DESPITE TEN YEARS of dharma practice and five years of psychotherapy, Leslie was still miserable. To those who knew her casually, she did not seem depressed, but with her close friends and lovers she was impossibly demanding. Subject to brooding rages when she felt the least bit slighted, Leslie had alienated most of the people in her life who had wanted to be close to her. Unable to control her frustration when sensing a rejection, she would withdraw in anger, eat herself sick, and take to her bed. When her therapist recommended that she take the antidepressant Prozac she was insulted, feeling that such an action would violate her Buddhist precepts.

There is a story in the ancient Buddhist texts that relates how the King of Kosala once told the Buddha that unlike disciples of other religious systems who looked haggard, coarse, pale, and emaciated, his disciples appeared to be “joyful and elated, jubilant and exultant, enjoying the spiritual life, with faculties pleased, free from anxiety, serene, peaceful, and living with a gazelle’s mind.” The idea that the Buddha’s teachings ought to be enough to bring about such a delightful mental state continues to be widespread in contemporary Buddhist circles. For many, Buddhist meditation has all of the trappings of an alternative psychotherapy, including the expectation that intensive practice should be enough to turn around any objectionable emotional experience. Yet the unspoken truth is that many experienced dharma students, like Leslie, have found that disabling feelings of depression, agitation, or anxiety persist despite a long commitment to Buddhist practice. This anguish is often compounded by a sense of guilt about such persistence and a sense of failure at not “making it” as a student of the dharma when afflicted in this way. This situation is analogous to that in which a devotee of natural healing is stricken with cancer, despite eating natural foods, exercising, meditating, and taking vitamins and herbs. As Treya Wilber pointed out in an article written before her early death from breast cancer, the idea that we should take responsibility for all of our illnesses has its limits.

“Why did you choose to give yourself cancer?” she reported many of her “New Age” friends asking her, provoking feelings of guilt and recrimination that echo much of what dharma students with depression often feel. More sensitive friends approached her with the slightly less obnoxious question “How are you choosing to use this cancer?” which, in her own words, allowed her to “feel empowered and supported and challenged in a positive way.” With physical illness it is perhaps a bit easier to make this shift; with mental illness one’s identification is often so great that it is extremely difficult to see mental pain as “not I,” as symptomatic of treatable illness rather than evocative of the human condition.

Of course, the First Noble Truth asserts the universality of dukkha, suffering or, in a better translation, pervasive unsatisfactoriness. Is the hopelessness of depression, the pain of anxiety, or the discomfort of dysphoria (mild depression) simply a manifestation of dukkha, or do we do ourselves and the dharma a disservice to expect any kind of mental pain to dissolve once it becomes an object of meditative awareness? The great power of Buddhism lies in its assertion that all of the stuff of the neurotic mind can become fodder for enlightenment, that liberation of the mind is possible without resolution of all of the neuroses. Many Westerners feel an immediate relief in this view. They find they are accepted by their dharma teachers as they are and this attitude of unconditional acceptance and love is one that evokes deep appreciation and gratitude. This is a priceless contribution of Buddhist psychology—it offers the potential of transforming what often becomes a stalemate in psychotherapy, when the neurotic core is exposed but nothing can be done to eradicate it.

Medicine Buddha, Central Asia, twelfth century, gouache on cotton

Eden’s situation typifies this. A writer whose crisis manifested in her twenty-ninth year, Eden suffered from an oppressive feeling of emptiness or hollowness for much of her adult life. Already a veteran of ten years of intensive psychotherapy, she understood that her feelings of numbness and yearning stemmed from emotional neglect in her youth. Her father, a cold and aloof physician, had avoided the children and retreated to a rarefied intellectual world of scientific research, while her mother was fiercely loving and protective but indiscriminate in her attention, praising Eden for anything and everything and leading her to distrust her mother’s affection altogether. Eden was angry and demanding in her interpersonal relationships, impatient with any perceived flaw, with any inability of her partner to satisfy all of her needs. She had recognized the source of her problem through psychotherapy but had found no relief; she continued to idealize and then devalue her lovers and could not sustain an intimate relationship.

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