Depression Again


I got an interesting response to my Suicide Girls article about depression:

“Part of the problem is that you seem clearly to be talking about clinical depression and not ‘the blues’ but I think you give some of the mental illness part of it short shrift. I’m assuming we’re talking about actual clinical depression.

I have a fundamental problem with the article. I believe that any article that attempts to discuss mental illness should definitely include statement saying, ‘if you are suicidal or think you may cause harm to yourself or others, please seek medical attention. Call a suicide hotline. Talk to a trusted friend, relative or doctor.’ Otherwise, we’re just Scientologists who forbid you to seek medical help.”

OK. Sure. Maybe I should have included that disclaimer. But I really think that’s a given. I tend to assume that anyone who can read is at least intelligent enough to figure out they have other options if they’re suicidal than taking me at my word on this blog. But perhaps I shouldn’t make such assumptions.

The guy who wrote this then went on to say a lot about the use of anti-depressants and other such medication in the treatment of depression.

First off, there is no general Buddhist rule that says one must never use these kinds of medications. Some Buddhist teachers are OK with them. Others are not. Nishijima Roshi does not seem to be a fan of them. But, then again, this is one of the many things you had to ask him about in person when referring specifically to yourself in a particular situation. He did not go around making general pronouncements about it. I never once heard him address the subject publicly in the 15 years I followed him around. He talked about it with me in private a couple times though.

Dogen, in his list of pieces of advice he received from his teacher Tendo Nyojo, quotes Tendo as saying, “Do not take medications for mental illness.” Who knows what sort of medications the Chinese of the 12th century had. But apparently they had some and Tendo Nyojo didn’t think it was a good idea for monks to take them.

Contemporary Western Zen places tend to be OK with residents using prescription anti-depressants and the like. I recall it was one of the items on the Tassajara check list of things you’d better remember because you can’t get them down in the valley. I also recall they wanted to know if you were on such meds and which ones you were taking when you applied to be admitted.

Personally I am not the world’s biggest fan of such medications. But I understand they have some use and value. Still, I think they are terribly over-prescribed and often act to normalize conditions that maybe ought not to be normalized. By that I mean drugs can mask the effects of poor diet, poor living conditions, overwork, etc. etc. that ought to be addressed either before or at least during treatment. You overload a kid with sugar and 18 hrs a day of video games, he gets hyperactive, so you feed him downers AND sugar and video games, and then he seems more normal. But really you should have tried taking away the sugar and 18 hrs a day of video games first. Oversimplification, I know. But it happens.

On the other hand, there are people with far deeper problems for whom the drugs can be useful. But I really don’t like them unless all other options have been checked out. I think we live in a culture that goes right for the pills.

On a larger scale, I think these kinds of medication can act to help mask deep rooted cultural problems that really must be addressed. Our society is generally pretty fucked up. And this is the cause of much of our mental illnesses and depression. Rather than finding a different way to live, though, we turn to medications that make our fucked up situation bearable. And so the root problem goes unaddressed.

I’ve never been on anti-depressants or any similar types of medication for mental illness. So you could accuse me of talking out my ass here. But I believe the only reason I was never on anything like that is that I went through my teenage years just before they became really popular and in my twenties I couldn’t even afford to see a doctor for the mononucleosis I caught, let alone go to a psychiatrist each week to deal with the nearly unbearable bouts of depression I had to endure.

I found another way because I was forced to. I had to really address these things step by step in a very dynamic manner. I’m not trying to sound heroic here. It’s just that I had no other choice. I saw what friends of mine in similar situations did, self-medicating with alcohol and other drugs, cutting themselves, killing themselves. I did not like those options. So I dove headfirst into the meditation thing.

I do not consider those who turn to prescribed psychiatric medications weak or stupid. You do what you have to do to get by in life. Some people have it way worse than I ever did in the depression area. I cannot judge so I do not judge.

I’ve talked to and held dokusan with lots of people who use these medications. I’ve spoken to some who have decided to stop doing the drugs and work on themselves through zazen instead. I try to be helpful in these cases. But I’ve had conversations with people who tried this and then decided they needed the medications after all. When that has happened, I’ve supported that as well. It is up to you, not me, what you do in your life. Gurus and “Masters” who give advice on matters like this should probably shut up.

I’ve also known people who really, really needed those medications and did not want to take them. I understand that too because those drugs all have unpleasant side-effects. It’s seems to me like trying to tune a piano with a sledge hammer. If you’re really skilled you might get the string you aim for to sound right, but you’ll mess up the ones around it. The options have to be weighed carefully. Maybe you need medication to get to the point where other approaches are even possible.

