced, wonderful author for any comments directed his way. All responsibility for faults in the article's title are mine.

  19. Good article, but will have to join the chorus about the title, particularly as it encourages a trend in the Buddhist/yoga world of people who don't know the difference between depression and feeling bummed out thinking they're authorities on the subject and writing about it–and, most unfortunately, those people are often leading senseis and gurus (thus the "Buddhist tradition" mentioned above, which seems to be as clueless about depression as the Christian tradition is about homosexuality). "Disease" does not necessarily mean "something you have to take pills for."

  20. As a bodyworker and practitioner of Zen Shiatsu I would like to address the aspect of bodywork for anxiety or depression. I think not only is psychotherapy important, but as talk therapy I think it can be a great supplement to regular bodywork. Regular bodywork can help to calm and settle an overactive autonomic nervous system, help the client to feel more connected with their body, and offer gentle and safe touch. It can also help them to integrate the many feelings and emotions that come up for them during talk therapy.

    I also agree that regular meditation is important and medication too when absolutly necessary. I think it all boils down to the fact that people are complex and in order for someone to heal we must look at anxiety and depression on all levels of someone’s being. As practitioner and health care providers we should collaborate together to help the patient/client receive the best care possible.

  21. Hi Liz,

    Sorry I missed your reply originally. I am a Buddhist, a fitness trainer, an integral coach, and a masters student in counseling psychology, not that any of that matters in what I said.

    The formula I posted comes from Dialectical Behavioral Therapy, created by Dr. Marsha Linehan, a psychologist and Zen lineage holder. She developed her model (based on Cognitive Behavioral Therapy and Zen mindfulness) to treat borderline personality disorder, one of the most difficult mental disorders to treat. It also works well with addictions, anxiety disorders, mood and depression, and chronic pain.

    Removing the resistance ends the suffering, NOT the necessarily the pain, although the meditation component can drop level 9 pain (on a 10 point scale of subjective experience) to less than 3 – the pain scale is standard in treating chronic pain.

    What Dr. Van Derveer says about social anxiety (in his brief comments about it in the article above) is exactly my experience. I have been diagnosed with social anxiety. However, I have chosen to ask the anxiety what it needs, and the answer is that I need to be aware of my surroundings and the people around me – I am also a "highly sensitive person," which means I am easily effected by the people around me, energetically, so I need to be more aware of my environment. The anxiety forces that awareness, so rather than medicate it away, I breathe through it and become more consciousness of what I am feeling and what is making me anxious. The anxiety remains, but the suffering it used to bring is gone because I have stopped resisting it.

  22. clark says:

    about a month ago I would have agreed with this article, but now not so much. About 2 weeks ago i had a horrible dream, woke up in the middle of the night in a cold sweat, and continued to toss and turn all night. The next morning i felt horrible, i felt naucious and couldn't eat anything. I thought I had a stomach virus, this went on for 2 more … See Moredays. I could tell something wasn't right because even though i was sick my mood was all wrong and i constantly felt like something bad as going to happen. Looked up the symptoms and it turned out to be anxiety. I was too embarrassed to tell anyone because I have always been the well balanced kid. I take care of my body, mind and soul. Eventually I had to tell mymom because before i went to bed every night i really felt like i was going to die.

  23. clark says:

    Its that feeling you get when something bad is going to happen to you but it never goes away. I knew knothing was going to happen to me but my body was saying something completely different. Its scary having your body not listen to you…Anyways went to the doctor, she prescribed hydroxyzine and within a couple hours i was feeling like myself. I hate taking medicine, especially this kind of medicine, but my goodness has it helped. Its not a very strong dose, it only helps to calm me down and put me to sleep. Anxiety still comes up during the day but yoga and breathing excercises help with that most of the time. I am finding new ways to deal with anxiety so eventually i wont have to take anything. With that said, unless you have experienced anxiety yourself, you shouldn't be so quick to judge.

  24. Clark – I know exactly what you are feeling, since I have anxiety as well (mine is mostly social now, but it was generalized about 15 yrs ago). Because I believe all of these things are body/mind/culture/society based, I thinks the meds are useful if that is what is needed, AND the yoga and breathing can reduce the symptoms over the long term so that the meds are no longer necessary.

