psychiatric drugs and the fifth precept

[Cittasanto]

"I undertake the precept to refrain from intoxicating drinks and drugs which lead to carelessness."

If the drugs prevent carelessness (seeing things, hearing voices, wild imaginations), then I don't see how they are against the 5th precept.

Moderation is key. And if you are mentally ill, and drugs can bring back some sense of sanity, then I think Buddha would have approved.

Hi Laura,

I just have to note here that seeing things, hearing voices, wild imagination, unmanageable levels of fear, etc...aren't "carelessness"...they are a medical disorder - sometimes genetic, sometimes due to environmental toxins, sometimes related to severely dysfunctional family situations, some due to unknown causes...many factors that can't be described as "carelessness". I only comment because someone reading this that is/has experience with any of the many serious mind/emotion medical disorders might feel blamed and responsible for their condition seeing it described as "carelessness".

I too think the Buddha would have approved of mindful medication use...what good are the precepts if there are shrieking voices in the mind, or if one believes that the CIA is following them and monitoring their communications? There are lots of problems associated with meds, but meds have also enabled countless thousands of people with mental dis-ease to function relatively normally. As a former psychotherapist I've met many of these people - their relief and gratitude for the meds is obvious.

Well, I have serious Anxiety and Depression issues which I take meds for, and I can definitely say (with my own experience) that they do cause carelessness. Now, maybe it's just me, but there have been many times that I haven't been 'careful' because of the way my mind works. I shouldn't have said that 'hearing voices and etc' were carelessness since you are right and the sick person isn't in control of them (outside of medications).They can definitely cause carelessness though.

Basically what I am saying is that you need mindfulness to practice Buddhism, and people with mental illnesses often lack mindfulness because of the way our minds work. If Drugs help you become mindful and sane, then I think Buddha would have approved (or at least not disagreed with). I think he was more concerned with people who abused intoxicants in his time and ours, not with people who took intoxicants in a modern world to keep them sane thousands of years down the line.

the only think I would really alter in this is (original underlined), I think the Buddha was concerned with the use of things which cause heedlesness (lack of mindfulness and or concern) and used in a recreational manner, not medication.
edit - and I'm not 100% sure if this is disagreeing in anyway (so to speak)

[Bonsai]

Yes, I agree. I definitely phrased it wrong, since it sounds like Buddha was obsessed with morals in and of themselves rather than a doctor who gets to the heart of the problem (First two noble truths).

[PeterB]

The above and this thread http://dhammawheel.com/viewtopic.php?f=11&t=2963 make it quite clear that the TOS in place here on DhammaWheel are appropriate.

Completely appropriate in my view. It is not my intention to rehash old battles, but there was a period of time on E sangha when psychiatric advice was handed out freely by anyone who felt so inclined. Some of it very scary indeed. That stopped partly as a result of very timely action from Ben when he was a mod there.

[LauraJ]

Hi Laura,

I just have to note here that seeing things, hearing voices, wild imagination, unmanageable levels of fear, etc...aren't "carelessness"...they are a medical disorder - sometimes genetic, sometimes due to environmental toxins, sometimes related to severely dysfunctional family situations, some due to unknown causes...many factors that can't be described as "carelessness". I only comment because someone reading this that is/has experience with any of the many serious mind/emotion medical disorders might feel blamed and responsible for their condition seeing it described as "carelessness".
[snip]

Hi PT,

I think Bonsai wrote that. It wouldn't occur to me to suggest that a person with any sort of mental illness is to blame for it.

[LauraJ]

The above and this thread http://dhammawheel.com/viewtopic.php?f=11&t=2963 make it quite clear that the TOS in place here on DhammaWheel are appropriate.

Completely appropriate in my view. It is not my intention to rehash old battles, but there was a period of time on E sangha when psychiatric advice was handed out freely by anyone who felt so inclined. Some of it very scary indeed. That stopped partly as a result of very timely action from Ben when he was a mod there.

I remember you speaking up about that in a number of threads when people were being told they don't need medications.
I was grateful that you intervened and at times even advocated for patients.

[PeterB]

Yes I remember your helpful input too Laura, there was one chap in particular who had read a book or two on Aryuveda and on that basis felt able tell to people to come off all meds ( which can result in convulsions ) and do Medicine Buddha practice instead. It was very good that Ben among others, stepped in.

