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Concepts of mental health and mental illness : a comparison of definitions and checklists in the Abhidharmakośabhāṣya… Desmarais, Michele Marie 1992

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CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS:A COMPARISON OF DEFINITIONS AND CHECKLISTSIN THE ABHIDHARMAKOABHASYA  AND THEDIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS(DSM-III-R)byMICHELE MARIE DESMARAISB.A., Simon Fraser University, 1987A THESIS SUBMITTED IN PARTIAL FULFILMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF ARTSinTHE FACULTY OF GRAD STUDIES(Department of Religious Studies)We accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIADecember 1992© Michele Marie Desmarais, 1992In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)Department of Religious StudiesThe University of British ColumbiaVancouver, CanadaDate December 29, 1992DE-6 (2/88)ABSTRACTThis study examines concepts of mental health and mental illness inVasubandhu's Abhidharmakogabhava (AKBh), and the American PsychiatricAssociation's Diagnostic And Statistical Manual Of Mental Disorders (thirdedition, revised) (DSM-III-R). The choice of these texts was made based ontheir importance and influence.Two general problems are encountered in this study. There are greatphilosophical differences between the texts. These differences are mostproblematic in regards to terminology. Buddhist terminology is used whereverappropriate and possible. Unfortunately, sometimes North Americanterminology and categories infiltrate this. The translation of the AKBh posesa second problem. Due to time constraints, the english translation was used,however this translation is faulty in a number of places. Correctedtranslations are offered in square brackets.This study is conducted on two levels. One is content-oriented, exploringthe relevant concepts in each text and examining the cultural, historical,religious, and theoretical influences that form or underlie these concepts. Thesecond level is exploratory and more like hypothesis testing. Both texts usethe format of lists, and a primary aim of this study is to identify and compare,not details, but broad structural similarities and differences between such lists.In such a way, the phenomenon and use of lists in such texts may be betterunderstood.11Through this approach one finds that concepts of mental health andmental illness in each text are influenced by values and norms. In particular,DSM-III-R reflects largely secular values, while the AKBh contains asoteriological psychology. These differences are linked to basic concepts of thenorm--against which mental health and mental illness are measured--asaverage or ideal.Due to such differences in values and norms, a comparison of individualitems on the lists is not possible. However, as these same values and normsform or underlie the lists, a comparison of such broad influences or structuresis methodologically justifiable. The finding that DSM-III-R shows the influenceof values and norms, indicates that it may be impossible to formulate anyconcept of mental health or mental illness without such influences.111TABLE OF CONTENTSPageABSTRACT ^  iiTABLE OF CONTENTS ^  ivACKNOWLEDGEMENTS  vI. INTRODUCTION ^  1Mental Healing In The West ^  6Mental Healing In India  13Summary ^  23Notes - Introduction ^  24II. METHODOLOGY  25The Diagnostic And Statistical Manual Of Mental Disorders (III-R)^28The Abhidharmakogabhäsya ^  31Notes - Methodology ^  36III. CONCEPTS OF MENTAL ILLNESS AND MENTAL HEALTH ^ 37Definitions Of Mental Illness ^  37Definitions Of Mental Health  42Psychological Changes On The Path ^  45Summary ^  64Notes - Concepts Of Mental Illness and Mental Health ^ 66IV. VALUES AND NORMS ^  68Values ^  68Norms  86Summary  91Notes - Values And Norms ^  92V. THE LISTS: MAJOR DEPRESSIVE EPISODE, ANUgAYA-S ANDKLESA-S^  93Major Depressive Episode: DSM-III-R ^  94Klega-s And Anugaya-s In The AKBh  100Summary - Comparison Of The Lists  105Notes - The Lists ^  109VI. CONCLUSION  111REFERENCES ^  115APPENDIX 1  120ivACKNOWLEDGEMENTSI wish to express my sincere thanks to my thesis committee--Dr. RichardMenkis, Dr. Karin Preisendanz, and Dr. Ashok Aklujkar--for reading andcritiquing this thesis on such short notice. I am especially grateful to Dr.Preisendanz for her careful reading of the thesis, and for correcting the englishtranslation. A special thank-you to my main supervisor, Dr. Aklujkar, for hispatience, support, and guidance, not just with regards to this thesis, but overthe last two years--and, in particular, for the reminder, at a crucial moment,that ninety percent of the world is good.I must also thank Dr. Manabu Waida, at the University of Alberta, forencouraging me to pursue graduate work in religious studies; and Dr. ShotaroIida, my first supervisor at the University of British Columbia, for hisguidance and advice.Finally, a special thanks to my family for their unfailing love andsupport. Thank you also to Anne McDonald, for really listening andunderstanding.v1I. INTRODUCTIONWhen people have information that they need to remember, such asgroceries that have to be bought, books to be read, or terms to be memorizedfor an exam, they often put that information into the form of a list. Lists helppeople to organize information and such organization is an aid to memory. Aswell, if people wish to communicate the information to others, lists provideuseful summaries that may be quickly understood and employed.Once a list has been made, however, it often does not reveal theunderlying information and organizational principles that were integral partsin its construction. For instance, even the simple grocery list, a necessary factof existence for most people, requires some degree of thought, choice andorganization. First a person looks in the refrigerator and cupboards to seewhat needs to be bought. Items are chosen or not depending upon a number offactors that may include menu plans, seasonal availability, personalpreference, finances, etc. Finally, having made some choices based on thesefactors, the person constructs a list and may even organize the list itselfaccording to some scheme such as, "dairy products," "produce," "meat andpoultry," etc. Thus a grocery list is only deceptively simple, for it actuallyrequires examining, planning, choosing and organizing.Both the Indian and North American traditions of thought haveproduced lists that summarize information in order to help people remember,communicate and use that information in an efficacious manner. For instance,the Abhidharmakogabhasya (AKBh),  a Buddhist philosophical-psychological2text dating from around the fifth century of the common era, gives a list of theklegamandbhiimika-s, or principal (mental) states existing in all defiledminds, as: delusion (moha); non-diligence (pramäda); idleness (kausrdya);disbelief (dgraddhya), torpor (stydna); and dissipation (auddhatya) (AKBh,ii.26a-c, 193).An example from the North American tradition is a list of the diagnosticcriteria for a major depressive episode (only part of which will be given here)taken from the Diagnostic And Statistical Manual Of Mental Disorders (ThirdEdition - Revised) (commonly referred to as DSM-III-R):(1) depressed mood (or can be irritable mood inchildren and adolescents) most of the day,nearly every day, as indicated either bysubjective account or observation by others(2) markedly diminished interest or pleasurein all, or almost all, activities most ofthe day, nearly every day (as indicatedeither by subjective account or observationby others of apathy most of the time)(3) significant weight loss or weight gain whennot dieting (e.g., more than 5% of bodyweight in a month), or decrease or increasein appetite nearly every day (in children,consider failure to make expected weight gains)(4) insomnia or hypersomnia nearly every day(5) psychomotor agitation or retardation nearlyevery day (observable by others, not merelysubjective feelings of restlessness or beingslowed down)(6) fatigue or loss of energy nearly every day(7) feelings of worthlessness or excessive orinappropriate guilt (which may be delusional)nearly every day (not merely self-reproachor guilt about being sick)(8) diminished ability to think or concentrate,or indecisiveness, nearly every day (eitherby subjective account or as observed byothers)(9) recurrent thoughts of death (not just fear3of dying), recurrent suicidal ideationwithout a specific plan, or a suicide attemptor a specific plan for committing suicide(DSM-III-R, 222).Separated by centuries and cultures, the sample lists fromAKBh and DSM-III-R are, of course, very different. Singly, they may appearquite straightforward, yet side by side the differences due to topic, scope,stance, time, and culture, are highlighted. Examining both lists together then,enables one to identify the various underlying theories, choices, andorganizational principles that, like the grocery list, might not have beenapparent from a cursory glance. As Paranjpe in Theoretical Psychology: TheMeeting of East and West, has noted:An attempt to compare two different systemsnecessitates "stepping out" of both systemsnow and then, since this enables us to assesseach of them as a whole. Temporary distancingfrom a system of ideas enables us to stop andquestion whether things which we have taken forgranted are indeed unconditionally true. Thus,our implicit assumptions become explicit in theprocess of comparison.. .We tend to exaggerateour strengths and discount our weaknesses whenworking within only one system, while a comparativeperspective enables us to see the strengths andweaknesses of our own as well as other systemsin their real proportions (1984, 2).Such a comparison of