Mental Health in Dharamshala:
Individualization Through Collaboration
By Alexandra Abelkis
Special thanks to doctors at Men-Tsee-Khang and Delek Hospital
“Whatever practice keeps you happy and calm, these are things which you should follow,” says Dr. Tenzin Tsundu. Dr. Tenzin Tsundu works at Delek Hospital situated near the base of the Himalayas in Dharamshala, the home to His Holiness the 14th Dalai Lama and the Central Tibetan Administration. There are two main hospitals in Dharamshala, Men-Tsee-Khang, and Delek Hospital. The doctors at both of these institutes are predominantly Tibetan. While doctors at Men-Tsee-Khang practice Tibetan medicine, doctors at Delek Hospital practice allopathic medicine. Historically, mental health challenges in Tibetan communities have been seen through a lens of Tibetan medicine and the law of karma. Since coming into exile, in 1959, Tibetans have been exposed to Western ways of thinking about and dealing with mental health, leading to new individualized options for treatment based on a collaboration of Tibetan and Western approaches.
The Tibetan medicine that is practiced in clinics today dates back to circa the 8th century [1]. The practice evolved alongside Buddhism and is based on a set of books called the Four Tantras. In Tibetan medicine, it is believed that an individual has three principle energies or humors: rLung (wind), Tripa (fire), and Baekan (earth and water). They flow through channels within the body and affect one another as they are interconnected. Given the right causes and conditions, the humors will be disrupted resulting in an imbalance. This leads to the manifestation of an otherwise dormant disorder [2]. Each of the three humors can be broken down into multiple subsets, which have different functions in the body. Disruption of the subset of rLung called “life-sustaining wind”, or sok-rLung in Tibetan, gives rise to many mental health disorders [3].
rLung disorders arise from desire stemming from ignorance about the world we live in [2]. Buddhism teaches that all beings live in ignorance, which is the original root of all disorders. The Oral Tantra explains that “[rLung] is the cause of disturbing all disorders. It acts in preceding, concluding, dispersing and spreading disorders” [4]. Dr. Tashi Yarphel, a Men-Tsee-Khang doctor, clarified this by explaining that while this is generally true, not all symptoms of anxiety and depression arise due to rLung imbalances as they can arise from imbalances in any of the humors. Because the humors are interconnected, when rLung gets out of balance, it causes the other humors to become unbalanced. This cascading effect can result in having symptoms arise due to either Baekan or Tripa [5].
Epstein and Topgay, researchers of Tibetan medicine, explain that “Tibetans conceive of most anxieties and depressions in terms of a disturbance in sok-rLung... When the [life-sustaining] current is more seriously affected, i.e., through invasion of its channels by other increased currents, symptoms of violent or hysterical behavior may appear. If severely affected, psychosis may result” [6]. The channels can be affected by a number of ways, including diet, lifestyle, medications, and therapies. Once an imbalance occurs, the disorders can become more severe unless treated properly. Fortunately, Buddhist teachings offer great help in preventing this cycle from commencing. Clifford explains how Buddhist practices can play a preventative role when it comes to Tibetan psychiatry as they allow individuals to tame their minds by becoming aware of their emotions [7]. Once aware of one’s own emotions, it is less likely that one’s emotions will get disturbed because they can be more easily regulated [8]. Given that Tibetan medicine is founded in Buddhism, it can help prevent this loop from occurring. However, emotional imbalances are not the only way for a mental illness to manifest.
Dr. Tenzin Yeshi, a doctor at Men-Tsee-Khang, spoke about how a lack of social connection can lead to more mental health challenges. He explained that in the past, women in his town would gather under a tree to converse and watch their animals, but given today’s modern and more comfortable homes, such things do not happen anymore. People tend to stay inside and hardly interact with one another which can lead to loneliness, frustration and mental health disorders [9]. This is because psychological stress can contribute to the manifestation of mental health challenges [7]. Once a mental health disorder manifests, it is advisable to seek support to reduce it.
In Tibetan Medicine, Loong Tea can help calm individuals with rLung imbalances, and
constitutes one of the many options available to subside mental unrest.