I do not know if the stuff I have gone through qualifies as clinical depression or not. I’ve never had anyone examine me in any manner that might have determined that. I suspect I had enough symptoms to be prescribed medication had I gone to a doctor inclined to do so during my darkest years. But I’ll never know for sure. I do know that whatever affected me then still comes on from time to time even now. But I know how to allow it to pass over. I know how to patiently wait for it to finish its business and go.

It’s not as bad for me these days as it used to be. Maybe it was never as bad for me as it is for you, dear reader. I have no way of knowing.

I also changed my lifestyle and my diet. They’re still not exemplary. But they’re better. I stopped drinking. I was never a big drinker to begin with. But I started seeing that if I got drunk, I didn’t really sober up completely after a good night’s sleep. The alcohol lingered in my system for quite a while. Same with other drugs. This, I had not noticed before I started doing more zazen. I started seeing what large amounts of refined sugar did to my mental state. This, too, I had not noticed before. I saw what a lack of exercise did. All kinds of things I hadn’t noticed because I had not been in touch with myself enough to notice them became clear.

I’m not a skeptic who says you ought to “pull yourself up by your bootstraps.” I know things can be really bad. I’ll say it again: Only you know how bad it is for you.

60 Responses

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  1. Tragick93 (Benjamin Cicelske)

    Brad,

    I am a person who takes Antidepressants as well as other psychiatric meds. I have also gone the street drug route a couple of times with speed and heroine and I really like the observation you made on psych meds being kinda like tuning a piano with a sledgehammer. I would go farther and say that self medicating mental illness with street drugs is more akin to tuning a piano with a jackhammer, although I know that this is probably outsifde the scope of this discussion. I agree that it woiuld be great for everyone to be able to use tecniques such as zazen to work on themselves but some of us do not have the luxury of not being F'ed up enough to do this without some sort of medication. This is a difficult subject and I applaud you for even speaking on it, I know I would not have the brass to do so if I was in such a position as yours. Keep up the great and very inspiring work.

  2. anon #108
    anon #108 January 18, 2011 at 8:44 am | |

    BTW – for anyone who might have missed the point of my copy/paste of those translations of the "dukkha" part of the Dhammacakkappavattana Sutta above, it has nothing to do with translations of "dhukka".

    The point was to offer an alternative to Dr Zenmonger's suggestion that the Buddha didn't say or mean "Life is suffering" but "Life means Suffering". This wasn't the Dr's main point (I agree with his/her main point: that the Buddha said there can be an end to suffering). But the passage shows that nowhere is the word "Life" (or any pali equivalent) used. To use the word "life" suggests that ALL experiences are included as characterised by suffering, and that's not what the Buddha says. That's all.

    FWIW, I'm quite OK with 'suffering', 'stress', 'pain'. 'dissatisfaction', 'dis-ease' unhappiness' and a whole bunch of whatever elses as translations for duhkka. It's not so difficult for a human being to understand the meaning. Whether it derives from dus-kha – a bad wheel-hub hole (hence, a rough ride/hard going), or is a prakritized (vernacular) form of dus-shta (bad or ill standing/situated, hence uneasy, uncomfortable, unpleasant, difficult), or whether it helps to think of it as the opposite of sukkha (good going[?]; pleasant, agreeable, comfortable, happy), all of us, I think can relate to what's being said in that passage. If still confused, see the Buddha's list of things that are dukkha, above.

    (Close readers might find it interesting to note that as used in this sutta, dukkha is not a noun, but, as indicated by the Pali grammar, an adjective – reflected in both translations above).

  3. anon #108
    anon #108 January 18, 2011 at 8:51 am | |

    This comment has been removed by the author.

  4. anon #108
    anon #108 January 18, 2011 at 9:04 am | |

    Of course, understanding WHY we find these things 'duhkka' (to keep Barbara O'Brien sukkha) and what to do about it is something else.

  5. Anonymous
    Anonymous January 18, 2011 at 10:10 am | |

    I'm wary of the declarative statements here regarding the reality of mental illness or effectiveness of medication. None of these assertions would help the people I've known struggling with mental illlness.

    Depression in particular becomes a habit in addition to whatever its primary cause within the brain may be. It digs a deep rut in your mind and makes it ever more difficult to get out. Even once 'recovered, it's very easy to slip back into self-defeating habits.

    Meditation is indeed helpful, but most people experiencing a serious depression are not in a place where they are able to begin a dedicated meditation practice.

    Some people say, "Medication is just as effective as exercise and diet changes," and research seems to support that, at least in part. Someone in the depths of a depression will not be starting an exercise regime or making sweeping changes to their diet.

