More than five weeks after I last put any medicine in my left ear–with the whole of that ear canal, including the ear drum, seamlessly lined with healthy dry skin that thickens with each passing day–I’m moving from problems with my hearing back to the problem of hearing. Having survived the ordeal of my ear, I’ve returned to my ordinary unhappiness, which I continue to explore. When last we left this scintillating drama, I had tentatively described the erotic, eternalist drive to assert my self behind the depressed half of my cyclothymia and the thanatotic, nihilist drive to withdraw my self behind the cyclothymia’s anxious half, with a particular emphasis on the difficulty of achieving that quiescent withdrawal with respect to sound and the anxiety that stems from that ongoing struggle.
Since then, I’ve become more acutely aware of that self (which has emerged and evolved through my interactions with reality) and its moods as something adventitious. I’m learning more about the effort taken to define and sustain that self, about the effects that self has on other selves in the world, and about its transient, dependent nature. This sense is still preliminary, coming only with careful awareness and going when that awareness passes. I still suffer a great deal on behalf of that self, and I imagine I cause quite a bit of suffering through it. This increased mindfulness places that suffering more fully in my attention, and I find myself unhappy more often. I wake in the morning with a sense of dread and any undertaking outside of my well-worn daily patterns is an occasion for anticipatory angst. But experiencing the self that’s the basis of all of that suffering as something adventitious, I find that I’m more able to abide the unhappiness. And I’m also becoming at least indirectly aware of some deeper agent that experiences all of this, and yet goes ahead and gets out of bed and moves beyond my daily patterns where necessary. Whatever this is, it has a broader awareness and greater motivation than that narrow self. It isn’t depressed or anxious.
This experience corresponds to the progress described in Buddhist tradition. The expectation is that more careful mindfulness of our mundane experience will lead us to develop a healthy disgust toward our deluded engagement with the world, samsara being that manner of engagement. “Revulsion is the foot of meditation,” as one Tibetan chant puts it. And that disgust or revulsion will motivate us to cultivate the Buddha nature that is capable of realization and bliss beyond our narrow, habitual sense of self and the samsara that arises from it. This sounds plausible, and as I’ve described, my experience seems to be bearing that out thus far. But I seem to have reached a tricky transitional stage in this process. I’ve begun to develop revulsion toward samsara, as evidenced by my deeply felt visceral–as opposed to cognitive–disgust with my habitual conduct, but I haven’t yet developed the blissful realization that lies beyond that. I’ve started to see evidence of that possibility in that, despite my dread and angst, I still proceed with what must be done and function in my life, even managing to interact positively and helpfully with those around me. But I’m still unhappy–either sad or anxious–often.
I’ve discussed this with my therapist, and she wonders whether I need to feel that way so much of the time. She points out that there are medications available that can address this, as I’ve seen for myself. But unlike the last time I went on a long-term antidepressant, the issues this time are less clear, the problems are more subtle. I’m fully functional, I sleep at night, and I engage fully and effectively with others. I read less than I used to, and I do less for the sheer pleasure of it. I spend more time slackly watching soccer and Arrested Development, and I don’t get out of the apartment much on weekends. And perhaps most ominous, I’m increasingly upset by noises from outside my apartment. But I’m not going days at a time without sleeping, and I haven’t yet found myself curled in a fetal position, uncommunicative, and hiding under a blanket on the couch. I’m unhappy and passive, but I can handle it. So the questions my therapist and I are considering include: How often should a person be unhappy? And if unhappiness serves as a means of understanding the causes of suffering, should it be suppressed?
In the midst of this discussion, Buddhadharma has published an article with results from a study on the balance and interaction between Buddhist practice and antidepressants. It’s a preliminary study, with only nineteen participants and no control group, and the participants suffer from major depression (which I don’t think describes me), but the results might help frame my discussion with my therapist. I think the article clearly lays out the issues to be considered and the ways in which they would most constructively be considered. It’s not as explicit as I would have liked about the distinction between the goals of meditation and those of psychotherapeutic treatment, but that distinction does ultimately seem to be reflected in the conclusion:
Being willing to face the unavoidable pains of life is often a sign of courage and wisdom. Nonetheless, being unwilling to use effective therapies to relieve unnecessary pains may be a sign of misunderstanding, and of a spiritual superego run amuck. After all, Buddhist psychology regards happiness and joy as healthy, beneficial, spiritual qualities, and discourages subjecting oneself to unnecessary pain as a spiritual path.
To put it another way, becoming attached to a dogmatic and misunderstood notion of Buddhist practice, or any other spiritual practice, is likely to interfere with my vow to end the suffering of all sentient beings, which would include myself. That is, I won’t be able to practice well if I don’t take care of myself. The participants in this study reported as much:
Clearly, the large majority of these meditators felt that they, and their spiritual practice, benefited significantly from taking antidepressants. The changes they described bear this out. In fact, whether looked at from either a classical contemplative or a contemporary psychological perspective, the multiple benefits they describe suggest greater psychological and spiritual well-being.
Several subjects reported that the antidepressants enabled them to recommence or significantly improve their meditation and spiritual practice. In addition, two subjects spontaneously reported that antidepressants gave them a lift that they were subsequently able to maintain with meditation alone.
Tomorrow I’ll discuss all of this with my therapist and my psychopharmacologist, and we’ll see where we go from here.