POPPING PILLS FOR DEPRESSION:
A BUDDHIST VIEW
By B. Alan Wallace
The whole of the Buddha’s teachings stems from compassion, the wish that all beings may be free from suffering and its causes. In today’s world, one of the most oppressive and debilitating kinds of suffering is depression. Far more than fleeting experiences of sadness, the clinically diagnosed mental disorder known as major depression is disabling in that it interferes with our ability to work, sleep, study, eat and enjoy once-pleasurable activities. The World Health Organization notes that mental ill health is increasing, and predicts that one in four persons will develop one or more mental disorders during their lives. By the year 2020, depression is expected to be the highest-ranking cause of disease in the developed world.
In order to treat depression effectively, we must identify the specific causes and circumstances that contribute to individual cases. Otherwise, there is the danger that we may blindly treat its symptoms without addressing its underlying causes. According to recent studies, it seems highly unlikely that depression arises purely from chemical imbalances, except in rare cases of vitamin deficiencies, stroke and so on. Further, a synthesis of hundreds of studies indicates that antidepressants are no more effective in treating depression arising from these types of causes than in treating depression arising from stress-related causes. This implies that depression is best understood as a mental, not a neurological, disorder.
I find it helpful to draw a distinction between these two kinds of disorders. Neurological disorders, such as autism, stem primarily from objective, biological factors, which in turn affect subjective experience. Mental disorders stem primarily from subjective mental processes, which in turn affect the brain. My underlying hypothesis here is that the mind and brain are causally interrelated but are not identical. Evidence suggests that depression is best understood as a mental disorder, so effective cures will be found by examining its principal psychological causes. This way of distinguishing between mental and neurological disorders helps to explain why our rapidly growing knowledge of the brain has not resulted in a corresponding degree of progress in developing drugs to treat mental diseases.
According to Buddhist psychology, major depression is itself not regarded as a “mental affliction” (kilesa) per se but is rather a symptom of the underlying afflictions of craving, hostility and delusion. All mental afflictions are characterized by their quality of disrupting the balance of the mind, resulting in unwholesome behavior, which in turn gives rise to suffering for ourselves and others. Buddhist practice—comprised of the cultivation of ethics, samadhi and wisdom—is intended to remedy these true causes of human misery.If we look for the afflictive psychological processes within the Buddhist context that may result in depression, we may find that the so-called Five Hindrances, or “obscurations,” play a crucial role.
These include (1) craving and attachment to hedonic pleasures, including those related to wealth, power and fame (resulting in chronic frustration and anxiety); (2) malevolence and resentment; (3) attention deficit and dullness; (4) attention hyperactivity and guilt; and (5) debilitating uncertainty. The Buddha declared that, “So long as these five obscurations are not abandoned, one considers himself as indebted, sick, in bonds, enslaved and lost in a desert track” (Sāmaññaphala Sutta). This is clearly a description of mental ill health, and it implies a fundamental, distinctive characteristic of the Buddhist worldview, namely that the mind of a person that is prone to all the above obscurations may be normal but it is not healthy.