Saturday, March 14, 2009

West treats East - Joining Western Psychology with Eastern Beliefs for Tibetan Trauma Victims

Where Jami (my girlfriend) works, at an in-patient mental health facility, they like to use mindfulness and meditation practices as part of the treatment program. But they also know that with trauma victims, meditation is not always a good option.

Many victims of abuse and severe trauma have spent their lives repressing the memories and feelings - and far from a being a bad thing, it's a very useful survival mechanism that psyche uses to maintain a semblance of health. Meditation can open the vault, so to speak, where those memories are kept and bring them flooding back into consciousness.

Among many Buddhists, Western psychology is seen as pointless - to them, Buddhism has all the needed tools to deal with any psychological issues. But for some Tibetans who have been tortured by the Chinese, meditation isn't a good option. So they are turning to Western psychology to heal the PTSD from which they suffer. Importantly, however, the psychological treatment is reframed within Eastern beliefs, providing a cross-cultural approach.

The Boston Globe reports:

West treats East

To help traumatized Tibetan monks, doctors in Boston turn to cross-cultural medicine

Dr. Michael Grodin (left) treated Tibetan monk Yeshi Togden for post-traumatic stress from his imprisonment and torture in the late 1980s. Dr. Michael Grodin (left) treated Tibetan monk Yeshi Togden for post-traumatic stress from his imprisonment and torture in the late 1980s. (MARK WILSON/GLOBE STAFF)
By Carey Goldberg Globe Staff / March 13, 2009

Though recently granted political asylum in America, Yeshi Togden, a Tibetan monk, knew no peace. All his training in meditation could not block the flashbacks from his months as a political prisoner, beaten and wracked by thirst, or stop the obsessive worry about the people he had to leave behind in Tibet.

When he tried to meditate - and Tibetan Buddhist monks are known as meditation superstars, their lives permeated by prayer - his mind "jumped, and could not settle."

The Western diagnosis was post-traumatic stress disorder. But Dr. Michael Grodin of the Boston University School of Public Health has treated Tibetans for 15 years and knew better than to limit himself to Western concepts. He added a Tibetan diagnosis: "Srog-rlung," an imbalance of the "life-wind," and added Eastern treatments to the Western antidepressants he prescribed.

"Whatever works," Grodin said.

These days, Togden can smile again, even occasionally laugh, and though his heart remains in Tibet with his people's struggle for greater freedom from China, he said the treatment has helped him to feel and meditate better.

In a paper published today in the journal Mental Health, Religion, and Culture, Grodin and his colleagues at Boston Medical Center's refugee health center describe the East-West treatment he tailored for Togden and seven other Tibetan monks in Boston. It included Taoist breathing, musical bowl-playing, and Eastern movement practices such as Tai Chi and Qigong, along with Western-style talking therapy and medications.

Today's study is the first published paper to describe attempts to integrate Western and Tibetan medicine to help traumatized monks, said Grodin, also a professor of human rights, psychiatry, and community medicine at Boston University School of Medicine.

Grodin's efforts fit into a growing field called cross-cultural psychiatry, which aims to offer more culturally sensitive mental health care to immigrant groups. It entails efforts to understand and work with foreign medical interpretations, such as the Tibetan belief that many ills can stem from problems with the "life-sustaining wind" that controls the body's health and harmony.

His mixed treatment is also an example of "integrative medicine," combining mainstream healthcare with alternative or complementary therapies such as traditional herbs, meditation, or yoga. Integrative medicine is increasingly being tried for post-traumatic stress disorder, said Dr. Robert Saper, director of integrative medicine at Boston Medical Center, and is "beginning to show tremendous promise."

This week, Tibetans outside China marked the 50th anniversary of an uprising against Chinese rule that failed, forcing the Dalai Lama, Tibetans' spiritual leader, into exile. The Chinese government accuses the Dalai Lama of fomenting separatism; he maintains that he is only seeking greater autonomy and more religious freedom to help preserve Tibet's culture.

Togden, a prominent figure in the political resistance to the Chinese presence in Tibet, said he was repeatedly imprisoned for months at a time in the late 1980s for participating in peaceful protests, and he fled Tibet in 1990, going first to India and then the United States.

His prison memories include thirst so extreme that he could not produce enough urine to drink and help slake it and waiting in dread with other prisoners to see who would be beaten next.

His and the other monks' cases presented some particular treatment challenges. Normally, Tibetan monks can seek healing through the enlightenment they gain from meditating. But the monks Grodin treated tended to find that the process of meditating only seemed to worsen their mental health.

Togden said through an interpreter that as he meditated, "a lot of other things would come up - I should have done this, and I should have done that," what in psychiatric terminology would be called "ruminating." Sometimes images of beatings would arise, sometimes feelings of sadness over Tibet's plight.

It seems, Grodin said, that meditation may reduce the brain's ability to inhibit unpleasant thoughts and memories and instead unleashes them. He has seen a similar process in aging Holocaust survivors, he said: As they begin to suffer from dementia, their brains become less able to inhibit bad memories, and they sometimes believe they are back in concentration camps.

So the very process that would normally help the monks instead made them worse. Grodin sought to steer them toward other relaxation techniques, such as breathing and Tibetan "singing bowls," which vibrate melodically when rubbed by a mallet, while working to heal their psychic wounds by talking and other methods.

Another challenge: The political situation that led to the monks' imprisonment and exile continues. While therapy for a traumatized war veteran might consist in part of convincing him that the war is over and that he is now safe, the monks worry that their loved ones in Tibet are not, in fact, safe. They suffer from homesickness and from guilt that they are not there, particularly when China clamped down on pro-Tibet protesters during the Olympics last summer.

"I couldn't stop listening to the news, and it brought back everything all over again," Togden said.

Grodin said that all the Tibetan monks he treats got psychologically worse during the Olympics. The United States has granted political asylum to many Tibetan monks, he said, because they so clearly face persecution at home. Once asylum is granted, an immigrant can feel safe from deportation; a green card, and later citizenship, can follow.

During an interview yesterday in Grodin's office, a cozy room bedecked with statues and photos from Tibet, Togden said that he was deeply grateful for the help he has received and that what helped him most of all was the cathartic feeling that he could tell Grodin anything.

"He knows about this kind of situation, so it was easy to open my heart to him," said Togden, who was wearing traditional, deep crimson robes.

"You are a very, very courageous man," Grodin told him, looking into his dark, shining eyes. "What happened to you should never happen to anyone. You're a very brave man and a very compassionate one, and it's been my honor to treat you and know you."

Ultimately, though,Togden said, his mind cannot be at ease until his country is free. "Until the situation in Tibet is resolved, my mental problem will not be," he said.

Carey Goldberg can be reached at goldberg@globe.com.

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