[LauraJ]

Yes I remember your helpful input too Laura, there was one chap in particular who had read a book or two on Aryuveda and on that basis felt able tell to people to come off all meds ( which can result in convulsions ) and do Medicine Buddha practice instead. It was very good that Ben among others, stepped in.

I do recall those specific incidents. Scary stuff

[Monkey Mind]

Medicine during Buddha's time period involved consuming a lot of hash and drinking elixirs that were highly alcoholic. So when we read suttas about monks who are severely ill, and "bravely" declining the medicine of the day, and thus receiving Buddha's praise... I think we have to consider the cultural context. It is also worth noting that 1) these were monks, not lay people; and 2) the hospice care they received from their monastic community was probably far superior to the quality of health care today. In other words, "don't try this at home".

[Dhammanando]

Medicine during Buddha's time period involved consuming a lot of hash and drinking elixirs that were highly alcoholic.

The accounts of medicine in the Vinaya Pitaka seem to indicate that the early sangha availed itself of a much more varied pharmacopia than this.

So when we read suttas about monks who are severely ill, and "bravely" declining the medicine of the day, and thus receiving Buddha's praise... I think we have to consider the cultural context.

In which suttas are such episodes reported?

Best wishes,
Dhammanando

[Cittasanto]

So if it is necessary then Yes! beside the fact medicines are not a breach of the precept, and even alcohol can be taken in some instances according to the vinaya (I have been told but not seen this specific exception to clarify its usage.

Hi Bhante,
Could you clarify where this is! I do believe it is the case the Alcohol is diluted but?

Thank-you

[Dhammanando]

Hi Manapa,

Could you clarify where this is! I do believe it is the case the Alcohol is diluted but?

See Ven Thanissaro's account of the 51st paacittiya rule, which gives all the sources:

http://www.accesstoinsight.org/lib/authors/thanissaro/bmc1/bmc1.ch08-6.html

Best wishes,
Dhammanando

[Cittasanto]

Hi Manapa,

Could you clarify where this is! I do believe it is the case the Alcohol is diluted but?

See Ven Thanissaro's account of the 51st paacittiya rule, which gives all the sources:

http://www.accesstoinsight.org/lib/authors/thanissaro/bmc1/bmc1.ch08-6.html

Best wishes,
Dhammanando

Thanks Bhante!
Nice to see your name on the new posts board again! hope you had a good sabbatical from the computer!

[chownah]

There are lots of different psychiatric drugs and people in general react differently to each of them and take them for different reasons and expect different effects so it doesn't make sense that there could be an answer that would blanket the issue conclusively. I think a good Theravadin approach to this is for each person to decide if taking the drug leads to dispassion and not to passion, if it leads to equanimity and not agitation, etc......or does not taking the drug lead in the right direction.....
chownah

[PeterB]

There are of course other alternatives for some people with some Mental Health conditions. Certainly in Europe ( which is the situation best known to me ) an eclectic model is emerging which uses medication and/or other forms of intervention. There was a time in the seventies and early eighties when the prescription pad was kept very close to hand, but, in Europe at least that is changing and has been for some time. Of course as has aready been said, it the question also needs to be asked how much dispassion and equanimity is likely to be experienced by a sufferer from Schizophrenia or Bipolar Disorder if they are unmedicated ? The answer is for many, not much at all.

[Cittasanto]

for the last two posts Sadhu

[Annapurna]

Hello, all,
This post is about taking psychiatric drugs (for instance antipsychotics or anti-depressants) and the fifth precept, which is to abstain from intoxicants. I don't know if someone can reach a conclusive "yes," "no," answer to this, but it could be discussed.
I know relatively less about anti-depressants than antipsychotics. But for those who don't know about antipsychotics, I'll put down some of their common effects. I won't distinguish between so-called side effects and main effects, because one doesn't get to choose which effects one gets, I'll just put down the common ones: Loss of energy, hallucinations, racing thoughts, dullness, anxiety, sleepiness, weight gain, perkiness, energy, less racing thoughts, less hallucinations, movement abnormalities, hunger, increased libido, decreased libido, mood alterations... these are the main ones I think...
I think this sila is based on cultivation of inner awakeness, non-negligence and laziness, the ability to be shameful and competent and moral and restrained, overcoming dependency on outside stimulants, and renunciation.
Coffee is accepted almost universally, I think, and that is an outside stimulant, but if it is used excessively to that effect, it might be considered a breach. These drugs, when used for stimulus, are generally quite potent, I think, so unless used with extreme moderation would likewise be a breach. Sometimes the drugs might appear to keep one more restrained, but I actually think if anything the opposite, even in those cases where it appears so. I think this because if one simply dulls their mind to prevent anger for instance from taking hold, it is not using restraint at all. One who develops restraint does so on the mental level.
It is kind of like the case of the monk who cut off his penis and the Buddha said he cut off the wrong thing.
Zack

Zack,

cancer patients also suffer from the side-effects of chemotherapy, and they are severe, believe me, and there is no guarantee it will heal them, sometimes it does, sometimes it increases the suffering.