    Taking medication is often the only thing a suffering individual feels capable of doing. So unless the disparagers of medication are ready to devote themselves wholly to the pursuit of taking personal responsibility for someone on the verge of giving up, perhaps a small nod to the worthiness of medication is deserved.

  6. Anonymous
    Anonymous January 18, 2011 at 10:37 am | |

    "Taking medication is often the only thing a suffering individual feels capable of doing. So unless the disparagers of medication are ready to devote themselves wholly to the pursuit of taking personal responsibility for someone on the verge of giving up, perhaps a small nod to the worthiness of medication is deserved."

    Well said. What wasn't said is that the medication provides a placebo that the sufferer believes in, which is what seems to be truly needed. Does it even need to be said? Perhaps not, but I sometimes tire of seeing the same old incorrect theoretical BS passed off as fact.

    Either way, please everyone take it easy and have a great day.

  7. O no Barbara O!
    O no Barbara O! January 19, 2011 at 2:22 am | |

    Although I've never heard her speak, I'm certain that she sounds just like Lily Tomlin as the operator.

    http://snltranscripts.jt.org/76/76aphonecompany.phtml

  8. Broken Yogi
    Broken Yogi February 27, 2011 at 4:22 pm | |

    I can understand the reluctance to use or endorse most pharmaceutical anti-depressants. They suck, they don't work much better than placebos, they have dangerous and toxic side effects, and they can even make depression worse.

    However, I've also found out that a lot of the "illegal" drugs that get a very bad rap can actually do wonders for depression. And that's from scientific studies on the subject.

    Ketamine, for example, which I had thought was a really bad heavy drug, turns out to be three times better than any anti-depressant in treating serious depression. I mean one single dose can knock depression on its ass for a week to ten days.

    MDMA has profound effects on depression, when used occasionally rather than regularly. This is clinically proven in study after study.

    Likewise, psilocin, the active ingredient in Psylocibin mushrooms, is also a fantastic anti-depressant, especially when used in micro-doses on a daily basis. Daily micro-doses of LSD also has proven anti-depressant benefits as well.

    I know these things can be abused, and it can be hard to find pure sources, but they have the advantage of being very non-toxic, highly effective, and generally work on natural systems our body is already geared to deal with. And they actually fuck with your head a lot less than pharmaceuticals, especially when used in microdoses or only occasionally.

    Also, of course, basic good nutrition, omega-3 oils, exercise, etc. All the simple good things to do to your body.

    Now, that's just one side of the equation, the bio-neurological. But that's an important side. If your brain chemistry is fucked up, it's hard to make use of Buddhism or any other mind-oriented approach. It works both ways, but oftentimes we need to work with the brain before we can use the mind. Sometimes we need a chemical kick start.

    yeah, call it the punk-Zen approach to depression.

  9. A beginner in Texas
    A beginner in Texas July 17, 2014 at 8:00 pm | |

    I came to this article doing a search on the term “medication”. While I was initially interested in seeing what Brad had to say on the topic of pain medication I went on through it since I’ve been on anti-depressants for a bit over a year.

    My reason for looking for insights on pain medication had to do with what might have been observed about pain medication and zazen. I underwent a medical procedure yesterday. For the procedure I was doped up with an anti-anxiety drug and then for post-procedure pain my doctor prescribed a mild narcotic.

    I took one dose of the pain med last night and it knocked me out. I woke up still seated where I had passed out even though I had slept for some hours after the procedure. I took a second dose this morning and then couldn’t hold my eyes open after having gotten sleep. Another five hours and I got up and since then have been cutting the dose by half of what was prescribed.

    What is amazing to me is that I have passed these same pain killers out to my patients at work and seen them take two at a time and still not be drowsy.

    I did do a “cheat” for zazen today. Back to the stool I had once used. The procedure was on my right leg and it is wrapped up. Bending it too close would cut off blood flow. I can discard the wrap tomorrow.

    I managed to get in a ten minute sit on the stool. Tomorrow I’ll go back to my improvised zafu on the floor minus the wrap.

    I don’t like how the narcotic made me feel, even at half-dose, for zazen. Glad I won’t have to do this too much for now.

  10. Alan Sailer
    Alan Sailer July 18, 2014 at 9:16 am | |

    A.B.T,

    You might try reading Brad’s first two books. I know that somewhere in those two books he talks about pain medication (for his kidney stones) and anti-depressants.

    As far as I can gather the subject of anti-depressant use in zen has a lot of different viewpoints. There are the hard-core “let practice take care of everything” people and one the other side, the “if medication helps, why not?”

    My personal opinion is that a regular practice can help you notice and drop those self-reinforcing negative thoughts that can lead to depression, but using practice alone to “treat” serious mental problems is not a good idea.

    Bets of luck with the pain. And the depression.

    Cheers.

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