There are two main medical practices that treat patients with mental illnesses in Dharamshala: Tibetan medicine and Western, allopathic medicine. In Tibetan medicine, mental health is treated through a number of ways. First, diet and lifestyle are addressed, then medicine is given, and lastly if symptoms are very severe, external therapies such as massage, hot compression, and acupuncture are applied. Patients are also counseled by doctors through the lens of Buddhism [10]. In contrast, in Western practices, patients will often first meet with a doctor and then be sent to a psychiatrist who will prescribe anti-anxiety medications. This is then followed by several sessions of counseling either with psychologists, doctors at Delek Hospital, or both [11]. In Dharamshala, these two ways of addressing anxiety and depression have worked together to create an individualized approach.
Men-Tsee-Khang (McLeod Ganj Clinic) is Devoted to Practicing Tibetan Medicine
Since coming into exile, doctors have made an effort to integrate the traditional methods of medicine with Western ideas of counseling and pharmaceuticals. Dr. Tenzin Tsundu explained that he will often refer people to speak to a psychologist or provide counseling at the hospital based on the needs of the patient [12]. Because Delek Hospital does not have a psychologist on sight, they are forced to look outside of their hospital for support. According to Dr. Tenzin Namdol, another doctor at Delek Hospital, doctors at Delek Hospital send patients both to psychologists and to Men-Tsee-Khang. Strong believers in Buddhism also visit lamas to receive divinations to rid themselves of “Neupas” or spirits. These spirits are believed to harm individuals and can be a cause of mental disorders [11]. Dr. Tenzin Tsundu practices evidence-based medicine, and wants his patients to feel comfortable and confident in their treatment. He also wants to help them fully heal as quickly as possible. While he believes that sending a patient to someone in the monastic community may only serve as a placebo, if the above goals can be met more easily by sending a patient to a lama, he sees no reason not to [10].
By combining Western medicine with Buddhism and Tibetan medicine, patients may recover more quickly, because an individualized approach can be created. By individualizing ones’ treatment, they are more likely to trust that this regimen will work for them. When someone trusts their doctor, they are more likely to adhere to their treatment plan [13]. Doctors at either Delek Hospital or Men-Tsee-Khang, attempt to treat patients with the medicine they practice; however, when they feel a patient would be better suited at the other institute, they send them there. Dr. Tenzin Yeshi says he would prefer patients to be treated at Men-Tsee-Khang. If someone trusts Western medicine more or has a strong religious belief, they may be sent to a Western doctor or a lama, respectively [9]. Dr. Rigzin Sangmo, also a doctor at Men-Tsee-Khang, said that if a patient has a severe case of mental illness, doctors may turn to Western pharmaceuticals, but only as a last resort. In general, the doctors at Men-Tsee-Khang intend to wean people off of Western pharmaceuticals. Dr. Rigzin Sangmo explained how transforming the mind is key to this outcome, and patients will be sent to a lama if they believe this will help transform a patients mind [12]. In fact, transforming one’s mind through meditation, mindfulness, empathy, and compassion has been shown to help with anxiety and depression [14]. If anxiety and depression can be lessened through transforming one's mind, there will be less of a need for pharmaceuticals. While Tibetan medicine is more holistic, it takes a long time until results are reached. When it comes to Western medicine, a patient can typically see results in as little as 4 weeks [15] In addition, the Western medicine regimen is less intense, as medications are typically taken once per day and with a meal [16]. When it comes to Tibetan medicine it has to be taken a half hour before or after a meal depending on the meal [17]. By combining different approaches to mental health, an individualized solution can be created.
Dr. Tenzin Namdol explained that she believes the biggest challenge for mental health within the Tibetan community is a general lack of knowledge regarding the topic. A stigma permeates the community and leads to the ostracism of those with mental challenges and a belief that mental illnesses are incurable [11]. Dr. Tenzin Tsundu echoed that this stigma prevails in the community [10]. Both doctors from Delek Hospital also felt that there were not enough psychologists to help the community. They suggest that many patients will not be given adequate time to express their challenges and get the counseling they need [11] [10]. Brock, in his article on Tibetan medicine, elaborates on this lack of counseling, explaining that Tibetans tend to avoid sharing about their struggles so as to not become a burden on those around them [18].