concepts of mental health, mentalillness, and lists, in the AKBh and DSM-III-R reveals a series of both broadcultural and more specific factors that are valuable aids in understanding andexplaining each system or tradition, and that might be overlooked without acomparative perspective. Thus the purpose here is not to say "this" is equal to4"that," but rather to see each list or concept as part of a whole tradition,history, and culture, embodying a specific approach to, or way of theorizingabout, a problem. In the same way, pictures of one flower may be taken by twodifferent cameras, and those pictures compared to identify the nature, scope,strengths and weaknesses of each camera.With regards to the specific lists, this approach then, is exploratory andmore like hypothesis testing. Although this present study may not find twolists that can be tellingly or conveniently compared, this does not mean suchlists do not exist. The Indian list literature is vast, being the result of longperiods of thinking, experimentation, and refinement.One of the primary aims of the present study therefore, is comparativeexperimentation with list literature. That is, the study seeks to identify andcompare, not details, but broad structural similarities or differences betweenlists; as well as to unravel the factors underlying those structures and lists.That the lists considered here are psychological (psychiatric), or religious, innature is due to what the present writer considers herself able to handle andelucidate.Before any comparison is possible though, one must gain someunderstanding of the general background and history of each tradition.Immediately, difficulties arise because of terminology. The term "psychology"comes from the Greek words "psyche" and "logos," meaning the treating orstudy of the soul or mind. Currently it is sometimes contrasted with"psychiatry" which is, "the branch of medicine dealing with the diagnosis and5treatment of mental disorders" (iatreia in Greek meaning "cure").' While thereis overlap between the two terms, or at least their object(s) of study andtreatment, they are usually regarded as separate, and sometimes rival, fieldsin the West.Further complications arise when applying the Western term"psychology" to Eastern traditions, for the Eastern, and in this specific case,Indian, traditions have very different approaches to, and understandings of, thestudy of the soul or mind. Such differences have led some to regard psychologyas a purely Western invention and to overlook the important contributions ofIndian thought. Unfortunately, this has even been true in India (Paranjpe1984, 16). However, the philosophical and religious traditions of India reveal agreat wealth of psychological theory and therapeutic techniques. Therefore,even though the material arising from such traditions was not labelled aspsychology per se, and even though psychology never developed as anautonomous discipline within India (until, perhaps, recent times), some of thecontent is obviously psychological and should be recognized as such, despite theabsence of this label (Paranjpe 1984, 4).To avoid further complications with terminology, particularly withregards to psychology-psychiatry disputes, one may use the term "mentalhealing." Mental healing,in its broader sense includes the humbleorigins of contemporary psychology andpsychiatry in the dawn of recorded historyas well as the latest exploits of scientificpsychotherapy as it is practiced in the major6centers of treatment (Ehrenwald 1976, 17).In the West, organized psychiatry and clinical psychology are scarcely twohundred years old (Bromberg 1975, v), while, as noted, there has been somereluctance applying such terms to Eastern thoughts and practices. The term,"mental healing," allows one to view issues of mental health, mental illnessand therapeutic interventions from a historical perspective. This reveals thatNorth American psychology-psychiatry is a recent off-shoot of a long traditionof interactions between Western religion, philosophy and science, while itsIndian counterparts emerge from their own philosophical and religioustraditions (Safaya 1975, 4).Mental Healing In The WestAs Walter Bromberg in his book From Shaman to Psychotherapist notes,no one can say when, in the early history of humankind, a shift took placefrom attention to physical pain to recognition and treatment of psychologicalsuffering (1975, 2). The earliest mental healers though undoubtedly wouldhave been shamans (as well as priests, teachers, elders, etc.) using amulets,charms, words and rituals, as well as insight into the fellow human beings, totreat physical and mental illnesses (Bromberg 1975, 3). While some of theseshamanistic practices were preserved in indigenous native populations, Greekphilosophy was the earliest significant influence for the tradition of mentalhealing in the West.7Greek philosophy was based on the ideas that there were universal laws,and that nature was orderly rather than chaotic (Paranjpe 1984, 60). Anysystematic inquiry into the nature of the human being or the mind beginswith, and depends upon, these fundamental concepts (Paranjpe 1984, 59).Greek thought emphasized rationalism and the spirit of reason, and from earlytimes regarded the rational ability of human beings as somehow separate fromintuition and feelings (Paranjpe 1984, 19). Since that time, the West has had afascination with the human being as a supreme and unique rational animal, afascination reflected in the Latin term homo sapiens (Halbfass 1991, 266).Apart from such general ideas, three Greek thinkers, in particular, weretremendously influential in shaping the development of the mental healingtradition in the West. Pythagoras (6th-5th century B.C.E.) and his philosophyof numbers provided a basis and rationale for the classification of bodilyhumors (blood, phlegm, yellow bile, black bile) and natural elements (fire, air,earth and water) that lasted in medical practice until relatively modern times(Bromberg 1975, 8). As well, the Pythagoreans applied their idea of the meanto medicine, and their concept of health as the "attunement and harmony ofopposites" (for example, the body is regarded as healthy when it is neither toocold nor too hot) has been a lasting influence (Jones 1970, 36). 2Hippocrates (c. 460-377 B.C.E.), commonly known as the Father ofMedicine, was dissatisfied with the emphasis on supernaturalism that existedin medical theory during his time (Bromberg 1975, 12). He maintained that8diseases arose from bodily, natural sources, and Bromberg notes that this typeof perspective contained in his writings,exerted a lasting influence on medicinefor a millennium or more. [Hippocrates]contributed a high moral tone to the therapeuticaspect of^medicine. Though his clinicalobservations were more medical than psychiatric,his influence proved to be significant in theevolution of psychiatric thinking (1975, 12).Plato (427-347 B.C.E.), whose thought has had enormous impact in theWest, suggested that mental disorders were "partly somatic, partly moral, andpartly divine in origin" (Bromberg 1975, 13). He advocated what might beconsidered an early form of cognitive therapy, namely the "curative effect ofwords," of "beautiful logic" (Bromberg 1975, 13).Greek thought and medicine were brought to the Latin world, asclassical culture flowed from Greece to Rome. The Romans resisted Greekmedicine at first, but accepted it around the first century B.C.E. (Bromberg1975, 14). However, in spite of the fact that Latin authors dealt with manyaspects of medicine, nutrition, etc., interest in psychotherapy, to judge fromextant literature as explored by experts, was quite minimal (Bromberg 1975,15). It was not until Christianity gained influence (c. 392 C.E.) that attentionagain became focussed on ideas of mental health, illness, and healing(Bromberg 1975, 17).While Greek thought emphasized rationality, the Christian traditionemphasized faith (Paranjpe 1984, 19). The Church of Rome was the mostpowerful force in the field of mental healing in the West until the eighteenth9century (Bromberg 1975, 21). That its influence is perceived to have retardedthe growth of science in general and psychology-psychiatry in particular, isnoted in the very first paragraph of Kaplan and Sadock's influentialComprehensive Textbook Of Psychiatry (1989, 1:vii). This perceived conflictbetween science and religion has resulted in the modern emphasis on value-free, objective and empirical methods in Western psychology and psychiatry,and has consequently dictated the appropriateness of certain fields of study(Paranjpe 1984, 6, 23-24).3 The importance of this perceived conflict betweenscience and religion cannot be underestimated, for many of the differencesregarding mental healing in the North American and Indian traditions havetheir basis in the fact that no such similar conflict developed in India, andtherefore their scientific or psychological theories and religious ideas remainedintermixed (Paranjpe 1984, 30).As mentioned, the Christian church was the single most powerfulinfluence in the Western mental healing tradition for approximately 1400years. Popular medical folklore existed, as did the humane treatment ofmental patients in a few hospitals during the eleventh to thirteenth centuries,but the church's theories about, and treatment of, mental illness were far morepowerful and pervasive (Bromberg 1975, 25, 27). With the Council Of Toledo'steaching in the fifth century that "demonic seizures" could only be cured bymiracles (as opposed to natural diseases that could be cured by human medicaleffort), nervous or mental disorders ceased to be regarded as diseases(Bromberg 1975, 27). The Malleus Maleficarum in 1484 was the culmination of10this tradition