    I guess my question would be, "What was going on in your life when the anxiety started? What was happening in your dreams? Was your diet and exercise good?" All these things are connected.

  25. clark says:

    Well it wasn't really a dream. Sometimes I fall into a wierd state thats in between being sleep and awake. It has happened 3 times before but never has it scarred me to the point where it effects me physically (nausea and shakes). But now that i think about it, the problem could have stared with those previous experiences and this last time was kinda the last straw. Its very hard to get the sleep I need at night or to meditate when I are scared to completely relax :/

  26. helen says:

    Anxiety and depression are 2 different things , expressions of 2 different energies, sitting meditation has been wonderful( for me)in cutting through anxiety, but not depression, ive spent years meditating in retreat, with a retreat master, a tibetan lama who remarked that he was struck by the amount of depression suffered by his western students within retreat, he said tibetans didnt have the same experience and he wondered what it was in our upbringing that might be causing it?

    He and other lamas recommended i get up and move to deal with the depression and when the retreat moved into a more physical phase, the depression went. simplistic? perhaps like occam's razor.
    what if most simple depressions were as a result of stagnated energy?

    i think there is not enough attention paid to the simple cures, diet,talking therapies and body energetics.

    Of course lets not forget that to feign normality in this culture could be construed as insanity , and that anxiety or depression are a sign somethings not right and we owe it to ourselves to figure out just what that is.

  27. Greg says:

    One factor that seems to color the discussion is a lack of understanding of the depth of the Buddhist practice. As is so often the case, there is an assumption that Buddhism is just another form of talk therapy with some periods of silence tossed in for good measure.

    The Buddha, however, was teaching a much more profound discipline. Probably not for everyone. If someone believes their body runs the show and dictates who they are and what they feel they may be quite a distance from the door of the sangha.

    Their attention may be so attached to the normal cultural beliefs – such as those provided by the pharmaceutical industry, which totally owns psychiatry – that they need a less demanding discipline, one that does not seek to bring enlightenment but rather one that provides a mild sedative quality that moves one away from awakening into slightly deeper sleep in which they will not suffer in the short run.

    Perhaps only when the boredom of sleep becomes the perceived problem will they be ready to sacrifice and suffer pain in order to move past barriers toward awakening. Awakening does have its cost – increased awareness of suffering – and this is not something everyone in our society chooses.

    It is a perfectly valid choice for some to desire less awakening and more sedation. At the branch in the road, some may choose one path, others may choose a different path. We all make individual choices. We should just keep in mind they are not the same paths and they are not intended to bring about the same results.

  28. Stephanie Potter says:

    This is a huge subject, subject to our own experience. I am 56, and come from an extensive (generational) history of learned helplessness and depression. Had I not learned how to work with my mind through the practice and study of buddhism I would not have learned how to make this a journey of inquiry,discovery, and empowerment. I can say this after a lifetime of trying all the modalities available within our current health care system, which is broken; watching the struggles of each member of my family, and finally arriving to experience true change in how I relate with my past, present, and future. It is work: However if I had not made this journey I would not have discovered the joy of doing this work, and all of the variations of rhythm and texture and the whole magic that, it turns out, is our human existence.

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  30. [...] summers ago in an attempt to quell some of my internal fire I signed up for a Buddhist psychotherapy course. A component of the course work was to attend various temples throughout Washington [...]

  31. A new post via a doctor making similar points re depression and disease and Buddhist tradition. http://www.elephantjournal.com/2010/05/defeating-

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  36. Most people suffering from bouts of depression, anxiety and general mood disorders that greatly affect their quality of life don't even know that they have non-prescription options to treat their depression effectively.

    Instead, most people will either "bite the bullet" through the rough times, or they will seek the advice of a professional such as a phychiatrist or psychologist, and perhaps go through counseling, or be put on a prescription antidepressant such as Zoloft or Prozac. Did you know that antidepressants are currently the third leading classification of prescription drugs by overall revenue and profitability?

  37. Most people suffering from bouts of depression, anxiety and general mood disorders that greatly affect their quality of life don't even know that they have non-prescription options to treat their depression effectively.

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  39. jim says:

    depression isn't a disease, huh. Who gave you your medical license?

  40. Jimbo says:

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