Dr Ruwan M Jayatunge 

Provencher and Keyes (2011) define positive mental health as feeling well, functioning well, and being resilient in the face of life’s challenges — improves quality of life and is integral to overall health and well-being, even when there are on-going limitations caused by mental health problems and illnesses. According to Buddhism mental suffering is due in large part to imbalances of the mind (Gunaratana, 1985; Wallace & Shapiro, 2006). Numerous Jātaka stories indicate the mental imbalance caused by Akusal Chitta (or pathological mind). These pathological elements impact the mental wellbeing.

Dr. Yukio Ishizuka, a Harvard trained Japanese psychiatrist hypothesized that there are three basic psychological needs or spheres that determined psychological health such as  the search for self, the need for intimacy, and the quest for achievement. As described by Westerhof & Keyes, (2010) there are three core components of positive mental health: feelings of happiness and satisfaction with life (emotional well-being), positive individual functioning in terms of self-realization (psychological well-being), and positive societal functioning in terms of being of social value (social well-being) The Jātaka Stories highlight the importance of positive mental health by spiritual enhancement. These stories help to promote spiritual wellbeing.

Having a sense of spiritual well-being is an important component of positive mental health. Spirituality is something holistic, beyond religious practices and beliefs, which includes broader values and principles that give meaning to life. Coyle (2002) describes spiritual well-being as a feeling connected to something larger than oneself and having a sense of purpose and meaning in life. The Jātaka stories encourage finding the purpose and meaning in life thus promoting positive mental health.

Search for self or know thy self is one of the dictums in Jātaka stories. Dr. Yukio Ishizuka as well as Eric Fromm strongly believed that Know thyself” is one of the fundamental commands that aim at human strength and happiness. Fromm’s notion Know thyself” was stated by the Buddha over 2600 years ago.

The story of Bhaddawaggiya Princes reveals the importance of knowing thyself. The Bhaddawaggiya Princes where looking for a woman who stole their valuable possessions. When they met the Buddha the princes asked Venerable Sir, did you see a woman? The Buddha answered What is more important whether look for a woman or to look for thy self? (i.e. know thyself). The princes replied that more important is to know thy self.

 

The Buddhist tradition has focused for over 2,500 years on cultivating exceptional states of mental well-being as well as identifying and treating psychological problems (Wallace & Shapiro, 2006). The Jātaka stories encourage self-perceived positive mental health. Perceived mental health is a subjective measure of overall mental health status. Jātaka stories reveal how virtuous people attained positive well-being through the cultivation of optimum mental balance.

Buddhism promotes an ideal state of well-being that results from freeing the mind of its afflictive tendencies and obscurations and from realizing one’s fullest potential in terms of wisdom, compassion, and creativity (Wallace & Shapiro, 2006).

Descartes’ Error

The French Philosopher René Descartes argued that the mind a thinking thing can exist apart from its extended body and therefore, the mind is a substance distinct from the body, a substance whose essence is thought. According to René Descartes mind and body are really distinct and Descartes believed that the nature of the mind is completely different from that of the body.

Beginning with the spirits of Animism in the 3rd millennium BC, the Greek invention of the soul and its properties, of thymos (emotion), menos (rage) and nous (intellect) are then traced from the time of Homer, in which the soul does not last the death of the body, to Plato in the 4th century BC who argued that the soul, incorporating the nous (now called mind) is incorporeal and immortal. Plato’s pupil, Aristotle, commented on the impossibility of an incorporeal soul interacting with a corporeal body (Bennett, 2007).

The modern psychology views mind as the totality of conscious and unconscious mental processes and activities  by which one is aware of surroundings, and by which one experiences feelings, emotions, and desires, and is able to attend, remember, learn, reason, and make decisions.

The Buddhism does not divide mind and body. The Buddhism defines mind as a non-physical phenomenon which perceives, thinks, recognizes, experiences and reacts to the environment. Mind impacts the body. These two entities have close connections. The Jātaka stories indicate how mind affects the body providing numerous case studies.

The Neurologist António Damásio (1994) intensely discussed Descartes’ Error. He assessed the mind/body dualism question. He argues that René Descartes’ “error” was the dualist separation of mind and body, rationality and emotion.

In Buddhist Psychotherapy mind and body are no two different entities. There is no sense in Buddhism that the body is a “vessel” that is guided or inhabited by the mind or spirit. Rather, the body and mind combine and interact in a complex way to constitute an individual (Wilson, 2004). The Buddhist Philosophy teaches the mind is supreme and it can have a profound impact on the body. The Jātaka stories provide numerous case studies of psychogenic ailments which have somatic impacts. However according to Kriel (2003) mind and body dualism still persists in the field of medicine.