In Tibetan society, people also believe karma is the reason behind disorders arising in some people.The law of karma is the law of cause and effect. Whereby, all suffering one endures is the result of previously acting out of greed, hatred, or delusion [19]. Because Tibetans feel they are responsible for the disorder they will not easily seek support, and instead take it upon themselves to fix the problem [18]. Because the suffering of this lifetime is a result of previous actions, Tibetans feel that it is their responsibility to handle their own suffering. However, a belief in karma can also be beneficial. Dr. Tenzin Tsundu elaborated on karma explaining that he believed that because Tibetans can blame their struggles on karma, they are less likely to find their struggles as burdensome as people do in the West. Karma acts as a kind of scapegoat. They can blame their karma for their challenges and thus life is less stress-inducing [10]. Tibetans often reassure each other with reminders to leave the past in the past. By clinging to negative emotions it is thought that more suffering will occur because it will lead one to act negatively. In this way, they are able to let go of the past more easily [20]. It has been shown that those who dwell on the past are more likely to suffer from anxiety and depression [21]. Therefore, by leaving the past behind them, they are less likely to suffer from these conditions.
What can be done to help those who suffer from anxiety and depression? First of all, the monastic community and medical institutes in the Dharamshala community can continue to work together. Having a diverse set of medical and spiritual practices can act as a great resource. When a community is able to truly work together, they can utilize the practices which fit the community best and create something even better. Besides combining the two medical practices more often, this research has identified two main ways to improve the mental health of the tibetan community in exile. First, more awareness can be brought to mental health issues and second, more resources can be raised for awareness and treatment.
The Tibetan community in exile needs more resources for those who are struggling with mental illness. Delek Hospital is small and many of its resources are being utilized to combat the tuberculosis epidemic [22]. Therefore, not many resources have been allocated to finding counselors. The main counselors are at the Kangra Medical College an hour away. Given this, those who are struggling can find it difficult to get the support they need. Dr. Tenzin Tsundu suggests combating the challenge by having multiple new psychologists in the community operate under the supervision of a well-experienced psychologist [10]. By having enough resources, if individuals feel empowered to share their suffering with others without fear of ostracism, they will likely get the treatment they need.
In addition, those in the monastic community can also spread more awareness about the topic. As Brock suggests, this education will have the greatest impact if a lama or another highly respected individual from the monastic community is the one forefronting it. Since lamas are highly respected and revered, their input can go a long way in changing the ideas around mental illness [18]. It may be best to make people aware of the symptoms of anxiety, depression and chronic rLung disorder, and explain that they are solvable, while not labeling what the conditions are. This is because it has been shown that the more Western ideas of medical conditions become known, the more people start to believe they have that condition [23]. It can also be detrimental to label someone with a given disease, as labeling can lead to someone feeling restricted by the given label [24]. If all of these solutions are considered, the mental health challenges of Tibetans in exile may be better met.
As seen here, mental illness, in particular, anxiety and depression, is a multifaceted challenge with multiple perspectives. Since coming into exile, more awareness has been brought to the issue and Tibetans have more ways to approach mental illness. Those who believe in religious traditions and ancient medicinal wisdom can be significantly helped by those beliefs, while those who have more of a Western viewpoint can seek help through other means. In this way, an individualized approach can be created for patients. By so doing, patients can have more trust in their treatment plan. While an attempt is currently being made to combine the different approaches, more collaboration can occur in order to give the patient the best possible treatment. This could allow for a combination of the fast-acting Western medicine and the slower more holistic Tibetan medicine resulting in more effective treatment plans.
References
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[2] Dönden Yeshi, and Jeffrey Hopkins. Health through Balance: an Introduction to Tibetan Medicine. Dehli: Motilal Banarsidass, 1997. Print.
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[4] Yon-tan-mgon-po, Gʹyu-thog, and Sonam Dolma. The Oral Instruction Tantra from the Secret Quintessential Instructions on the Eight Branches of the Ambrosia Essence Tantra. Dharamsala, India: Men-Tsee-Khang, 2017. Print
[5] Dr. Tashi Yarphel, (Men-Tsee-Khang clinical doctor). Personal interview. 29 Nov. 2019.
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[9] Dr. Tenzin Yeshi (Men-Tsee-Khang researcher and former clinical doctor). Personal interview. 16 Nov. 2019.
[10] Dr. Tenzin Tsundu (Delek Hospital doctor). Personal interview. 15. Nov. 2019.
[11] Dr. Tenzin Namdol (Delek Hospital doctor). Personal interview. 15 Nov. 2019
[12] Dr. Rigzin Sangmo (Men-Tsee-Khang researcher and former clinical doctor). Personal interview. 16 Nov. 2019.
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