Suffering and Cessation through the Lens of Modern Neuroscience and Buddhism
(This post was originally a talk given at Lion’s Roar Dharma Center, Sacramento, California.)
The Truth of Suffering
For my dharma talk today I am going to take Julie Andrews’ advice and start at the very beginning. The very beginning of Shakyamuni’s teachings was the Four Noble Truths, and the First one was the Truth of Suffering.
Today I want to discuss the super-fun topic of suffering, or dukkha. I want to look at both Buddhist and non-Buddhist conceptualizations of suffering and cessation, especially medicine and psychiatry, and show how modern neuroscience may be offering us a way to integrate some of the secular knowledge with the Buddhist teachings on dependent origination. Finally, I will relay some of Lamala’s knowledge on the subject gleaned from several darshans.
Sources for my talk are Darshan with Lama Yeshe Jinpa, Geshe Tashi, Lama Tsongkapa, Thich Nhat Hanh, Dr. Gabor Mate, Michael Pollan, and some other physicians and psychiatrists whom I’ll name at the time.
After his enlightenment the Buddha chose to begin his teachings with the noble truth of suffering.
Buddhist teacher Geshe Tashi Tsering professed that is very profound that the Buddha decided to begin to teach from this difficult subject. Those who know Shakyamuni Buddha’s origin story know that when Prince Siddhartha left the palace he knew nothing of real suffering. It wasn’t until he saw sickness, old age and death that he was shocked out of his complacency and began his quest to transcend the human condition.
Typical Western Response
In the West birth, sickness, old age and death tend to be hidden away from our view similar to Prince Siddhartha in his palace. And yet we all experience these sufferings nonetheless. Geshe Tashi says that like the Buddha we need to see these things as the reality of our lives and that chasing sense pleasures is a trap, just like Siddhartha’s palace was a gilded cage. He says that only by investigating the nature of our suffering can we come to see the whole story and from that point find our way out of this condition.
A Variety of Views
In general I think that when we suffer it invites reflection and a struggle to make meaning of it. If we can understand it then we can do something about it, fix it, or at least make it better. Of course the Buddha wasn’t the only one interested in suffering and cessation of suffering. We can see throughout history different directions in the goal of eliminating suffering, one in the form of healing or treatment and the other either hiding away or literally eliminating the person who suffers. I’d like to give a few brief examples of these. In Ancient times suffering was largely believed to be a result of gods, demons, or spirits. An imbalance in or a tainting of bodily fluids and/or humors was also a common belief, and still is in traditional Tibetan and Ayurvedic medicine as I understand. Various religious rites or primitive medical treatments were tried like trephination: boring a hole in peoples’ skulls. Between the 15th and 18th Centuries, numerous people who visibly suffered were considered witches and subjected to horrible deaths by hanging, burning, or stoning. Luckier folks perhaps were subjected to exorcisms and allowed to live. One of the most egregious attempts to eliminate suffering of course was in Nazi Germany as part of the euthanasia program. Anyone who obviously suffered, such as physically and mentally disabled people, were killed (along with anyone believed to be of an inferior race), since there was a belief among the Nazis that they could breed an ideal master race by eliminating signs of weakness, which they viewed outward signs of suffering as an example of.
The Biomedical Model
More modern conceptualizations of suffering have mostly moved it from the religious realm into the realm of science and medicine, and suffering has been codified into diseases and disorders.
In the early 20th Century the Biomedical model was proposed, and this is where the concepts of disease and cure really took root as the prevailing model for understanding suffering from a secular standpoint. The biomedical model is basically that illness resides in the body or in the body’s reaction to the environment, such as toxins introduced into the body. Diseases occur when there is a disturbance between the body and the environment. This model has led to a codification of somatic suffering into a discrete set of diseases e.g diabetes, hypertension, cancer, each with medical treatments in the form of medications, dietary changes, surgical procedures, and the like.
This biomedical model has come to predominate medical training and the healthcare system in general, and especially since insurance payment relies on the biomedical model we patients are subjected to quick visits with physicians who may seem less interested in us than our symptoms. We are sent to do labs or imaging to “find” the bodily source of our suffering and then have a medical treatment e.g. meds or procedures. Up to 50% of medical visits however are for medically unexplained symptoms, which doesn’t stop many physicians from ascribing suffering to a physical finding in the imaging, like a disc degeneration in the back. However, 50% of back pain has no known medical origin. The biomedical model acts like a reductive set of blinders for the physician who is under much pressure from all aspects of the system to come up with a physical finding for the suffering. Doctors operating from the biomedical model will often ignore mental suffering, not seeing it as part of their scope of practice, or they may attempt to medicate the suffering as their first line of treatment.
Around the same time that the biomedical model was taking root the field of psychiatry was founded in order to explain and treat mental illness. Psychiatry also attempted to codify mental suffering at this time. Illness was viewed as “clinical symptoms” that had a predictable course, outcome, and prognosis. This framework came to dominate psychiatry, particularly as it tried to keep a sense of legitimacy in line with modern medicine. Of course, in psychiatry there is no imaging or blood tests to tell us that something is wrong mentally, so a bunch of psychiatrist experts got together to hash out what set of symptoms would be classified as certain disorders. Eventually the Diagnostic and Statistical Manual of Mental Disorders (DSM) was created. Now we have disorders like Major Depressive Disorder, Bipolar Disorder, and Disruptive Mood Dysregulation Disorder.