that viewed mental illness as a form of demon possession, andthat advocated exorcism, including torture to make the "demon" confess, as thesole cure (Bromberg 1975, 27, 43).It was in opposition to such a dangerous combination of ignorance andpower that the Western sciences developed. In the sixteenth century,the doubts, the questionings, and thechallenges to the teachings and commands oforganized religion helped to foster empiricism,which is essentially a belief in the value ofunderstanding our world and increasing ourknowledge of it through sensory experiencesand a conviction that all we know is whatwe have learned (Reisman 1991, 4).René Descartes (1596-1650) furthered this trend by asserting that the humanbody and mind/soul are separate entities that interact with each other (Fancher1979, 19). This mind-body dualism has been tremendously influential in theWest, and can be seen in the current theories and questions regarding possiblebiological versus psychological factors in the etiology of mental illness.Descartes also tried to show how certain physiological processes might parallelsome psychological phenomena, and although few of his ideas on this topic areaccepted today, his attempts helped to set the stage for psychology to emerge asone of the sciences (Fancher 1979, 19).In the seventeenth and eighteenth centuries, Spinoza, Locke and Humedeveloped theories that provided a reasoned approach to the understanding ofthe mind, while others focussed on developing a physiology of the brain andnervous system (Bromberg 1975, 69). With this combination of work, mental11disorders again came to be accounted for on naturalistic grounds (Bromberg1975, 63). Such a development resulted in more humane treatment of thementally ill. For example, Pine! (1745-1826), often called the "father ofscientific psychiatry," brought about a "therapeutic revolution" by liberatingthe mentally ill from their chains, and insisting on better forms of treatment(Bromberg 1975, 94). Pinel also introduced the practice of keeping records andtaking case histories for patients, and tried to form a systematic classification,or nosology, of mental illnesses (Reisman 1991, 7).In the nineteenth century, there was great progress in the fields ofphysics, chemistry, biology and medicine (Reisman 1991, 13). It was at thispoint that psychiatry and psychology proper developed. Scientific work inbrain anatomy and physiology provided a foundation for psychiatry, and thisled to a shift in emphasis and attention from asylums to departments ofpsychiatry in university medical schools (Reisman 1991, 14). The goals ofpsychiatry became to "identify specific diseases, to determine their particularetiologies, and to develop methods of treatment appropriate to each" (Reisman1991, 14).Scientific psychology emerged as Wilhelm Wundt (1832-1920) andWilliam James (1842-1910) established the first psychological laboratories inuniversities (Leipzig and Harvard respectively) (Fancher 1979, 126). Wundtand his contemporaries defined psychology as the "study of consciousness," thesoul not being regarded as an appropriate or even possible object of study(Reisman 1991, 15). The psychoanalytic school--Freud (1856-1939), Adler (1870-121937), Jung (1875-1961), and others--though, emphasized the unconscious mind.Then Watson (1878-1958) and the behaviorists stressed the importance ofbiology and of understanding, predicting, and controlling overt behavior(Fancher 1979, 319). Behaviorism was at least partially succeeded by whatbecame known as the "Third Force," humanistic psychology, represented by thework of Maslow (1908-1970), Rogers (1902-1987), and others. Of course, each ofthese schools of psychology developed its own ideas of the etiology of mentalillness, and devised its own methods of therapeutic intervention. RaghunathSafaya has humorously summarized these many developments and changes inWestern psychology as: "first psychology in the West lost its soul, then itsmind, then its consciousness and lastly all its behaviour" (1975, 6).Much could still be written on developments in psychiatry andpsychology in the twentieth century, particularly in the area ofneuropsychiatry. However, the purpose here has been to identify some of themajor factors that shaped current approaches to mental healing. Given this,one last factor needs to be mentioned. Since the 1960s, Western psychologistsand psychiatrists have become interested in Eastern approaches to the mindand mental healing. Although much of the work of those known as"transpersonal psychologists" is of questionable scholarship, or at least is at avery basic level, some fine and useful work is being produced by many others.This recognition of the great wealth of Eastern psychological theories andmental healing techniques is long past due.13Mental Healing In IndiaIt is a difficult undertaking to trace the development of mental healing(or for that matter, nearly any other aspect of thought or practice) in India, forIndian thought is not monolithic (Halbfass 1991, 267). Statements oftenaccepted in the West, such as "all Indian thought is monistic," or "all Indiansbelieve the world is an illusion," etc., only reflect Western illusions and naiveteregarding Indian philosophy and psychology. At most, one may only speak ofdominant trends in Indian thought (Paranjpe 1984, 57). Accordingly, some ofthese dominant trends will be examined here to see how they might haveshaped the tradition(s) of mental healing in India and, specifically, of IndianBuddhism before the common era. Such an approach, limited in scope,necessarily leaves out the many impressive contributions of Indian thought inthe areas of perception, motivation and cognition.It seems natural to begin a study of Buddhist mental healing with theBuddha himself, and yet this, perhaps, is not the best place to start. TheBuddha is credited with achieving great insight through his enlightenmentexperience, and while this may be true, it is also undeniable that he inheritedrich traditions of psychological thought and practice (Reat 1990, 282). Somespeculate that the cumulative knowledge the Buddha directly or indirectlyinherited, was a result of a synthesis of the Vedic and Upanisadic traditionswith the indigenous yogic traditions of India (Reat 1990, 143) (although it is byno means certain that yoga is not Vedic or Upanisadic). Thus in order to trace14the development of mental healing, one must begin with the Veda-s and theirview of the human being.Halbfass, in Tradition and Reflection, notes that unlike the West, thereis no tradition in India of "explicit and thematic" thought that tries to definesome essence of human beings as completely separate and different from, orsuperior to, other forms of life (1991, 266). Generally, and in a basic sense, theVedic texts classify the human being (manusya, purusa) as a domesticatedanimal (pa.§14), albeit a special and distinguished one (Halbfass 1991, 268). Inthe Veda-s, and particularly the Brähmana-s, correspondences between thehuman being and the cosmos are identified, for example, between breath andthe wind (Reat 1990, 80). This early interest in micro-macrocosm connectionswas developed further in the Upanisad-s, some of which sought to identify anessence in human beings, such as the &man, with a common, ultimate,macrocosmic essence, such as brahman (Reat 1990, 206).This type of speculation formed in conjunction with the development ofideas about karma. The fact that belief in the law of karma (literally meaning"action") is common in India, reflects a pervasive underlying belief in, orphilosophy of, the lawfulness of nature and the cosmos (Paranjpe 1984, 61).Generally speaking, the law of karma may be summarized as, "yatha karmatathd phalam," "just as the action, so also the fruit" (i.e., you reap what yousow). In other words, for much of Indian philosophy and religion, the law ofkarma involves the concept that the nature of acts--including acts of thought--influences and, eventually, transforms the nature of the doer (Reat 1990, 276).15This type of perspective on karma, which has great psychologicalimplications, is examined further by Paranjpe:the theory of karma implies that humanbehavior is lawful in every way. It iscontrolled by laws of physical naturewhich nobody can violate; each action issystematically related to the individual'sentire past; and finally, in a moral sense,no one can escape experiences of joy orsuffering as the fruits or consequences ofhis own past action (1984, 61).Given this, it is not surprising that ideas of karma, coupled with micro-macrocosm speculations, resulted in views of the human being that were, andare, very different from Western views, and which form the basis of Indianpsychologies and mental healing traditions.As mentioned previously, in Indian thought the concept of the humanbeing as completely separate, different, reasoning, reckoning, and planning"animal rationale," is not emphasized to the degree that it is in the West(Halbfass 1991, 281). Instead, the potential of human beings to attainliberation (moksa) is stressed, as Halbfass summarizes well:[In the Mahabharata] Man's potential forintelligent planning, for applying toolsand techniques, for subduing other creaturesand for dominating the earth, that is, hispotential as a rational animal ("animalrationale"), appears as a temptation tobe resisted. Exploiting this potentialwould be a misuse of a unique soteriologicalopportunity. The true privilege of manis not to be the master of his world,but to be liberated from it; his mandateis not to employ other creatures asinstruments for his own needs and desires,16but to use himself, his own human existence,as a vehicle of self-transcendence (1991, 272).This emphasis on self-transcendence, and acceptance of