Forward

It is my great honor to be invited to address the problem of depression on behalf of the Buddhists in this important and timely international meeting. According to a World Health Organization (WHO) report, 3% of the world population suffer from depression in the year of 2001. Depression becomes one of the three most threatening illnesses to public health besides Cancer and AIDS in the 21^st century.

Although I come from a country where Buddhists are in overwhelming majority, I myself am not of Buddhist faith. When I was asked to address the subject “The Meaning of Depression and Malaise seen from the Perspective of Buddhism,” I hesitated to accept this invitation since I know little about depression. However, I was advised to seek help from the Buddhists,  either religious or lay people for advice. After I did some preliminary research, I decided to accept the offer to address this issue.

Take Taiwan and the United States as examples, the problem of depression is very serious. A 2002 survey recently released by the Bureau of Health Promotion, Department of Health of my country, in Taiwan almost 9% of the 18.4 million people above the age of 15 have symptoms of depression, that is to say 1.63 million people among the total 23 million population in Taiwan suffer from depression, most often caused by the challenges people have to face in an ever-competitive consumer-oriented society. Women experience depressive disorders twice as many as men. Among the depressed, only 2.3% of them seek medical treatment.  This research report also revealed that among those in the white collars group, 32% have the idea of committing suicide, 26% thinking of punching their bosses, only 8.2% take medicines to relieve their psychological pressure.

According to another recent research report on depression carried out by the National Institutes of Health in the USA, more than 16% of Americans, as many as 35 million people, suffer from depression severe enough to need treatment at some time in their lives, resulting in a US$30 billion loss to employers.

Realizing the seriousness of this problem, I sought help from Ven. Prof. Heng-ching Shih, a Buddhist Nun who has a Ph.D. from the University of Wisconsin and Professor of Philosophy at National Taiwan University in Taipei. Prof. Shih has written extensively  on Buddhist spirituality in the modern society, particularly in Taiwan, China, Korea, and Japan. Professor Shih tells us, Buddhism has a different approach towards depression facing the problem with meditation and emphasis on compassion and loving-kindness. Even though these methods may neither be quick nor always effective, negative side effects are virtually unheard of.  Now, I wish to present Ven. Shih’s paper:

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     Depression is one of the most common emotional disorder, afflicting more and more people in the modern world. Although psychologists and psychiatrists have not yet discovered all they would like to know about depression, they agree that the apparent symptoms of depression include dysphoria, lost of interest, anhedonia, social dysfunction, problems of memory and concentration, low self-esteem, suicidal tendencies, shame and guilt, hopelessness, eating and sleeping problems, etc. (Costello, 1993). All these symptoms are precipitated by biological, psychological factors, i.e., neurological abnormality, illness, bereavement, frustration, unemployment, and so forth.

     Instead of discussing the causes, symptoms and treatments of depression from the Western psychological and psychiatric viewpoint, let me turn to Buddhism to find different analysis and answers. There is a Chinese Saying: “the illness of mind can only be treated with the medicine of mind”. Actually, Buddhism is the codification of insight about human psychology development by Gotama Buddha in the course of his meditation investigations of his own mind. Thus, the primary emphasis of Buddhism is placed on learning about and transforming the mind and body through direct spiritual experience.

A. The FOUR NOBLE TRUTHS

    As an excellent doctor of mind, the Buddha’s diagnosis of human life through the Four Noble Truths (四聖諦) provides us insight into the causes and treatments of depression. The Four Noble Truths are: suffering (dukkha 苦), the cause of the acumination of suffering (集), the cessation of suffering (滅) and the ways to the cessation of suffering (道). This doctrine delineates the symptom, diagnosis, prognosis, and treatment plan to alleviating human suffering. (Rahula, 1959, pp.16-50)

     In the First Noble Truth, the Buddha equated all existence with dukkha (suffering). In addition to the general meanings of suffering such as “pain”, “sorrow”, or “misery”, dukkha also includes deeper ideas such as “imperfection”, “impermanence”, “emptiness”, “insubstantiality”.

     The conception of dukkha many be viewed from three aspects: (1) dukkha as ordinary suffering (苦苦), (2) dukkha as produced by change (壞苦), and (3) dukkha as conditioned state (行苦). Dukkha as ordinary suffer refers to all kinds of suffering in life like birth, old age, sickness, death, association with unpleasant persons and conditions, separation from beloved ones and pleasant conditions, not getting what one desires, grief, lamentation, distress—all such forms of physical and mental suffering, which are universally accepted as suffering and pain.