Egnew (2005) states that Medicine is traditionally considered a healing profession, but it has neither an operational definition of healing nor an explanation of its mechanisms beyond the physiological processes related to curing. He further states that Healing is an intensely personal, subjective experience involving a reconciliation of the meaning an individual ascribes to distressing events with his or her perception of wholeness as a person. Buddhist Psychotherapy is holistic and it addresses individual’s suffering and helping him to find a meaning.

The Human Body and Mind

According to the definition provided by the NASA (National Aeronautics and Space Administration) Life is a self-sustained chemical system capable of undergoing Darwinian evolution.

Buddhism regards life as the unity of the physical and the spiritual. The teaching of Buddhism centers primarily on human existence consisting of life, suffering, death and the way out of it. In Buddhism, the primary purpose of life is to end suffering.

A man is composed of six elements: solidity, fluidity, heat, motion, space and consciousness. Human beings were viewed as biological organisms (materialism) to be understood by examining their constituent parts (reductionism) using the principles of anatomy, physiology, biochemistry and physics. Disease was seen as a deviation from the biological norms, caused by some identifiable physical or chemical event and intervention involved introduction of a corrective physical or chemical agent (Mehta, 2011). According to Gold (1985) human body is not an object, but multiphasic, experiential beings of finite freedom.

Buddhist psychology analyses the person into five constituent aggregates (khandhas): matter or physical body (rūpa), feeling (vedanā), perception (saññā), volitional activities (saṅkhāras) and consciousness (viññāṇa). The first aggregate  represents the material component of a person (rūpa) and remaining four represent mental  components of a person or what we call mind (nāma) (Sumanacara, 2011). Buddhism offers a vision of radical inter-identification. A vision where all living beings are identified with all other entities. This vision does not merely teach that we are all in this together, but that we all are this, rising and falling as one living body” (Cook, 1977).

The human mind can be viewed as a cluster of functions that are developed and shaped by the ongoing interaction between man and his surroundings (MIELI). The Buddhist theories of mind center on the doctrine of non-self which postulates that human beings are reducible to the physical and psychological constituents and processes which comprise them (Stanford Encyclopedia of Philosophy).

In general, the mind can be defined as an entity that has the nature of mere experience, that is, “clarity and knowing.” It is the knowing nature, or agency that is called mind and this is non-material. But within the category of mind there are also gross levels, such as our sensory perceptions, which cannot function or even come into being without depending on physical organs like our senses. And within the category of the sixth consciousness namely- the mental consciousness, there are various divisions, or types of mental consciousness that are heavily dependent upon the physiological basis, our brain, for their arising. These types of mind cannot be understood in isolation from their physiological bases (Dalai Lama).

The Jātaka stories help to understand the dynamics of the human mind by giving a variety of stories. These stories highlight how human mind perceives ideas. How mind reacts in extreme situations. It narrates self centeredness to selflessness, anger to loving kindness, self indulgence to search for meaning. The Jātaka stories emphasize the power of mind and mind’s supremacy. The Buddhist doctrine underlines that all things are preceded by the mind, led by the mind, created by the mind. In Dhammapada the Buddha states: In Our life is shaped by our mind. We become what we think.

Mind and Mental Factors in Buddhism

Understanding the nature of the human mind is arguably the greatest intellectual quest of all time (Kanwisher, 2010).

Psychomotor theory explains the neural origins of human mind. This theory rejects the mind-brain duality. Psychomotor theory was created to explain the psychomotor coupling in health and disease, stating that, not the mind-brain duality or unity, but the mind-brain-body triad as a functional unit may be essential in health and disease, because mind does not end in the brain, but further controls movements, in a reciprocal manner; mental and motor events share the same neural substrate, cortical, and spinal motoneurons; mental events emerging from the motoneuronal system expressed by the human language may be closely coupled with the unity of the mind-brain-body triad (Tan , 2007). Psychomotor abilities can be defined as the process of interaction between the perceptual systems (or five senses), the brain (where perceptual information is interpreted) and the body (where the individual reacts to such perceptual stimuli) (Vorster, 2012).

Buddhism is a religion that deeply discusses human mental process. Human mind has a special place on Buddhist philosophy and it has gone in depth to analyze the human mind. In Abhidhamma (which is the higher teaching of the Buddha profoundly analyses human mental process) man is described as a psycho-physical being consisting of both mind and matter, and it gives a microscopic analysis of the human thinking process (Narada, 1956).

The system that the Abhidhamma Pitaka articulates is simultaneously a philosophy, a psychology, and an ethics, all integrated into the framework of a program for liberation. The Abhidhamma may be described as a philosophy because it proposes an ontology, a perspective on the nature of the real (Bodhi , 1993).