such a religiousor soteriological goal, are key elements in Indian psychology and mentalhealing. Indeed, many of the mental healing techniques and psychologicalconcepts were developed by those who were seeking self-transcendence, or bythose who had already attained it (Paranjpe 1984, 5, 31). Because the quest forliberation was a common concern crossing philosophical and religiousboundaries, certain techniques and psychological concepts came to be shared bypeople, or groups, of many different persuasions (Paranjpe 1984, 31).In this way there existed, to some extent, at the time of the Buddha theperspective that people could, and should, strive for psychological or spiritualself-transcendence, as well as a variety of yogic techniques that had beendeveloped to aid in the attainment of such a goal. The Buddha himself is saidto have tried a number of these techniques before finally becomingenlightened.Many scholars today acknowledge that we cannot know, for certain, theexact nature of the Buddha's teachings. There is even debate over the datingof the time he lived, although 563 BCE to 483 BCE, or the shorter chronologyof 463 to 383 BCE, are the most common dates given. The Buddha becamefully enlightened and then taught others until his death. Traditionally it issaid that his words and teachings were remembered and collectively rehearsed,until finally they were preserved not only orally, but in manuscripts (Warder171970, 4). However since the preserved material shows some differences indoctrines, we are unable to know for certain what the Buddha taught.Nevertheless, the general character of the earliest teachings ofBuddhism reveal a number of things. The Buddha and early or primitiveBuddhism, seemed to accept some ideas common during the time, for examplethe concept of karma, but rejected certain kinds of philosophical speculation.The characteristic feature of the teaching was that it "admitted no esoterictruths, and was meant for all who were not satisfied with leading a life ofnatural inclinations. It was a 'folk-gospel" (Hiriyanna 1949, 73).Although the earliest teachings rejected such speculation andesotericism, they did not necessarily represent a movement against thepredominant religion of Hinduism. Some scholars even maintain that thefundamental Buddhist doctrine of andtman was a later development (Hiriyanna1949, 73). Instead, the focus at this point in time was primarily pragmatic--examining one's experiences within the universe, rather than defining theessence of the self and universe (Reat 1990, 22). This phenomenological-psychological focus remained, although it became more analytical over time.The basic doctrines of Buddhism that are usually (but, as we have seen,not necessarily) attributed to the Buddha, are contained in the four nobletruths. The first truth, recognizes that frustration, dissatisfaction, andsuffering are a part of normal living. This truth is often translated as life issuffering (dulgeha), but suffering should be understood in a very broad sense(Johansson 1969, 15). The second truth states that suffering or18unsatisfactoriness originates in desire (trsrj.Ct; P. tanhä - meaning "thirst" or"craving") which later was understood as being based in ignorance (avidya).4Thus if desire and ignorance are eliminated, then suffering too will beeliminated (third truth). The fourth truth delineates the path or method bywhich desire and ignorance can be eliminated. This is known as the eightfoldpath.The eightfold path consists of right views, right intentions, right speech,right conduct, right livelihood, right effort, right mindfulness, and rightconcentration. From a modern Western psychological perspective, one can seethat this path involves cognitive and behavioral elements. Right views, rightintentions and right effort are all strongly cognitive, while right speech, rightconduct and right livelihood are behavioural. Right mindfulness and rightconcentration though, which involve meditation, go beyond most Western formsof mental healing.The four noble truths and the eightfold path are thus interesting, forthey reveal a distinctly therapeutic paradigm (Halbfass 1991, 246). In thetruths, "we have what corresponds to a physician's treatment of a disease--ascertaining the nature of the disease, discovering its cause and setting aboutits cure by adopting appropriate means thereto" (Hiriyanna 1949, 75). In otherwords, these truths offer concepts of diagnosis (suffering); etiology (desire orignorance); prognosis (abolition of desire and ignorance); and therapeutics (theeightfold path).19The traditional Western medical paradigm is diagnosis, etiology,therapeutics and recovery. Thus given the above, which only changes orcombines the last two elements, one might wonder whether such a medicalparadigm existed in India as well, and provided a basis for these truths.However, there is no evidence that such a scheme existed prior to the Buddha(Halbfass 1991, 245). This type of approach to problems is practical andlogical, so the Buddha, or early Buddhists, need not have borrowed it.Although the paradigm was not necessarily borrowed, it is obviouslytherapeutic. It is not surprising then that medical metaphors and comparisonsare common in Buddhist literature (as well as in other Indian philosophicaland religious literature) (Halbfass 1991, 244). For instance, the Buddha iscompared to a doctor; his teachings to medicine or a remedy; and his followersto patients (AKBh, vi.75b, 1033).Given this, one can see that there is recognition, even within theBuddhist community, of the therapeutic nature of Buddhist practices andteachings. An early and enduring goal of Buddhism, as stated in the truths,was the alleviation of suffering. Since the etiology of this suffering (desire orignorance) was located within the person, one may regard such suffering andits cause as being primarily mental. Then, since the remedy for this sufferingwas mainly cognitive and behavioural, one might consider the eightfold path tobe, among other things, a form of therapy designed for mental healing.The idea of the eightfold path as a form of therapy must be qualified,since the goals, doctrines, practices and philosophies of Buddhism certainly go20far beyond concerns for mental health. However, one of the main goals ofBuddhism, as in other Indian psychologies, is self-transcendence orenlightenment, and this, as we shall see, includes some elements that arepsychological or therapeutical. Therefore, the state of enlightenment might, atleast for the purposes of this study, be viewed as representing some type ofmental health.The development of Buddhist doctrines and thought continued beyondthese basic four noble truths and eightfold path. Over time, people formulatedvarious theories regarding the nature of the self and the world. According tocanonical Buddhism, there is no dtman. Instead, the person (pudgala) is onlya "complex," consisting of body or form (rapa), and mind (näma) (Hiriyanna1949, 75). Other views regard the person as an "interacting assemblage" offive skandha-s (P. khanda) or heaps (Rao 1962, 108). These skandha-s are:form (rapa); feelings (vedanti), ideas, apperception, or sensations (samfful) (P.safilid); volitions and other faculties (sarnsktira); (P. sankhara); andconsciousness (vijfitina) (P. viiiiiart.a) (Stcherbatsky 1923, 5).Briefly, riipa is form, matter, the material or physical aspect of things.Vedanti, feeling or affect, is classified as pleasant, unpleasant, or neutral(Conze 1967, 107). It is, "a basic psychological function which imparts to everyconscious content, of whatever kind it may be, a definite value" (Guenther1974, 37). Sniffle-1 is the function of perceiving and the perceived image istransmitted to consciousness (Guenther 1974, 39). Samskdra-s, difficult totranslate with one single english word, "are all active dispositions, tendencies,21impulses, volitions, strivings, emotions, etc., whether 'conscious' or repressed"(Conze 1967, 107). Finally, vijriana is consciousness or awareness in its generalsense (Conze 1967, 110-111).Analyses such as these grew more complex over time as Buddhismdefined itself against other philosophies and also underwent various schismsand divisions from within. In much of Buddhism it was clear that, whether theperson was considered a complex of two or five factors, there was no permanentself (Hiriyanna 1949, 75). Rather, the person was undergoing constant changeand therefore, like other things, was impermanent (anitya) (P. anicca). Theelaboration of these ideas in particular, led to the rise of a number of Buddhistschools of thought.Around 386 or 376 BCE, the Buddhist community became divided asEastern, liberal, monks debated with those who were Western and moreorthodox (Haldar 1981, xii). This took place at Vai6a1i and resulted in twomain Buddhist sects, known as Mahasamgha (great community), andSthaviravada (school of the elders) (Warder 1970, 208). Both sects, as timepassed, underwent further divisions, only one of which shall be noted heresince it concerns the nature of the person.Circa 286 BCE, a monk named Vätsiputra and his followers (calledVatsiputriyas) split off from the Sthaviravadins. Orthodox Sthaviravadinsmaintained that references in scriptures to "the person," were "no more than akind of pronoun, a demonstrative like 'this' used when referring to a particular(philosophically speaking) collection of the elements or phenomena combined in22a living body with consciousness" (Warder 1970, 241). The Vätsiputriyas,though rejecting the concept of an eternal soul or self (eitman), accepted someunity termed "person," as reality. For them, the living being was somethingmore than simply five skandha-s and the senses (Warder 1970, 241). The firstview, that of the Sthaviravalins "won," for it was accepted by most, if not all,other schools of later Buddhism (Warder 1970, 241).Other notable developments in thought and schools, had their roots inthe early doctrine of impermanence (anitya). This basic doctrine--that allthings are subject to change, that everything has a beginning and an end--wasdeveloped into a theory of momentariness (k.sanika-vetda) (Chatterjee and Datta1960, 136). This theory held that things do not last for even short periods oftime, but exist for one moment only (Chatterjee and Datta 1960, 136). The"things" that exist are merely momentary elements called dharma-s, and theSarvastivddins (school of all exists) (who seceded from the Sthaviravddins circa237 BCE) in particular emphasized that these dharma-s alone were "realities,"every combination of them being "a mere name covering a plurality of separateelements" (Stcherbatsky 1923, 62).5The doctrines of andtman, momentariness, and dharma-s, were supportedand elaborated upon by many later writers and Buddhist schools. From apsychological perspective, the result of such doctrines was largely a conceptionof the person as a series of momentary elements, and a realization that theperceptual world (what we know to be the world) is made up of materialprocesses and "endless sequences of conscious processes" (Johansson 1978, 24).23Thus one can see two interesting "streams" within early Buddhistthought. One, having its basis in the four noble truths, eightfold path, andgoal of enlightenment, has some emphasis on therapeutics, or as we are callingit here, mental healing. The other stream is more philosophical, but still hasgreat psychological relevance, for it concerns the nature of the person andworld. It therefore provides a specific religious-philosophical context for themore applied psychological practices.Summary No thinker develops his/her thought in intellectual isolation, no text orbody of thought arises without a tradition. The purpose of this introductionhas been to identify some of the major events and elements that shaped thetraditions of mental healing in the West, and in Indian Buddhism before thecommon era. We have seen that the Western traditions were intimatelyconnected with, and strongly affected by, the philosophies and religions of theirtime. Further, what might, in the West, be regarded as psychology and mentalhealing, were important parts of the Buddhist religion and philosophy. Theimplications of these influences and elements will be explored further as theconcepts of mental health and mental illness in the AKBh and DSM-III-R areexamined. Both of these texts may be regarded, in various ways, asrepresenting the culmination of their traditions.24NOTES - INTRODUCTION'Gage Canadian Dictionary,  s.v. "psychology," "psychiatry. "20ne might speculate that the Western tendency to use the norm oraverage as the standard of mental health against which mental illness isdefined and measured (an idea to be examined in a later section), may betraced to this idea of the mean.'There is some question whether or not the Western mental healingtradition is truly value free and objective. This will be examined in a latersection.411albfass describes avidya as a "cognitive disease or affliction," andtranslates it as "nescience," "misconception." He notes that "this avidyä isdeep-rooted metaphysical confusion, a radical misunderstanding of the worldand one's true nature. It is essentially self-deception, self-alienation, apparentloss of one's own identity" (1991, 252).Vi key or defining doctrine for the Sarvastivädins was the idea that allelements or dharma-s exist on two planes, which consist of "the real essence ofthe element (dharma-svabhava) and its momentary manifestation (dharma-lakshana)." The first was said to exist always, in the past, present and future.Past existence referred to past appearances of its phenomenal existence, andfuture existence referred to potential appearances of its phenomenal existence(Stcherbatsky 1923, 35).Such concepts or doctrines are primarily philosophical and will not beexamined in this study.25II. METHODOLOGYIn recent years, North American psychiatrists and psychologists haveshown growing interest in the Indian mental healing traditions. Two groups inparticular, the transpersonal psychologists, and physicians and psychologists inbehavioural medicine, have been responsible for most of the studies done onthe Indian traditions. However, there are some general problems with thestudies of each group. Transpersonal psychologists tend to overemphasize theexperiential aspect of their work, and to embrace Indian philosophies andtechniques quite naively, leading to charges that they borrow too glibly andapply these techniques too superficially (Taylor 1988, 94). People in behavioralmedicine may investigate specific Indian techniques, and their studies areusually quite objective, but they often demonstrate only limited understandingof the philosophical and psychological systems that underlie their object(s) ofstudy (Taylor 1988, 94). Both groups may be further faulted on some of theirtext-based studies, for their use of questionable translations and for definingtheir subject matter far too broadly (Taylor 1988, 102-103).Recently, one scholar has suggested that these problems may beovercome through "the systematic introduction into western psychology ofobjective methods in historical scholarship adapted from the western academicfield of comparative religions" (Taylor 1988, 94). Use of such methods leads to:an emphasis on history and cultural relativity; an awareness, and examination,of changing thoughts or ideas over time; more careful linguistic analysis; and a26sensitivity to the advantages and problems inherent in using primary sources(Taylor 1988, 97).In the present study, methods from the field of comparative religions willbe employed to examine concepts of mental illness and mental health in theAKBh and DSM-III-R. The purpose of this, as stated in the Introduction, is notto equate one tradition with the other, for that would be methodologicallyunsound, nor to explore some Indian technique or method of meditation andconsider its applications in North America. Rather, the purpose here is toexplore concepts of mental illness and mental health as found in each text, andthen to examine the cultural, historical, religious, and theoretical influencesthat underlie them.Despite the centuries and cultures that separate them, DSM-III-R andthe AKBh seem logical choices as texts for this type of study. Both examineconcepts of mental health and mental illness--albeit not in identical senses orextents--using, at least at some points, the format of lists. This allows one toapproach each text in a parallel way; facilitates what comparisons mightjustifiably be made; and, gives one the chance to explore the phenomenon anduse of lists. Insight into the factors that influence and underlie the texts ingeneral and the lists in particular, facilitates both the understanding of eachindividual text, and comparison between them. In other words, there is a built-in element of interdependence or circularity in such an approach.Having already explored a general history of each tradition in theIntroduction, this study shall first examine definitions and ideas of mental27illness and mental health, as found in DSM-III-R and the AKBh. The basiccultural and religious value systems underlying or forming these concepts willthen be explored, with particular attention paid to the questionable existenceof a "value-free" approach in DSM-III-R, and a recognition of the AKBh'sopenly "value-laden" approach. The question of values leads to a considerationof norms, particularly, who or what is the norm against which mental illnessand mental health are measured? The norms will be identified in each textand their implications discussed.Having thus arrived at some understanding of the concepts of mentalillness and mental health in the texts, as well as the values and normsinfluencing and underlying them, one list from each text will be examined andcompared. In this way, the study moves from the general to the particular.Through this process, one will see that the lists given in each text contain agreat deal of hidden information.As indicated above, DSM-III-R  and the AKBh are, among otherpossibilities, logical choices for this type of study. Using the comparativeapproach, it would be questionable and difficult (particularly due tophilosophical difficulties) to examine more than one text from each tradition.Given this, the choice of texts was made based on their importance andinfluence, as well as their discussion of the relevant concepts and the use oflists. The individual lists chosen from these texts may not directly address thesame field or phenomenon to the extent some may wish. However, as28explained in the Introduction, the present is an experiment in unraveling listsof a particular kind.The Diagnostic And Statistical Manual Of Mental Disorders (III-I0In Western psychiatry and psychology, many kinds of lists exist, createdand used for various purposes by a great variety of movements and schools. InNorth America, perhaps the most widely used lists are those found in DSM-III-R. This text, its terminology, and concepts, are often extensively referred to intextbooks and journal articles that discuss psychopathology (Spitzer andWilliams 1987, xviii). Although not universally accepted, or even liked, it hasundeniably become "the common language of mental health clinicians andresearchers for communicating about the disorders for which they haveprofessional responsibility" (Spitzer and Williams 1987, xviii). Patients whoenter a psychiatrist's office are likely to be diagnosed according to DSM-III-Rcategories, and the same is often true for