     Buddhism teaches that all things are impermanent. Phenomenal things are in existence due to particular causes and conditions. When a happy feeling or a happy condition in life, which is not everlasting, changes, it produces pain, suffering, unhappiness. This vicissitude is dukkha as suffering produced by change.

     The third form of dukkha as conditioned state is not easy to comprehend, because it involves the understanding of what Buddhism consider as “being”. According to Buddhist philosophy, what we call a “being” is only a combination of ever-changing physical and mental forces or energies, which may be divided into five groups or aggregates, i.e. those of matter (色), sensations (受), perceptions (想), mental formation (行) and consciousness (識). The Buddha said, “These five aggregates of attachment are dukkha.” The existence of and the attachment of the five aggregates, which constitute the personality, are suffering. In other words, the five aggregates and dukkha are not two different things; the five aggregates are themselves dukkha.

     The second Noble Truth is the cause of the acumination of suffering: desire, attachment and craving. The Buddha explained in the Majjhima Nikaya, “It is craving, which brings renewal of being, in accompanied by delight and lust, that is craving for sensual pleasure, craving for being and craving for non-being.” Suffering, from the Buddhist perspective, derives from our difficulty in acknowledging a fundamental aspect of life: that everything is impermanent and transitory. Suffering arises when we resist the flow of life and cling to people, events, and ideas as permanent. The doctrine of impermanence also includes the notion that there is no single self that is the subject of our changing experience.

     The Third Noble Truth is that suffering can be completely eradicated, and emancipation, liberation, freedom from suffering can be achieved. This is called the Noble Truth of the Cessation of dukkha, which is nirvana.

     The Fourth Noble Truth provides a treatment plan, the Eightfold Path (八正道), to alleviate suffering and achieve ideal health. The Eightfold Path are right speech (正語), right action (正業), right livelihood (正命), right effort (正精進), right mindfulness (正思惟), right concentration (正定), right view (正見), and right thought (正念). These eight practices aim at promoting and perfecting the three essentials of Buddhist training and discipline: namely: (1) ethical conduct (sila戒), (2) mental discipline (samadhi)定 and (3) wisdom (prajna慧).

B. SUFFERING

     The issue of human suffering has occupied both Buddhism and psychoanalysis since their inception. The anxiety and depressive affect have been the central focus of most psychoanalytic views on psychopathology and suffering. Both anxiety and depression relate to loss, i.e., object loss, loss of love, and physical loss. Depression relates to loss in the present or past, whereas anxiety relates to loss in the future (Christensen, 1999, pp.39-42).

     Suffering is a desire or wish for one’s experience to not include loss. The degree or strength of a person’s suffering is directly related to the degree that the loss subjectively threatens a particular self-state. For example, for most people, death may be the most intense suffering humans endure. For others, extreme suffering may be related to the desire to be loved. People get depressed and anxious, because they want things to be different than they are, hence is suffering.

    Buddhism emphasizes the nature and the role of suffering and the nature and role of the self. Suffering and self are interrelated and that they interact in perpetuating mental pain. From a Buddhist perspective, not understanding or experiencing the self clearly or correctly leads to suffering. Buddhism contributes to the understanding of the self by proposing that three main features define the dialectic self: (1) the self is both process and structure, (2) it is associated with both suffering and liberation, and (3) it is interdependent with others and at the same time separate.

     Buddhism stands unique in the history of human thought in denying the substantial existence of a Self (atman 我). According to the teaching of the Buddha, the idea of self is an imaginary, false belief, which has no corresponding reality. The attachment to the idea of a permanent self produces harmful thoughts of “me”, “mine”, selfish desire, craving, hatred, ill-will pride, and other defilements, which all result in suffering. Although the absence of a permanent, fixed self is considered a foundation of the Buddha’s teaching, it is not so much the self that the Buddha encouraged one to relinquish rather one’s attachment to the view of a permanent, substantial self, because it is the attachment to a false view of self that leads to sufferings.

     The definition of suffering derived from psychoanalytic sources is close to the Buddhist view, that suffering is wanting things to be different from that they are at the moment. From the Buddhist perspective, all of life is association with suffering. Not only psychopathology but also normal healthy living is associated suffering, however, this does not mean that life is nothing but suffering and pain.

