Vipassanā, Therapy and Medicinal Drugs

Vipassana, Therapy and Medicinal Drugs.
There are two questions concerning the practice of vipassana, insight meditation that arise frequently. Is
there a role for therapy in spiritual practice? Is there a role for medicinal drugs?
In the Buddhist Tradition in general, but especially so in Theravada, a student would live close to their
teacher, usually a monastic, or live with their teacher in a monastery as a layperson, and as a samanera
(lower orders) or a junior monastic would stay with their teacher for at least five years. In other words,
the contact would be continuous and most probably long lasting. The relationship would be about a
person’s understanding of the Buddhadhamma and spiritual growth. Spiritual growth would include
vipassana and mindfulness in ordinary daily life where both social difficulties and personal difficulties
may arise. When it comes to relationships both within the family, local community, at work or in the
wider society, the teacher would be there to consult. And when it comes to personal psychological
problems – and any continuous practice of vipassana will unveil unresolved conditionings - the teacher
would be the person to approach for guidance.
In the West this system rarely pertains. I, myself, was lucky. I had two very good teachers resident in
Birmingham, Ven.Dr.Sayadaw Rewata Dhamma and Ven.Sayadaw U Nynaponika. Over time they
became familiar with our western ways and although it was difficult for them to give specific advice they
were always there to re-enforce general guidelines and, of course, any problems arising through
vipassana were always addressed. However, what normally happens now is that students may go for a
week’s vipassana course and contact is then lost till the next time which is normally a year. Some go to
various teachers, but again rarely see them. In other words there is little or no follow-up support or
‘pastoral’ care. And I cannot see this gap being filled until teachers, both lay and monastic, settle in cities.
Even in my own situation, it would be only the immediate surroundings where I could offer full on-going
support, although email and skype do offer greater contact.
In the meantime we have to find solutions. Fortunately these days, there have developed many
psychotherapeutic and counselling techniques and many charities and groups have formed to deal with
specific sufferings such as grief, anxiety and depression. The danger here is conflict of teachings and
guidance. So much depends on the therapist or group leader as to the orientation of their therapy and
group. For instance, one of my advanced students was told by her therapist that meditation would do her
harm! So beware of therapists who have limited or no understanding or practice of vipassana and have
yet formulated clear opinions. I also attended a self-help group for people suffering from depression and
from a Buddhist perspective they were actually making things worse for themselves.
So it would seem that a student, who is grounded in Vipassana and perhaps in Buddhadhamma (the
teachings of the Buddha), when they look for help with personal or social problems, needs to find
someone who is tuned in to their way of thinking. It may even be the case that for particular problems, a
therapy may be even more effective than vipassana. The reason for this is that vipassana is a specific
practice aimed at spiritual insights, although it does purify the heart and mind. But, for instance, in the
case of severe problems such as alcoholic addiction, vipassana brings insight into the cause of the
suffering and allows personal psychological trauma to be healed, but the programme run by AA is
credited to be extremely effective in dealing with the psychological and habitual nature of such a
problem.
I asked a practising therapist and long time meditator, Richard Gilpin, about seeking a therapist. He
replied that ‘the standard party line amongst therapists is that the most important thing is to find the
therapist that works for you. This can only be a trial and error process (i.e. check out a few and decide
who you want to spill your beans to). The model of therapy your therapist trained in will generally
become of secondary importance. It's the relationship that counts, as the old line goes. The other reason
for the therapist being more important than the therapy is that most therapists have, to some degree,
integrated different models into their own therapeutic style - often one, say, Gestalt therapist's style will

be unrecognisable to another for a particular client. Therapy tends to be a lot more idiosyncratic than
practice schools, although of course the latter also have huge variety.’ And I agree with him when he goes
on to say, ‘I guess this all fits similarly to how one might be drawn to a particular spiritual teacher and
how that teacher will offer the teachings in a way quite distinct from another in the same tradition.’
I was surprised when I met other vipassana teachers how varied their methods were, often intermingling
techniques from other Buddhist traditions. This would be most rare in the East where each vipassana
tradition tends to be seen as whole and entire and where respect for one’s teacher would prohibit any
experimentation. And I must confess I am guilty myself!
So it would seem that just as hatha yoga and chi kung/t’ai chi complement vipassana both as physical
exercises and exercises in calm concentration, so certain therapies may also be good supports. There are
certain therapies that are grounded in the Buddhadhamma such as Core Process Psychotherapy, taught
and based at the Karuna Institute www.karuna-institute.co.uk , Tara Rokpa, a Tibetan Buddhism based
therapy www.tararokpa.org/, Mindfulness Based Cognitive Therapy www.mbct.com/ , and Mindfulness
Based Stress Reduction and some that are influenced by or have similar understanding to
Buddhadhamma such as Focussing, Gestalt, Psychosynthesis and Jungian therapy. I am informed that
Cognitive Analytic Therapy (CAT) has interesting Buddhist parallels. Needless to say, I know virtually
nothing about psychotherapy since I never had cause to use it myself, though I have had tasters to find
out what it’s all about.
As for taking medicinal drugs, there was a time it was a no-no in Buddhist circles, but now is seen more
as skilful means. The hard line is that all suffering is due to karma and therefore you have to endure. But
I think a more skilful and compassionate line is the use of drugs to relieve severe conditions and
establish a balance of mind wherein understanding and virtue can grow. For in such severe conditions as
clinical depression, anxiety disorder and schizophrenia, and even for periods when circumstances
become intolerable, a person is caught as in a storm and only in exceptional cases are they able to find
that objectivity wherein insight can be made as in the film, ‘A Beautiful Mind’ (highly recommended).
Hopefully, in time patients will be able to wean themselves off the drugs under medical supervision.
There is a very good article on this very subject in Buddhadhamma, spring 2009 – ‘Medicate or
Meditate’ which centres on depression. Again it very much a matter of finding a therapist or doctor with
whom one resonates.
Finally, it is important to acknowledge that whether we practice with a vipassana teacher with or without
a therapist, with or without medicinal drugs, it is we who have to do the work. And it is we who heal
ourselves. We can only be assisted in the process. The Buddha only points the way. There is no easy way.
Alas!