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Buddhadharma : Spring 2009
33 SPRING 2 00 9 buddhadharma: the practitioner’s quarterly why combining both approaches can be very helpful. Medita- tive qualities can facilitate psychotherapeutic healing of painful patterns, while the psychotherapeutic healing of these painful patterns can reduce their disruption of spiritual practice. What are the practical implications of this conjunction of psychotherapy and spiritual practice? It seems clear that the question of whether meditation and psychotherapy can enhance one another has been decided: many people benefit from com- bining them, and this has been observed by clinicians and dem- onstrated by research. When old traumas, pains, and patterns recycle endlessly, or make spiritual practice seem overwhelming and hopeless, the best answer may not be simply the classic one of more practice. Instead, psychotherapy may be called for. Medication and Meditation Sometimes neither meditation nor psychotherapy—nor even the combination of the two—is enough. Depression can be so debilitating, anxiety so agitating, and old pains so trau- matic that spiritual practice withers and psychotherapy has little effect. Mental approaches alone prove insufficient. And this brings us to one of the most hotly debated topics among spiritual practitioners: the appropriateness of using medica- tion to help with psychological and spiritual difficulties. Two groups have staked out polar positions. We could call them the purists and the pragmatists. Spiritual purists argue that if mental suffering is funda- mentally spiritual and karmic, spiritual practice alone is appropriate to treat it. A standard response to difficulties is therefore “more practice.” Moreover, they are concerned that medication may dull or derail spiritual practice. They worry that if suffering is merely dissolved with a pill, the motiva- tion to practice may dissolve with it. They also worry that medications may reduce or distort awareness, and thereby make practice more difficult. In this view, medications such as antidepressant or antianxiety agents can be novel forms of the “mind-clouding intoxicants” prohibited by the lay precepts to which many Buddhist practitioners adhere. Therefore, tak- ing these modern pharmacological agents is tantamount to violating this precept. Another worry is that potentially valu- able spiritual challenges such as the classic “dark night of the soul” may be misdiagnosed as psychopathology, and then be suppressed with drugs rather than explored and mined. By contrast, pragmatists hold that spiritual practice alone is simply insufficient, or at least not optimal, for healing all mental suffering. While not denying the validity of some pur- ist concerns, pragmatists argue that certain problems and pathologies respond best to other therapies, and one of these therapies can be medication. Stan and Christina Grof—who have written extensively about spiritual emergencies and founded the Spiritual Emergence Network to offer support to people who find themselves in such emergencies—encourage this pragmatic perspective. They certainly agree that some spiritual emergencies are best treated not with medical sup- pression, but with time-honored spiritual and psychological principles. These principles include providing a supportive relationship with a spiritual guide, reframing (where appropri- ate) the emergency as a spiritual process and opportunity, and setting positive expectations. However, they also recognize that some emergencies are so overwhelming that they require medical intervention. As for the idea that there is something inherently unspiri- tual about taking drugs to modify neurotransmitters such as serotonin, we might consider how John Tarrant Roshi, who is also a Ph.D. psychologist, demystifies the brain’s chemistry. “What is serotonin?” he asks. “It, too, is a piece of the original light. For some people it comes in the form of serotonin; for others in the form of a smile. There is more than one way to move neurotransmitters around—meditation can do it; having someone hug you does it, too.” The purist-pragmatist debate is curiously reminiscent of one that rocked psychiatry decades ago. At that time, the Spiritual purists argue that if mental suffering is fundamentally spiritual and karmic, spiritual practice alone is appropriate to treat it. A standard response is therefore “more practice.”