      Buddhism believes that the self and all phenomena are unsatisfactory and creating suffering. This follows the Buddhist logic that everything is in constant change and decay. Buddhism encourages practitioners to be aware of and experience the desires, thoughts, and feelings connected to a view of a permanent self as being in constant change and with substance. Working with suffering from this perspective, one would become more and more aware of anxiety and depressed affect through the tools of empathy, inquire and enactment. For example, in depression the loss, despair, and loneliness would be explored with the hope that those experiences, being impermanent, could be tolerated. (Christensen, 1999, p.49­­)

Just like every other phenomenon, suffering itself is also impermanent and without a separate entity. In other words, there is no separate self who is experiencing the suffering. Thus, in a paradoxical turn, Buddhism states that suffering too is conditioned by external causes, has no essence, is inseparable from other phenomena, and thus is empty, non-self (anatman無我) and liberated from any constraints. In this dialectic, the self is both associated with suffering and liberation and joy. As the famous Buddhist Philosopher Nagarjuna explained, “There is not slightest difference between cyclic existence (loss, desire and suffering) and nirvana (liberation)”. (Christensen, 1999, p.44)

C. MEDITATION

     Now we have discussed the Buddha’s diagnosis of the symptoms and causes of human illness of the mind (depression being one of human mental illnesses), what then are the Buddhist methods and techniques to alleviating the illness?

     Fundamentally, the Buddha stressed perceiving reality as it is with minimum distortion and interpretation. Technically, the Buddha avoided theoretical and metaphysical constructs that are difficult to measure and/or have questionable usefulness to problems of daily life. The Buddha’s whole approach is aimed at the person living more fully in here and now. Thus, Buddhist practices, particularly meditation, lead to a more direct perception of the present, while decreasing the amount the person is lost in memories of the past and anticipations or anxiety for the future. Thus, meditation is one of the best antidotes for the depressed patients.

      Meditation refers to a family of techniques, which have a conscious attempt to focus attention to a non-analytical way, and an attempt not to dwell on discursive, ruminating thought. Meditation aims at producing a state of perfect mental health, tranquility and equilibrium in body and mind through breath and mind regulation.

The mental development from meditation cleanses the mind of impurities and disturbance, such lustful desires, hatred, ill-will, indolence, worries, restlessness, skeptical doubts, and cultivating such qualities such as concentration, awareness, intelligence, will, energy, confidence, joy, the analytical faculty, tranquility, leading finally to the attainment of highest wisdom, which sees the nature of things as they really are, and realizes the Ultimate Truth, Nirvana.

Within many different branches of Buddhism there is a wide variety of meditation practice. All of them, however, stress both of the following components: “concentration (止 samatha)”, the one-pointedness of mind, and “insight (觀 vipassana)”.

     In concentration meditation, we focus on a single object, such as the breath, a mantra, or a zen koan (公案), with wholehearted attentiveness. It is the cultivation of self-control of attention through the control of the mind. In Buddhism, the mind is often described as a drunken monkey running wildly within six windows. Five of the windows correspond to sensory impressions from our five senses and the sixth window corresponds to our mental sense of internally generated impressions including thought and memories. For most people the monkey runs from window to window out of control. Through concentration practices, the meditator learns to control the monkey and keep consciousness focused on some meditation object. (Mikulas, 1981, pp.333)

     One of the most well-known, popular and practical examples of concentration meditation is called “the mindfulness of in-and-out breathing (anapanasati). We breathe in and out all day and night, yet we are hardly mindful of it. In order to mediate, we sit physically still in an upright position to the immediate flow of moment-to-moment experience-attending to the breathing process, silently noting the inhalation and exhalation at the nostrils and abdomen. The effort is not to control the breathing but to be attentive to it.

     At the beginning it is difficult to pay attention to our breathing for even a few consecutive seconds. The more we attempt to pay attention to it, the more we become distracted. Memories, daydreams and anxieties arise. There is an apparently endless flood of thoughts, feelings and fantasies. One of these usually catches our attention and we become oblivious to the present moment.

     As soon as we notice that our attention has wandered, we should resumed our attention to the breath. Like a child who reaches for one toy becomes bored and reaches for another, and then another, our mind keeps jumping from one thought, feeling or fantasy to another. Interestingly, by noticing that we have been inattentive we slowly cultivates increased attentiveness and focus. (Rubin, 1999, pp.7-8.)

