Electronic Journal from Sakyadhita USA
Issue No. 16 Winter 2018
Kim Allen began practicing Buddhist meditation in 2003 with Insight teacher Gil Fronsdal and now serves on the Teachers Council at Insight Santa Cruz. She has spent cumulative two years in silent retreat, and another two years living at the Insight Retreat Center in Scotts Valley. She has completed the Sati Center’s Buddhist chaplaincy training, and offers spiritual care and meditation in a hospital. In 2009, she founded the Buddhist Insight Network and served as its first President until 2015. She also has a Ph.D. in physics and a master’s degree in sustainability. Her website is http://www.uncontrived.org.
Teaching Meditation in the Psychiatric Ward
by Kim Allen
A friend once asked what frames my dharma activity in the world. In one of those moments where the answer just comes and surprises us, I said, “I care about people who are dismissed because they don’t fit the conventional model.” Although it is questionable whether anyone exactly fits a model, surely those considered mentally ill fall outside of many cultural norms.
I teach meditation in the psychiatric ward of a local hospital. It started as an occasional session of the facility’s weekly “spirituality group,” interleaved with sessions taught by the Catholic priest and Christian chaplains, and then became its own entity. As a teacher at an urban sangha with a year of training in both Buddhist chaplaincy and Somatic Experiencing (a technique to heal trauma), and half a dozen years of hospital/hospice volunteering, I find that this setting draws from all of these elements and is also unique.
Here, I offer some observations about teaching this population. I am neither a mental health professional nor a full chaplain, and do not profess to speak from these perspectives. I have taught meditation for nine years in a variety of settings, and also work one-on-one with people engaged in Buddhist practice. My observations are experiential.
Many of the usual components of meditation training turn out to be inappropriate for psychiatric patients. Mindfulness has a place in my teaching at the psychiatric ward because attention in the present moment greatly reduces suffering. However, mindfulness as typically taught is ultimately a deconstructive practice, and these folks have already “deconstructed” themselves in a harmful way. They are not in need of seeing through the illusion of self, in such terms. They are also all too familiar with having multiple voices in the head, and are not so interested in observing different “parts” of themselves.
Mindfulness of the body can be very grounding when done in safe ways. I tend to begin the meditations with awareness of the contact points – seat, feet, hands on table or legs. I remind people that they are simply sitting in a room – as a counterbalance to the tendency toward runaway thoughts, which particularly plagues this population. Closing the eyes is suggested “if it feels comfortable.” Deep body awareness, however, can trigger traumatic memories, so we stick with whole-body groundedness. Meditations must be closely guided and fairly short.
In contrast, practices like lovingkindness and compassion could be called “constructive,” and do feel safer in the room, but are not always met with much comprehension. Psychiatric patients live in the midst of a huge amount of suffering, and their hearts have many walls that cannot be effectively approached head-on. Still, I do try to point them toward gratitude. I ask them to recall one good experience they had today, whether a conversation with a friend, a good meal, or a hot shower, and if possible to recall it in their body.
What does work well? They like poetry (not too abstract) and simple teaching stories (I use Buddhist ones, but without any obvious references). They can easily connect with simple wisdom phrases/ideas like, “You never know how things will turn out, so it’s best to stay in the present moment” or “We are all connected to each other, so it’s good to be kind.” They can even be led to finding applications of these ideas in their daily life.
The structure of a session is simple: Names and some brief introduction, guided meditation, a reading or poem (printed in large print and read out loud by one or more participants), discussion of the meaning, and then a final guided meditation. And yet, this format can be powerful. People regularly report feeling peaceful or relaxed. Sensing a receptive atmosphere, some speak up about their suffering (which must be managed in the group setting – holding their pain, but not allowing long monologues). Sometimes a person will ask sincere and deep spiritual questions, or offer wisdom surpassing what they have been able to manifest in their life.
I have seen some amazing things, such as a very quiet, anxious man coaxed into singing a song from his childhood that had meaning for him – by one of the other patients during the group. Beneath dysfunctional behavior and poor executive function, these are fellow human beings with the impulse to connect, express, and learn. Through incidents like this, they become my teachers.
Some fraction of these folks have a strong connection to the spiritual and are easily transported to spiritual feelings and images by the simple meditation instructions. Reports of seeing angels or experiencing transcendent bliss or bodily sensations are not unusual. Projecting a bit, I have the sense that in other cultures such people might be held in high esteem as shamans or other spiritual figures rather than pathologized in a mental ward. Imagine if there were a cultural context for this type of non-worldly experience.
After a couple years of this, I can step back and assess more analytically what is taking place. The techniques of meditation and reflection do reduce suffering related to the critical issues of identity and self in the psychiatric patients. On the one hand, these tools can bolster the qualities of a healthy sense of self: Self-compassion, self-restraint, social awareness, and connection. Simultaneously, the tools can help people hold their emotions and thoughts lightly – not getting so caught up in every idea that flashes through their head, or running down trails of speculation and paranoia.
I have no illusions that I am teaching a skill in the same way as I would at, say, a sangha. Overall, the best healing through these meditation sessions is to help the psychiatric patients find some sliver of refuge from the onslaught of difficult thoughts and emotions they endure all day. At the very least, the 30 minutes spent in the group are likely better than those 30 minutes would have been otherwise. More positively, the feelings and reflections evoked by the session might slightly shift the momentum of their mind for some time into the future. Although the soil is difficult, some seeds may be planted.
We carry an image that we are “normal” people compared to the mentally ill, but what specific quality do they possess that we do not, in some form? Not being completely free from delusion, anger, or passion myself, I cannot draw the line so sharply. Encountering their “insane” stories, responses, and worldviews – and the suffering these entail – only heightens my interest in examining my own views and behaviors, and the associated suffering.