March 24, 2008

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

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: [email protected], 303.260.9685.

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