     After a certain period of practice, we may experience just a split second that our mind is fully concentrated on our breathing, when we will not hear even sounds nearby, when no external would exists. This slight moment is such a tremendous experience, full of joy, happiness and tranquility. (Rahula, 1959, pp.67-75)

    The exercise of mindfulness of breathing, which is one the simplest and easiest practices, can be applied to every action of daily life. People do not generally like their present actions. They live in the past or in the future. This is especially true with the depressed patients. Though they seem to be doing something now, they live somewhere else in their thought, in their imaginary problems and worries, usually in the memories of the past or in desires and speculations about the future.

     The Vietnamese Zen Master Thich Nhat Hanh gives the following instruction of practicing mindfulness: while washing the dishes, you might be thinking about the tea afterwards, and so try get them out of the way quickly as possible in order to drink the tea. But that means that you are incapable of living during the time you are washing the dishes. When you are washing the dishes, washing the dishes must be the most important thing in you life. Just as you are drinking tea, drinking tea must be the most important thing in your life. (Morvay, 1999, pp.29-30)

     As awareness becomes clearer and more focused through mindfulness meditation, people experience a sense of psychological spaciousness. Wholehearted attention promotes greater receptivity and attunement to internal and interpersonal experience. This fosters a more spacious perspective on one’s experience. In other words, meditation fosters what Buddhists term non-attachment, a non-grasping state of mind to which the meditators hold their viewpoints less tightly. It can help reduces self-criticism and tolerate a greater range of feeling without fleeing from them, and relate to oneself and others with greater flexibility and openness. It helps some people, such as many depressive, keep from being overrun by undesired thoughts. Most importantly, it helps them increasingly tolerate the presence of depressive thoughts and moods without being overwhelmed. That is, the depressed patient would develop “the capacity to experience having the depression instead experiencing the depression as having him”, and thereby overcoming his depression. (Christensen, 1999, pp.38)

      The second meditation component is “insight”. The insight meditation is to develop the ability to notice objectively whatever arises in one’s consciousness without elaborating on it, reacting to it, identifying with it, or getting lost in it. It is called choiceless awareness, bare attention, and detached observation. It involves the cultivation of comprehensive, objective, non-reactive observation of sensations, covert behaviors, and related processes of the mind, and eventually the experiences of self and will. (Mikulas, 1981, p.334.)

      In insight meditation, we attend without attachment or aversion to whatever thoughts, feelings, fantasies, or somatic sensations are being experienced. The purpose of such practice, contrary to popular misconception, is not to make anything happen such as silencing or emptying the chattering mind but to relate to and examine whatever is happening in our experience (no matter how painful). It is an analytical method based on mindfulness, awareness, vigilance, observation, which sees the true nature of things, lays the groundwork for insight into the basic understanding of self, existence and reality, and eventually leads to the realization of the Ultimate Truth.

D.  Morita Therapy

      As we have discussed above, Buddhist teachings provide very good antidote for people suffering from depression. “Morita Therapy” is a well-known example of applying Buddhism, especially Zen Buddhism, to psychotherapy. Morita therapy is a therapeutic technique developed by the Japanese psychologist Shoma Morita (1874-1938) in the early part of the twentieth century. Many of the principles of Morita Therapy are based on Zen Buddhism. Morita himself was strongly interested in Zen Buddhism and had some experiences in Rinzai Zen Buddhism under Zen Master Shaku Soen, the teacher of D.T. Suzuki. Morita’s method was initially developed as a treatment for a type of anxiety neurosis, and in the last decades the applications of Morita therapy have broadened to the treatment of depression and other mental disorders.

Here are the main concepts of Morita psychotherapy:

(1)   Desire for life: According to Morita, the basic force of human being is the strong desire for life. The converse of this is the fear of death, both being aspects of the same force. The efforts of human beings to lead a fulfilled life are all manifestations of desire for life. At the same time a manifestation of desire for life is the tendency to fear curtailments and threats to one’s own well-being; Morita calls this tendency “hypochondriacal basic tone”. This tendency is common to all human beings, but in introverted and very sensitive persons, this tendency can be the starting point of a process, which finally ends in depression and neurosis.

(2)   Psychic interaction: If attention is paid to some sensation, the sensation becomes very sharp; and by mutual interaction of sensation and attention, the sensation will become more and more excessive. This is a kind of vicious circle which grows out of being prepossessed with one’s own over-sensitiveness, for example, sad feelings, hopelessness, fear, distraction, insomnia and so on.