those going to psychologists.As one might deduce from the title, DSM-III-R, published in 1987, is thethird edition (revised) of a manual for diagnosing mental disorders. DSM-I waspublished in 1952 and listed 60 mental disorders; DSM-II was published in1968 and listed 145; and DSM-III was published in 1980 with a listing of about230 disorders (Reisman 1991, 36). The growth in the number of categories ofmental disorders is said to reflect growing sophistication and knowledge in thefield, rather than increasing insanity on the part of North Americans. The29changes in each manual not only include new categories proposed or added, butalso some category modifications and omissions (Reisman 1991, 37).Since DSM-III-R is a diagnostic manual, it does not generally discussetiology, or therapeutic interventions. One reason for this is that the manualwas designed to be used by persons of many different schools or approaches inthe Western mental healing tradition. Since these schools offer differingconcepts of etiology, therapeutics and recovery, a generally atheoreticaldescriptive approach, with operational criteria focussing only on diagnosis,was judged to be of greatest use to the greatest number of people (Spitzer andWilliams 1987, xxiii).Another reason for the narrow focus on diagnosis, is that:For most of the DSM-III-R disorders.. .theetiology is unknown. Many theories have beenadvanced and buttressed by evidence--not alwaysconvincing--attempting to explain how thesedisorders come about. The approach taken inDSM-III-R is atheoretical with regard toetiology or pathophysiologic process, exceptwith regard to disorders for which this is well-established and therefore included in thedefinition of the disorder (Spitzer and Williams1987, xxiii).As ideas of therapeutic intervention and recovery are often dependent upondiagnosis and concepts of etiology, this lack of certainty about etiology thusnecessitated that the manual deal only with identifying and diagnosing mentalillness.With regards to diagnosis itself, DSM-III-R is very specific. It has amultiaxial scheme that takes into account developmental and personality30disorders, levels of adaptive functioning, relevant physical diseases, socialstressors, and, of course, syndromes or disorders of the mind (Akiskal 1989,1:590) In this way, DSM-III-R is said to provide a "biopsychosocial approach toassessment" (Spitzer and Williams 1987, xxv).The lists of disorders or syndromes found in DSM-III-R are descriptive.This means that:the definitions of the disorders are generallylimited to descriptions of the clinical featuresof the disorders. The characteristic featuresconsist of easily identifiable behavioral signsor symptoms, such as disorientation, mooddisturbance, or psychomotor agitation, whichrequire a minimal amount of inference on thepart of the observer. For some disorders,however, particularly the Personality Disorders,the criteria require much more inference onthe part of the observer (Spitzer and Williams1987, xxiii).Given this final admission, some would question the reliability or validity ofDSM-III-R as a diagnostic tool, and studies on this topic are always beingconducted. Nevertheless, DSM-III-R remains the most widely used manual forthe diagnosis of mental disorders in North America, and has had significantinfluence internationally (Spitzer and Williams 1987, xviii).Although DSM-III-R is said to focus only on diagnosis, examination ofthis text also reveals that it contains discussions relating to concepts of mentalhealth and mental illness in general. Further, regarding DSM-III-R as aprimary text rather than as a manual one is using for diagnosing mentaldisorders, reveals considerable information about the cultural milieu that31underlies, gives rise to, and makes use of, this text. For these reasons inparticular, DSM-III-R is a valuable source of information for a study such asthis.The AbhidharmakogabhasyaThe AKBh, in many ways, represents a pinnacle of Indian thought andpsychology, for it is an encyclopedic work, an almost exhaustive inventory ofHinayana scholastics. There is heated debate regarding authorship (since somemaintain that there were two Vasubandhu's) and the dating of this author'slife, although circa 400-480 C.E. is most often accepted. The influence of thisparticular text of Vasubandhu's, is reflected in the great Sanskrit romanceKadambari, which speaks of parrots in a Buddhist hermitage reciting versesfrom the AKBh (Rao 1962, 104). Scholars have described the AKBh as "atreasury of the fundamental doctrines of Buddhism" (Chaudhuri 1976, 11), and,"perhaps the most instructive book of early Buddhism" (Poussin 1913, 4).From its title, one can see that the AKBh is part of the abhidharma (P.abhidhamma) tradition of early Buddhism. The word "abhidharma" in itsnarrow usage, refers to the third of the Trip itaka, Three Pitakas, or collections,of scriptures that comprise the Pali (=Theravada) Buddhist canon (Pruden1988, xxx). The Pali canon consists of the Satra-s (or Agama-s) (P. Sutta-pitaka), which are the words of the Buddha; the Vinaya or monastic rules; andthe Abhidharma Pitaka, which contains analyses of the elements and nature of32reality and the world, and which was compiled later than the other two(Pruden 1988, xxx).More broadly, the word "abhidharma" may signify not only this thirdPitaka, but also its type of contents, style of thinking, and manner of writing(Pruden 1988, xxx). Abhidharma may thus refer to "a certain type ofcommentarial literature, the gästras or commentaries on the Satras of theBuddha" (Pruden 1988, xxx).The precise meaning of the word abhidharma itself is not clear. Withthe prefix abhi added to dharma it may mean "further dharma" or "supremedharma" (Conze 1951, 105). The AKBh gives several explanations of the word,first stating that abhidharma is "pure praf rid [wisdom] with its following," anddefining "prairie as "the discernment of the dharmas" (AKBh, i.2a, 56).1 It isimportant to note that profile-I is usually understood as the methodicalcontemplation of the essential elements (psychological, material, etc.) ofexistence (Conze 1951, 105)(although there are other types of prajrid as well).This is certainly a very specific definition or understanding of "wisdom," andone that is needed to comprehend why the Buddhists would undertake thesometimes long, dry, and seemingly insignificant (but very systematic)discussions found in Abhidharma literature.A second definition of abhidharma, is also found in the AKBh. Whilethe first definition stated that abhidharma is wisdom, the second (paraphrased)notes that "In common usage, the word Abhidharma also designates all praffidwhich brings about the obtaining of Abhidharma in the absolute [first33definition] sense of the word" (AKBh, i.2b, 56). Here the text refers to othertypes of prajnii leading to that praj 'rid which is equated with the abhidharma ofthe first definition. With this understanding of abhidharma, a text such as theAKBh is also referred to as abhidharma:One also gives the name of Abhidharma to theTreatise [the AKBh], for the Treatise alsobrings about the obtaining of pure prajita(AKBh, i.2b, 57).Compared with the first portion, the remaining words in the titleAbhidharmakogabhasya are simple. "Ko.§a" means "sheath," or "treasury," so"abhidharmako.§a" is a compound meaning the "sheath or treasury of theabhidharma." Vasubandhu explains that this refers to the fact that "theAbhidharma enters into it [the treatise] through its meaning [truly, really, asregards the meaning]; or because the Abhidharma constitutes its foundation"(AKBh, i.2c-d, 57). A bhaqya is a commentary. Vasubandhu originallycomposed the Abhidharmakaa from the Sarvästivada point of view, and thenlater wrote a commentary from the Sauträntika point of view, to accompanythe original work. Thus the title, Abhidharmakaabhäsya,  means"commentary on the sheath/treasury of the abhidharma." As one mightconclude from the preceding discussion, the word "abhidharma," is better leftuntranslated.From the title of Vasubandhu's text, one knows that it is a study of thedharma-s, and thus that it embraces a great variety of topics and problems(Poussin 1913, 5). These include expositions on: analyses of the elements of34matter (dharma-s); the cosmos or spheres (bhami-s); karma; the path toenlightenment; etc. The text contains a number of heated debates betweenrepresentatives of a number of Buddhist schools, and therefore can be quiteconfusing. Nevertheless, the fine philosophical-doctrinal disputes, may, for themost part, be ignored for the purposes of a study such as this, which seeks onlyto find some general information on basic psychological concepts.Thus the main purpose of the AKBh is certainly not to discuss mentalhealth or mental illness per se, much less to be a diagnostic manual of mentaldisorders. However, it is useful for this study because of its tremendousimportance in Indian Buddhist thought; because of its format which uses lists;and also because, as is typical of Abhidharma literature, it contains (amongmany other things) a great wealth of psychological thought.This last reason once again emphasizes the pragmatic nature ofBuddhism. Investigation of the dharma-s leads to wisdom (prajiiii), andwisdom, in Buddhism, is not simply intellectual, but is the key element inpsychological health. Conze is especially helpful in identifying thispsychological nature of Abhidharma literature and studies:The chief purpose of Buddhism is theextinction of separate individuality,which is brought about when we cease toidentify anything with ourselves. Fromlong habit it has become quite natural to usto think of our own experiences in the termsof 'I' and 'mine.' Even when we areconvinced that strictly speaking such wordsare