Even a flu shot can make you ill.

It's the best to accept a disease, the therapies and also their side effects.

This is earth, a location of suffering, and nobody promised us a rose garden.

Violent schizophrenics aren't exactly fun either, nor the trouble they pose...so I agree with the above posts..

Seeking out alternative treatments in symptom free times to prevent a relapse is a good idea. Have you found therapies that look promising, or have first hand experience?

[Annapurna]

Medicine during Buddha's time period involved consuming a lot of hash and drinking elixirs that were highly alcoholic. So when we read suttas about monks who are severely ill, and "bravely" declining the medicine of the day, and thus receiving Buddha's praise... I think we have to consider the cultural context. It is also worth noting that 1) these were monks, not lay people; and 2) the hospice care they received from their monastic community was probably far superior to the quality of health care today. In other words, "don't try this at home".

The Buddha also consulted a doctor: Jīvaka Komārabhacca .

Mahāvagga
MV.VIII.01

[Mothra]

I'm so tired of people using the "mental illness is like diabetes or cancer" argument. That analogy is not true. Quotes from this article say it better than I can:

"For example, a defect in a person's visual field may be satisfactorily explained by correlating it with certain definite lesions in the nervous system. On the other hand, a person's belief -- whether this be a belief in Christianity, in Communism, or in the idea that his internal organs are "rotting" and that his body is, in fact, already "dead" -- cannot be explained by a defect or disease of the nervous system."

"Let me therefore say once more that my aim in presenting this argument was expressly to criticize and counter a prevailing contemporary tendency to deny the moral aspects of psychiatry (and psychotherapy) and to substitute for them allegedly value-free medical considerations. "

The full article is at http://psychclassics.yorku.ca/Szasz/myth.htm
It was written in 1960 by a psychiatrist. The title might sound provocative but the argument is fairly plain and eloquent. There's not enough reasonable (scientologists and new age gurus don't count) argument out there about the dangers of psychiatry as it is practiced today. You have prepubescent kids being prescribed things for ADD and Autism, older kids whose grades slip and they are diagnosed ADD and medicated. Not to mention the countless prescriptions for antidepressants and antianxiety medications. It is uncompassionate to thrust the suffering and vulnerable into the hands of psychiatry so that "their disease can be cured". It should be reserved for only the most extreme cases (like the TOS talks about), which is only a (small?) part of the amount of patients being treated.

[altar]

Hi,
I don't think these drugs can be compared to other more physical related illness remedies for a few reasons, one in particular related to sila: These drugs are taken with the intention of altering the mind.
As for the effectiveness and harmfulness of these drugs in general, this is not quite as related, but still relevant.
This is a good article on the subject. http://www.scribd.com/doc/19458201/The- ... t-Whitaker
Also askapatient.com is a good source of user reports, there are thousands.
Another reason these drugs are more suspicious than physical ones is that they cause a host of effects that indicate some mental change, maybe more-so than any physical-related remedy.
Lastly, these drugs are introducing a physical change, however there is no observed physical abnormality. Actually, it is observed that at least some of these drugs create physical abnormalities.
I think sila is individual and circumstantial to a certain extent but here I think too many allowances are made.
So, there you go,have a good day..
Zack

[Cittasanto]

couple of points!
The fifth precept is specific about the drugs effects i.e. leads to carelessness, not specifying drugs used to remedy conditions which cause people to act carelessly, or in a dangerous manner!
all drugs have side effects, some more than others, and I will refer back to my initial post

what its it for?
why is it being prescribed?
what are the risks both if prescribed and if not?
what are the known effects?
do the benefits out way the disadvantages?

Just because someone disagrees with their use because of side effects does not mean they are a breach of the precepts, I know many people who would not be able to function without medication and the side effects to them are a small price to pay.