(3)    Self-suggestion: Self-suggestion helps to fix a problem in the form of a symptom through formation of a conviction that, for example, blushing is abnormal, and endless repetition of this conviction, so that rational reflection is excluded. Thus free-floating attention, a main characteristic of a healthy and productive person, is lost, and attention is always fixed on the same ideas.

(4)   Contradiction of thought: Sensations and feelings are an integral part of human life; they arise, reach their climax and vanish. The inclination to contrast a present feeling or sensation with the ideal state, and trying hard to realize this ideal state instead of pursing the task at hand, is call contradiction of thought by Morita. Contradiction of thought, aided by self-suggestion, works together in the formation of neurosis and depression.

(5)    Arugamama—to be as one is: Arugamama, literally “as it is”, or regarding a person, “to be as one is”, is the central conception of Morita therapy and at the same time forms the goal of therapeutic efforts. Instead of making efforts to change a given reality, the patient is taught to accept reality as it is. This means that if he feels depressed, he accepts his feeling of depression. If he feels anxious, he accepts the feelings of anxiety. Rather than direct his attention and energy to his feeling state, he instead directs his efforts toward living his life well. (Rhyner, 1988, pp.7-8) 

Key Ideas of Zen Buddhism

(1)   Zen discipline consists in attaining enlightenment.

(2)   For Zen Buddhism, enlightenment finds its meaning hidden in our daily

concrete particular experiences, such as eating, drinking, or business of all kinds.

(3)   The meaning thus revealed is not something added from the outside. It is in

being itself, in becoming itself, in living itself. This may be called “as-it-is-ness”. Reality is its isness.

(4)   Some may say, “there cannot be any meaning in mere isness.” But this is

not the view held by Zen, for according to it, isness is the meaning. When I see into it I see it as clearly as I see myself reflected in a mirror.

(5)    This is what made P’ang Chu-shih, a lay disciple of the eighth century,

declares:        

How wondrous, how mysterious!

I carry fuel, I draw water.

The fuel-carrying or the water-drawing, in fact, every move in daily life, apart from its practical purpose, is full of meaning; hence full of wonder and mystery.

(6)   Zen does not, therefore, indulge in abstraction or in conceptualization.

(7)    Enlightenment is emancipation, moral, spiritual, as well as intellectual.

(Rhyner, 1988, pp.8-9) 

     Having understood the principles of Morita and Zen Buddhism, we can now compare them. Morita first claims that the basic force in human being is desire or craving for existence. According to Buddhism, craving (for sensual pleasure, existence, and non-existence) is one of the main factors that keep beings in the cycle of rebirth, or suffering.

     In the next stage, we have contradiction of thought, due to a very strong intellectual attitude, which labels a normal phenomenon, e.g., shyness in front of strangers, as abnormal and causes strong wish to get rid of this shyness. Increased attention is paid to shyness, which in turn intensifies it (psychic interaction) and finally turns into a depressive tension.

     In the case of the Zen monk, his desire for enlightenment gets him involved in endless attempts to sole his koan. The koan is a challenging statement of question (for example, What was your nature before you were born?) given to the monk by the Zen Master. The monk tries to solve the koan with all his intellectual strength, he concentrates his thought again and again on the koan but is unable to solve it. He is caught in a vicious circle and soon finds himself deadlocked, which leads to great anxiety and suffering. His strong intellectual attitude makes himself believe there is a rational solution to his problem. He focuses again and again on his koan and repeats it countless times for himself, which is the same process Morita describes a psychic interaction and self-suggestion.

     Another point in common on this level is an egocentric attitude. It is this directing of attention inward, which, together with the intellectual attitude, opens the way to the depressive and neurosis, according to Morita theory. But Morita does not go as far as the Buddhists, who deny the reality of the self. It is exactly the intellectual attitude and the notion of a self which Zen training, through meditation and the use of koan, wants to break.

     Regarding the breaking of the neurotic vicious circle, Morita advises the patient to go directly into his depression, to become with it. This psychic state, in which the patient accepts his sufferings and becomes one with them, Morita calls it “the psychic conflict is emancipation”. In other words, in the midst of his suffering, which he has tried so much to escape, there lies the answer.

     Similarly, Buddhism has a saying: Affliction is enlightenment (Klesa is Nirvana.). That is, in the middle of suffering there lies enlightenment; suffering and enlightenment cannot be separated, like the lotus flower growing in mud. Obviously, Morita has phrased his psychological findings along the line of this Buddhist saying.