too nebulous to be tenable and thattheir unthinking use leads to unhappiness inour daily lives, even then do we go on using35them. The reasons for this are manifold. Oneof them is that we see no alternative way ofexplaining our experiences to ourselves exceptby way of statements which include such wordsas "I" and "Mine." It is the great merit ofthe Abhidharma that it has attempted to constructan alternative method of accounting for ourexperiences, a method in which the "I" and"Mine" are completely omitted, and in whichall the agents invoked are impersonal dharmas.The Abhidharma is the oldest recordedpsychology, and it is, I think, still sound forthe purposes for which it was designed (1951, 106).Conze further adds the caution that one should,beware of assuming that the dharma theory isoffered as a metaphysical explanation of theworld, to be discussed and argued about. Itis, on the contrary, presented as a practicalmethod of destroying, through meditation,those aspects of the commonsense world whichtie down our spirit. Its value is meant tobe therapeutical, not theoretical (1951, 108-109).With this understanding of the chief purpose of Abhidharma, one mayassuredly regard Vasubandhu's AKBh as a psychological text in which onemay seek (and find) pragmatic information about mental illness, mental health,and mental healing. In such a way, it thus becomes possible to compare thisinfluential, brilliant and diverse early Buddhist text with a modern, morenarrow, Western (psychiatric) text that is also tremendously influential. Sucha comparison between the two is only possible due to the disciplined,intelligent, and consistent manner in which the authors of both textsapproached their subject matter.36NOTES - METHODOLOGY'The word dharma is etymologically explained as "that which bears(dhdrana) self-(or unique) characteristics" [It is called dharma "because of thebearing (dhdratla) of self-characteristics"] (AKBh, i.2b, 57). The following ofprcdiiet is the five pure skandha-s (AKBh, i.2a, 56).37III. CONCEPTS OF MENTAL ILLNESS AND MENTAL HEALTHSince DSM-III-R and the AKBh have different cultural and historicalbackgrounds, it is not surprising to find that these texts have differing viewson the nature of mental illness and mental health. These differing conceptsare important for they are the foundations underlying the specific lists thatwill be examined below. As well, a thorough exploration of concepts of mentalillness and mental health will provide one with the information needed tounderstand the religious and cultural values found in these texts as a whole,and the lists in particular.Definitions Of Mental Illness In the introduction to DSM-III-R it is noted that an adequate definitionof "mental illness," or, more precisely, "mental disorder," doesn't exist (Spitzerand Williams 1987, xxii).1 Nevertheless, the committee responsible for DSM-III-R thought it useful to offer the definition of mental disorder that"influenced the decision to include certain conditions in DSM-III and DSM-III-Ras mental disorders and to exclude others" (Spitzer and Williams 1987, xxii).From this one can see that the basic concept or definition of mental illness isthe most important factor in a text of this nature, and indeed, in anydiscussion of mental illness, for how one defines mental illness, and mentalhealth, is crucial for the development of further thought on related issues. Inother words, one may regard such definitions as the fundamental substrataunderlying each list in such texts.38In DSM-III-R, each mental illness or disorder isconceptualized as a clinically significantbehavioral or psychological syndrome or patternthat occurs in a person and that is associatedwith present distress (a painful symptom) ordisability (impairment in one or more importantareas of functioning) or with a significantlyincreased risk of suffering death, pain,disability, or an important loss of freedom.In addition, this syndrome or pattern mustnot be merely an expectable response to aparticular event, e.g., the death of a lovedone. Whatever its original cause, it mustcurrently be considered a manifestation ofa behavioral, psychological, or biologicaldysfunction in the person. Neither deviantbehavior, e.g., political, religious, orsexual, nor conflicts that are primarilybetween the individual and society aremental disorders unless the deviance orconflict is a symptom of a dysfunction inthe person, as described above.There is no assumption that each mentaldisorder is a discrete entity with sharpboundaries (discontinuity) between it andother mental disorders, or between it andno mental disorder (Spitzer and Williams 1987, xxii).The implications of, and implicit assumptions in, this definition will beexamined later. For now it is sufficient to make some general observationsabout the definition. Firstly, a number of terms are vague, for example,"clinically significant," "distress," etc. This vagueness is only partiallyremedied in DSM-III-R through the use of specific descriptions and criteria inthe diagnostic lists.Secondly, the term "expectable response" gives a sense that expectations,or value judgments, are going to be present in this text that arises from a39tradition which is supposed to be value-free. The caution that one should notview deviant behavior as mental illness, recognizes that value judgments inthe past have led to misdiagnosis of mental illness (for example the "witches"in the Middle Ages, or, more recently, the controversy over homosexualorientation being included as a mental disorder in previous DSM's). As weshall see, in spite of statements such as the one in the introduction, thisparticular area of value judgments is still problematic.Thirdly, the statement that mental disorders are not necessarilydiscrete entities with sharp borders, is interesting, given that DSM-III-R thendescribes each disorder as if the opposite were the case. Such a discrepancymay reflect, at least, arbitrary decisions on boundaries, and needs to beexamined further.Although these criticisms, and others, may be levelled at this definition,the definition is useful for giving some idea of how the A.P.A. (AmericanPsychiatric Association) defines mental disorders. Particularly important isthe idea that mental disorders, regardless of etiology, are considered to bemanifestations of "behavioral, psychological, or biological dysfunction in theperson." This is the core of the definition, representing both the tripartiteinfluences on the North American mental healing tradition--namelybehaviorism, psychology in general, and medicine—and the way in which ahuman being is understood--that is, as a combination of body and mind, withbehavior being the result or action of the two.40As one can see then, this definition, which must have been challengingto compose, contains a number of key elements that need further study. It isnot simply a definition, but rather a statement arising from a committee thatis influenced by a society with particular values and norms. Moreover, as thisdefinition is the "guiding principle" behind the development of specific criteriaregarding the diagnosis of mental disorders, it is, therefore, very significant.The AKBh does not give many definitions of mental illness, but anumber of ideas about the nature of mental illness may be culled fromdiscussions on other topics. Firstly, the term "mental illness" is not used, butrather the term "mental ruin" (ksepa). Mental ruin is said to be produced "inthe mental consciousness" (AKBh, iv.58a, 632). It is the ruin of consciousnessor cognition itself--the senses are understood as not the primary cause of theruin: "the five sense consciousnesses cannot be troubled [ruined] because theyare free from imagining [conceptualization]" (AKBh, iv.58a, 632).Mental ruin is thus understood as a disturbed moment or sequence ofmoments of mental consciousness itself. This type of ruined mentalconsciousness is described as confused or mixed up; not having power (overoneself), or not having one's free will; and being devoid of mindfulness, or ofdecayed or ruined mental consciousness (AKBh, iv.58c-d, 633-634). Thisdescription of mental ruin thus comes close to North American definitions ofmental illness, however, understandings of the word "mental" would be verydifferent for the Indian Buddhists and North Americans.41Other forms of suffering are also examined in the AKBh. These arecertainly not regarded as forms of mental illness or ruin, however they areimportant, for they contain some information about mental suffering. The ideathat concepts of, and attachments to, an atman lead to some sort of suffering,which might at least partially be termed "mental," is found in a number ofplaces in the AKBh. A basic Buddhist view of the human being (here from aschool known as the Sauträntikas) is presented in chapter two:Blinded by ignorance, foolish persons imaginethat the series of conditioned phenomena(samskdras) is a "self" or belongs to a "self,"and, as a consequence, they are attached tothis series. The Blessed One ]the Buddha]wanted to put an end to this erroneousimagination and to the attachment whichresults from it: he wanted to show that theseries is conditioned, that is to say,"produced through successive causes"[dependently].[Blinded by ignorance, foolish persons arefaithfully convinced that the series of conditionedphenomena (sari-islet-was) is eitman or belongs toatman, and, as a consequence, they are attachedto this series. The Blessed One, for thepurpose of putting an end to this erroneousfaithful conviction, wanting to show that thisseries is conditioned, said the following...](AKBh, ii.46b, 241).Another quote then highlights the suffering or trouble that is producedthrough identification with these "series:"Don't we see that certain persons, ignorantof the true nature of the conditioned dharmas(i.e., the samskeiras) that constitute theirpretended "self," are attached to thesedharmas through the force of habit, as42completely devoid of personality as thesedharmas are, and suffer a thousand painsby reason of this attachment?