The Abhidhamma states that consciousness performs a task of ‘selfless’ data processing (there is action without an actor) and speaks mainly about ‘conscious cognition’, the dynamics of input and output (Barendregt, 2006). In Abhidhamma the Buddha describes consciousness as a flowing stream intensely interconnected. These words were echoed by William James and in his theory of mind (1890) described that conscious mental life flows continuously like a stream. William James further illustrates the consciousness and writes thus – the transition between the thought of one object and the thought of another is no more a break in the thought than a joint in a bamboo is a break in the wood” (James, 1988).

Abhidhamma describes the mind as a combination of citta (consciousness) and cetasikas (mental factors or concomitants of the mind). There are 52 cetasikas or mental factors—some can defile the mind, some can purify the mind and some are neutral. The total number of possible combinations between citta and cetasikas is 121.  When the unwholesome mental factors such as lobha (greed), dosa (anger), uddhacca (restlessness), kukkucca (remorse), vicikicchà (doubt), thina-middha (sloth and torpor) can be calmed down not to arise in the mind, then the mind is in unperturbed, peaceful and lucid state. This is the state of upacàra-samàdhi (neighbourhood concentration or access concentration), meaning it is close to jhàna (absorption). (Tin Mon, 1995).

Sanity vs Insanity

The Buddha said “Sabbe Puthujjana Unmantaka” (All non-enlightened folks are insane). In Civilization and Its Discontents Freud wrote: All neurotics, and many others besides, take exception to the fact that ‘inters urinas et faeces nascimur.”  

Although sanity refers to the soundness, rationality and healthiness of the human mind there is no clear demarcation between sanity and insanity. Some believe the distance between insanity and sanity is measured only by success. Thomas Szas states that insanity is the only sane reaction to an insane society.

The causes for insanity are multi-factorial. Genetics, life stressors, infections, injuries to the central nervous system, drug abuse and even society and culture can contribute to the progression of different mental disorders. In addition Deficits or defects in the structural or functional integrity of the nervous system could lead to insanity. For instance Neurotransmitter imbalances can cause mental disorders. Neurotransmitters are endogenous chemicals that allow the transmission of signals from one neuron to the next across synapses. Acetylcholine, dopamine, GABA, serotonin, epinephrine, norepinephrine and endorphins are the most significant or crucial neurotransmitters found in the human brain and neurotransmitter imbalances within the brain   are the main causes of psychiatric conditions.

The Anti-psychiatry Movement which was formed in 1960 questioned the fundamental assumptions and practices of psychiatry. Foucalt pointed out that the specific definitions of, or criteria for, hundreds of current psychiatric diagnoses or disorders are vague and arbitrary, leaving too much room for opinions and interpretations to meet basic scientific standards. In addition inappropriate and overuse of medical concepts & tools to understand the mind and society, including the miscategorization of normal reactions to extreme situations as psychiatric disorders. Hence Foucalt emphasized that prevailing psychiatric treatments are ultimately far more damaging than helpful to patients. 

The Psychologist Eric Fromm proposed that, not just individuals, but entire societies may be lacking in sanity”. Eric Fromm further says that yet many psychiatrists and psychologists refuse to entertain the idea that society as a whole may be lacking in sanity. They hold that the problem of mental health in a society is only that of the number of ‘unadjusted’ individuals, and not of a possible un-adjustment of the culture itself.”

Mental Disorders and the Influence of Buddhist Jātaka Stories

In general terms a mental disorder is a psychological or behavioral pattern that is associated with subjective distress or disability that occurs in an individual and which are not a part of normal development or culture. The mental disorder is characterized by impairment of an individual’s normal cognitive, emotional, or behavioral functioning, and caused by social, psychological, biochemical, genetic, or other factors, such as infection or head trauma.

The DSM- IV defines Mental Disorders as thus.

A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (i.e., a painful symptom) or disability (i.e.,  an impairment in one or more important areas of functioning) or with a significantly increased  risk of suffering death, pain, disability, or an important loss of freedom. The syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event. It must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. No definition adequately specifies precise boundaries for the concept of mental disorder. Also known as mental health, mental impairment, mental illness, brain illness, and serious brain disorder. 

A mental disorder is an undesirable (e.g. harmful) condition caused by a dysfunction in a mental Cummins-function (Brülde, 2003). Cultures differ in what is considered normal and what is considered abnormal (Hall, 2009). Psychiatry itself, like most of the rest of medicine, is a product of Western culture. As such, it embodies ideas of illness and wellness, of normal and abnormal, of well-functioning and malfunctioning, of adaption and maladaptation which have their roots in our own shared sentiments regarding the character of reality, of what is desirable, and of what ought to be desired (Leighton & Hughes, 2005).