     Now we come to the central point of Morita therapy, both on the level of theory as well as concerning the therapeutic effort: the concept of  “as it is”. This basic principle means to see reality as it is, to accept it and to act according to the actual situation. The realization of the state of arugamama (as it is) in Morita therapy is equal to a complete cure. But being cured does not mean that a patient will not have depression, fears or anxieties any more. He will experience every kind of emotion as before. What changes through his experience of Morita therapy is his attitude toward his problems. Where before he tried to escape, he is now able to accept fear as, anxiety as anxiety, and pain as pain. He faces the same reality but now he can accept it as it is.

     Both the patient and the Zen monk try with their might to realize their ideals: the patient wants to be cured by solving his self-made problem, the Zen monk wants to reach enlightenment by solving his koan. In pursuing their ideals, both are split in themselves and miss the only manifest reality. By giving up their pursuit and accepting reality as it is, the split between patient and symptom, monk and koan ceases to exist and at the same moment the problem situation ceases to exist, there is no more problem to be solved. (Rhyner, 1988, pp.9-13)

     In general, the stronger we desire something, the more we want to succeed, and the greater our anxiety about failure. Our worries and fears are reminders of the strength of our positive desires. Our anxieties are indispensable in spite of the discomfort that accompanies them. To try to do away with them would be foolish. Morita therapy is not really a psychotherapeutic method of getting rid of “symptoms.” It is more an educational method for outgrowing our self-imposed limitations. Through Morita therapy we learn to accept the naturalness of ourselves.

     In conclusion, I will cite the following enlightening quotation from the Shobogenzo by the eminent Zen Master Dogen, which best illustrates the close relation between the principle of Zen Buddhism and Morita therapy (Christensen, 1999, p.37) . It says:

      To study Buddhism is to study the self.

      To study the self is to forget the self.

      To forget the self is to be at one with the ten thousand phenomena.

      To be at one with the ten thousand phenomena

      Is to free one’s body and mind and those of others.

********…………………*********

     It seems to me that Ven. Shih’s advice to those who have symptoms of depression is to study the self and forget the self. To many, to forget is more difficult than to remember. I guess it would be nice for people to remember something pleasant and to forget something unpleasant.

     Finally, I wish to add that, in order to protect public health, my government has included the illness of depression in our National Health Program. On the non-governmental side, a “Depression Prevention Association”  was established in Taiwan on December 9, 2001 to promote the awareness of this problem and to provide advice for prevention and treatment. The Catholic Church in Taiwan together with other religions is also a source of help for the depressed.

Thank You!

Ven. Prof. Heng-ching Shih,
Buddhist Nun
Professor of Philosophy at
National Taiwan University in Taipei.

Raymond R.M. TAI
Ambassador of the Republic of China to the Holy See

Reference:

l. Christensen, Laurence W., “Suffering and the Dialectical Self in Buddhism and Relational Psychoanalysis,” American Journal of Psychoanalysis, 1999, vol. 59, pp.37-58

2. Costello, Charles, G., Symptoms of Depression, John Willey & Sons, Inc. New York, 1993.

3. Kleinman, Arthur, ed., Culture and Depression: Studies in Anthropology and Cross-Cultural Psychiatry of affect and Disorder, University of California Press, Berkeley, l985.

4. Loy, David, “Avoiding the Void: The Lack of Self in psychotherapy and Buddhism,” The Journal of Transpersonal Psychology, 1992, vol.24, no.2, pp.151-181.

5. Mikulas, William. L., “Buddhism and Behavior Modification,” The Psychological Record, 1981, vol.31, pp. 331-342.

6. Morvay, Zoltan, “Horney, Zen, and the Real Self: Theoretical and Historical connections,” American Journal of Psychoanalysis, New York, 1999. vol.59, pp.25-36

7. Pruett, Gordon E., The Meaning and the End of Suffering for Freud and the Buddhist Tradition, University Press of America, New York, 1987.

8. Rahula, Walpola, What the Buddha Taught, Grove Press, New York, 1959.

9. Rhyner, Bruno, “Morita Psychotherapy and Zen Buddhism: A Comparison of Theoretical Concepts”, Psychologia, 1988, Vol. 31, pp.7-14.

10. Rubin, Jeffrey B. “Close Encounters of a New Kind: Toward an Integration of Psychoanalysis and Buddhism,” American Journal of Psychoanalysis, 1999, vol.59, pp.5-25.

11. Thomson, Roger F., “ZaZen and Psychotherapeutic Presence,” American Journal of Psychotherapy, 2000, vol.54.