For over 100 years now we have been largely looking at suffering as primarily a manifestation of diseases and disorders. In the earlier versions of the DSM there were many disclaimers that the categories and syndromes should not be taken as objective truth but merely as descriptors that can guide decision-making about how to treat people’s suffering. Somewhere along the way however the idea that these diagnoses were objective truths began to seep into our collective consciousnesses. We simply believe in the idea that things like Bipolar Disorder, Major Depressive Disorder, ADHD, and Schizophrenia exist from their own side and aren’t just people’s ideas of how to codify various symptoms. There’s no objective truth that says if you don’t have enough symptoms of MDD that you don’t have MDD or that if you have a period of elevated mood for several days that you have bipolar disorder. In addition, the experts keep changing the criteria for diagnosis of many disorders with each new version of the DSM.
A side-effect of these diagnoses is that people begin to ego-identify with them in self-limiting ways. The misperceived self is conflated with a fundamentally damaged self. They might even say “I am anxious, I am depressed” or “I have PTSD.” I see a danger here of reifying suffering into a category that becomes self-limiting, as if a person can only aspire to a certain level of well-being because they have a certain condition. There are many doctors and mental health professionals who will provide prognoses based on their certainty of the conditions. I have seen people live down to these prognoses more than once.
None of this is to say that people who suffer with mental and physical afflictions shouldn’t see health care professionals. It’s the over-identification with diagnosis that I see as the problem. Healthcare professionals can also get hung up on this. I see some of the physicians I work with doing this in such a way that they seem to care less about understanding the person’s suffering and more with whether they meet criteria for certain disorders or not, and if not then they aren’t due for any treatment.
Integration of Approaches
Are you ready for some good news?
I believe that there is some hope for an integration of medical and mental health understandings of suffering that find the middle way between the Psycho and the somatic and may even have room to bring in dharmic understanding of suffering and cessation as well. There has been a growing emergence of a unifying model that has come to be known as the biopsychosocial model. The biopsychosocial model looks at suffering and healing as having a complex interweaving element of psychological and social conditions impacting physical health and vice versa. Especially important and increasingly more well-understood is how our social connections influence our mental and physical well-being. There is a growing field of study known as epigenetics, which looks at how psychosocial stress changes our gene expression to influence the development of disease processes. We can see this in the Adverse Childhood Experiences study, which demonstrated that a certain number of adverse experiences one has in childhood are strongly correlated to the development of physical conditions like cancer and heart disease as well as mental conditions. This is California Surgeon General Nadine Burke-Harris’ mission, to educate people about how to overcome and mitigate adverse childhood experiences. The neuroscientist Candace Lewis, who studies epigenetics, wrote “more and more the science is demonstrating this holistic model of who we are. It’s more than just what’s enclosed in my skin- it’s everything I’m surrounded by. Not to see that is to remove healing from medicine.”
Dr. Bessel van der Kolk, who has devoted his career to studying trauma and its aftermath, has said that “our culture teaches us to focus on our personal uniqueness, but at a deeper level we barely exist as individual organisms.”
Dr. Gabor Mate writes that “even a healthy ego is convinced of its separateness, an entirely reasonable perception: the capacity to experience individual selfhood in all its facets (physical, psychological, biographical, etc.) is part and parcel of being human. Our difficulties begin when we lose sight of the other side of the equation—our interconnected nature– which is just as real, if less apparent.” This appears to directly align with the concept of the Two Truths in Buddhism: relative truth and ultimate truth. Dr. Mate goes on:
“The interrelatedness of seemingly isolated organisms has now been discovered even in the lives of trees that form living networks.The oldest trees in the forest serve as “mothers” and communicate with others through interconnected mushroom networks to provide nutrients to trees that are in danger and the trees forge alliances against environmental threats.”
In his excellent recent book The Myth of Normal, Dr. Mate eloquently laid out how neuroscience and other fields are demonstrating this interconnectedness. He wrote about the psychiatrist Daniel Siegel some years ago recruiting co-workers in all the different fields that study the human experience to try to come up with a consensus definition for the term “mind.” What they found was that our brains and minds are not independent operators, functioning in isolation from other brains and minds. Siegel coined the term Interpersonal neurobiology, which views the mind as a process that regulates the flow of energy and information through its neurocircuitry, which is then shared and regulated between people through engagement, connection, and communication.
Dr. Mate says that in fact, nothing about us, mental or physical, can be comprehended apart from the many-faceted milieu in which we exist. Interpersonal biology also accounts for why loneliness can kill, especially in older people separated from pleasures, social connections, or support. The lethal effect of deficient interpersonal relationships is comparable to such risk factors as smoking and alcohol and even exceeds the dangers posed by physical inactivity and obesity.
Like Dr. Mate did, we can easily tie these findings to the Buddhist understanding of reality. The Zen Buddhist monk Thich Nhat Hanh long taught the concept of “Interbeing”. He said “It’s not merely that we are, we “inter-are.” He wrote “There are no separate entities, only manifestations that rely on each other to be possible.” The whole planet is one giant, living, breathing cell, with all its working parts linked in symbiosis.
Interdependent Co-Arising
Buddha said “Contemplate the nature of interdependent co-arising during every moment. When you look at a leaf or a raindrop, meditate on the conditions, near and distant, that contributed to the presence of that leaf or raindrop. Know that the world is woven of interconnected threads. This is because that is. This is not because that is not. This is born because that is born. This dies because that dies.” Dr. Mate pointed out that Buddha is saying that the leaf is both a discrete entity-a thing- and a process that derives from sun, sky and earth, and perhaps even the activity of humans and animals.
Understanding this dependent origination is the heart of ridding ourselves from our suffering and it appears that science may be starting to understand this as well. I take a lot of comfort and hope from how these scientific advancements are changing the scope and direction for the fields of medicine and psychiatry. If they continue to advance these scientific concepts that align with the Buddhist understanding of dependent origination then more people will come to understand the dharma view of suffering and cessation of suffering, and at least many people will have their suffering eased more than the traditional models have given them.