In traditional societies human distress is more likely to be seen as an indicator of the need to address important life problems than as a mental disorder requiring treatment (Burton, 2012). As described by Dube (1979) Ayurveda, the ancient Indian system of medicine is described in Atharva Veda and in subsequent treatises by Charak, Susrut, and Vagbhatt, containing the details of etiology, symptoms, diagnosis, and therapy of afflictions in humans and animals.  The Buddhist literature also possesses the esoteric material of Medical Science, which is practiced and conserved in India since centuries. It refers to the fundamentals of medicine, rules of good living, which lay considerable emphasis on the hygiene of body, mind (Narayana & Lavekar, 2005).

In ancient India, two branches of knowledge are concerned with human suffering, trying to theoretically explain as well as to practically overcome its reasons: (practical) philosophy and medicine. Buddhism was regarded as a medical discipline (Butzenberger & Fedorova, 1989).

The Buddhist philosophy talks about the human mind and its pathological and non-pathological portions. Jātaka stories describe extensively conditions from mild neurosis to severe psychoses.

Stigma and discriminations are often associated with mental illness. Mental illness stigma is defined as the devaluing, disgracing, and disfavoring by the general public of individuals with mental illnesses.(Abdullah & Brown,  2011) Stigma often leads to discrimination. Public stigma and discrimination have pernicious effects on the lives of people with serious mental illnesses (Corrigan et al., 2012).

The Buddhist Jātaka stories describe various types of mental disorders and how it affects the individual as well as the society. For centuries these stories helped the people to treat individuals affected by mental illnesses with utmost compassion. There is no evidence of persecution of psychiatric patients in the ancient Buddhist societies.

In the Medieval Europe, psychiatric patients were often targeted as the agents of Satan and subjected to torture and execution.  Mentally ill women were often burnt at the stake as witches. As indicated by Schoeneman (1982) the psychopathological interpretation of the European witch hunts of the 16th and 17th centuries, which has been prominent in histories of psychiatry, contends that demonology overwhelmed psychiatry in the late middle Ages, with the result that the mentally ill were executed by the thousands as witches. The witch hunts of sixteenth and seventeenth-century Europe impeded psychiatric progress for centuries (Schoeneman, 1977).

In his famous book Gendercide and Genocide by Prof Adam Jones of the international studies at the Center for Research and Teaching in Economics (CIDE) in Mexico City writes thus.

…….. for three centuries of early modern European history, diverse societies were consumed by a panic over alleged witches in their midst. Witch-hunts, especially in Central Europe, resulted in the trial, torture, and execution of tens of thousands of victims; about three-quarters of victims were women. Arguably, neither before nor since have adult European women been selectively targeted for such largescale atrocities. Modern estimates suggest perhaps 100,000 trials between 1450 and 1750, with something between 40,000 and 50,000 executions, of which 20 to 25 per cent were men. (Gendercide and Genocide – Adam Jones).

In 1247 London’s Bethlem asylum was found and the term bedlam” became associated with chaos, confusion, and poor treatment, which reflected the general attitude toward mental illness. The mentally ill received harsh treatments. The 17th century English physician Thomas Willis declared that: discipline, threats, fetters, and blows are needed as much as medical treatment for the mentally ill.

Institutions for the mentally ill were established beginning in the 14^th century. Institutionalization is a deliberate process whereby a person entering the institution is reprogrammed to accept and conform to strict controls that enables the institution to manage a large number of people with a minimum of necessary staff. Until the end of 1960 s Institutionalization was considered as the viable option to treat psychiatric patients. In these institutions psychiatric patients were often subjected to humiliations and maltreatment. Prolonged years of Institutionalization diminished the social and life skills of the patients. This condition was identified as Institutionalization Syndrome which had the features of loss of independence, loss of self-confidence, erosion of desire and skills for social interaction, excessive reliance on institutions and fear of authority.

The humane way of treating mental patients started in Europe mainly with the reformations introduced by Dr Philippe Pinel (1745- 1826) and he initiated moral treatment for the psychiatric patients.  In 1793 he was appointed the director of the Bicêtre Insane Asylum and took numerous revolutionary decisions. He unchained the mental patients and stopped ill treatments.   Dr.  Pinel treated the patient as well as his surrounding environment. His innovations in treating mentally ill patients are still used by the modern psychiatry.

Conversely many centuries before Philippe Pinel the Buddhist societies in Asia treated psychiatric patients with empathy. The King Buddhadasa of Sri Lanka (398 AD) treated psychiatric patients with compassion.  The King Buddhadasa used herbs, empathetic words and healthy community atmosphere to treat the mentally ill.

It is important to note that in the ancient Buddhist societies the mentally ill were never persecuted, excommunicated or subjected to any maltreatment. The Jātaka stories may have had a weighty effect on de-stigmatizing mental disorders.  For centuries, these stories helped people to view individuals with mental illnesses with a compassionate eye.