[For just as, through the force of habit,certain persons, ignorant of the characteristicsof the conditioned dharmas, with regard toconditioned elements which are not thedtman, develop attachment (to them) asthe dtman, and suffer pains by reasonof this attachment...] (AKBh, iii.93d-94a,481).Thus one can see that there is a brief description of mental ruin in theAKBh that comes close, in some ways, to North American understandings ofmental illness. However, the idea that some types of suffering have a basis inthe belief in the atman, indicates a much broader and more soteriologicalunderstanding of mental suffering than is seen in the DSM-III-R definition. Asa number of passages indicate, if belief in the existence of, or identificationwith, the dtman is viewed as a source of mental trouble or suffering, then mostpeople would be regarded as, at least potentially, mentally troubled (accordingto this Buddhist definition). Indeed, further examination of the concepts ofmental health and mental healing will show this to be the case, and highlightone of the most interesting differences between the North American and theBuddhist mental healing traditions.Definitions Of Mental HealthDSM-III-R does not provide a clear definition or picture of mental health.This reflects a common tendency in the West, for psychologists or psychiatristssuch as Abraham Maslow, who study the healthy or optimally functioning43person, are quite rare (Liebert and Spiegler 1982, 299). An indication of thisrarity is found in the massive Comprehensive Textbook of Psychiatry/V, which,although consisting of over two thousand pages, has only one page on health(in the section on psychosomatic medicine) and no entries for mental health.The focus for much of the North American mental healing (and especiallypsychiatric) tradition, is clearly on diagnosis and removal of mental disorders.Health is thus often seen as the absence of certain symptoms rather than thepossession of positive qualities that might characterize a state called "health."The closest that DSM-III-R comes to offering a definition of health, is theGlobal Assessment of Functioning (GAF) Scale, which is designed to help thepractitioner assess a person's "mental health-illness" (DSM-III-R, 20). Thisscale focusses on the person's psychological, social, and occupationalfunctioning (DSM-III-R, 20). Functioning at an optimal level is characterizedby:Absent or minimal symptoms (e.g., mildanxiety before an exam), good functioningin all areas, interested and involved ina wide range of activities, sociallyeffective, generally satisfied with life,no more than everyday problems or concerns(e.g., an occasional argument with familymembers) (DSM-III-R, 12).One may infer from this brief description, that mentalhealth, according to DSM-III-R, consists of three components:firstly, the complete, or near complete, absence of certain symptoms--heresymptoms associated with mental disorders; secondly, "good" or "effective"44functioning in everyday life--the behavioral aspect of health; and thirdly, thesense of being "satisfied with life," and "interested" in activities--whichrepresent the subjective side of health. Again, the influences of medicine,behaviorism, and general psychology are present in this definition.Other than this short description of healthy functioning given in theGAF scale, one finds no mention of mental health in DSM-III-R. Since the textis a manual of mental disorders, this is not surprising. However, as noted, thetendency to leave the concept of health almost unexamined is found throughoutthe North American, and especially psychiatric, mental healing traditions.Given this, one may conclude that the subject matter of DSM-III-R representsthe influences of an underlying, and largely unstated, value system, and is notonly the result of stated mandates or purposes.In contrast to DSM-III-R, the AKBh offers a number of definitions ofpositive (mental) states which here will be considered as representing states ofmental health. Although one might regard the characteristics of a Buddha asproviding the best examples of this ultimate state of mental health, theologicaland historical considerations also play a role in the idea(s) of the nature andcharacteristics of a Buddha. Therefore, in this study, the enlightened person,or Arhat, shall be taken as the standard or example of one who has achievedthis state of health. Moreover, one may gain a better understanding of AKBhconcepts of mental health if one examines some of the psychological qualitiesgained, or abandoned, on the path leading to enlightenment.45Guenther notes that, "in the strictly Buddhist sense of the word,delusion is the conviction of one's own importance" (1974, 106). This supportsthe idea that general (mental) suffering has some source in the imagining of,and identification with, the Caman, which is said to not exist as an independentnon-composite entity. With such a perspective, it is not surprising to find thatthe Buddhist path, which may be considered here as a form of therapy thatbrings about a healthier state, emphasizes insight, wisdom, and seeing realityas it is: impermanent (anitya); andtman, and unsatisfactory (dupha).Psychological Changes On The PathThe path, or therapeutic process as one might consider it here, containsa number of parts, and, in the Buddhist scheme, may take several lifetimes tocomplete. There is the distant preparatory path, the preparatory path, and thepath proper, which is further divided into two main paths: the path of seeing(dar§anamitrga) and the path of meditation (bhävandmeirga). As one can see,the entire path represents a long process and one that is meant to bring aboutthorough and lasting changes in the person. Again, it is important to notehere that the person is the bundle of five skandha-s which proceed in a seriesover various lifetimes.The whole process towards soteriological health, or enlightenment,begins with the acquisition of some essential qualities, the roots of good(kugalamala-s), which provide a foundation for everything that follows. Mostimportant here is the development of "the force of the desire for deliverance,"for a person must always be willing to change, and to reach a goal, before any46form of change can take place (AKBh, vi.25a, 943). This resolute desire forchange or deliverance is brought about through exposure and commitment toBuddhist teachings:This foundation of the good and wholesomeis qualified as 'conducive to and formingpart of the process of liberation'(mokfabhagiya) and comprises of listeningto (gruta) and pondering over (cintä) themessage of the Buddha and of making theresolution (pranidhi) to follow theBuddhist doctrine and discipline, thisresolution overshadowing all our behaviorin words and deeds (Guenther 1974, 216).2If a person has done this and acquired the firm resolution to follow thepath, it is expected that this will not simply affect the intellect, but theemotions as well:It is recognized that whoever, understandingthe sermons concerning the defects ofSarpsdra, the non-self, and the qualitiesof Nirvana, has his hairs stand on end andwho pours forth tears, possesses themoksabheigrya roots of good.[It is to be determined/ascertained thatwhoever, having heard the sermon illuminatingthe defects of Sainsara, the fact that thereis no &man, and the good qualities of Nirväria,has his hairs stand on end and who pours forthtears, possesses the moksabhägrya root of good](AKBh, iv.125c-d, 707).It is further expected that these "moksabhäOya roots of good" will manifestthemselves not only intellectually and emotionally, but in behavior also. Theseearly qualities or tendencies being acquired are primarily mental, but,Bodily action and vocal action are also47moksabhagFya when they are embraced bythe resolution (pranidhana) for deliverance;this resolution is a type of volition(cetand...): by giving alms, a bodilyaction, by obliging oneself to observe arule, a vocal action, or by studying astanza of four peidas, one projects amoksabhägCya, when the force of thedesire for deliverance comes to qualifythose actions.[Bodily action and vocal action are alsomoksabhägiya when they are embraced bythe resolution (pranidhana) for deliverance;having given even one alm, having obligedoneself to observe even one rule, someoneprojects a moksabhägFya, because he places(into these acts) the force of the desirefor deliverance] (AKBh, vi.25a, 942-943).It seems then, that this acquisition of the roots of good has bothintellectual or cognitive and emotional components. Here it represents somesort of intellectual and emotional conversion that is needed to set the person ona new path toward health and enlightenment. Again, the critical element isthe desire for change or deliverance. This can be expressed through specificbehaviors such as giving alms, reciting verses, etc., which undoubtedly serve toreinforce that desire for deliverance.The changes taking place in this early stage, the distant preparatorypath, may seem similar to the Western idea that a person must first have theinsight (cognitive, emotional, or both) that "something is wrong," in order forhim/her to willingly seek psychotherapy. Here though, rather than suchspecific insight, there is a sense that something is wrong not just with oneself,but with life as a whole. Then the distant preparatory path not only identifies48the critical element for successful change and healing--the desire fordeliverance--but also notes ways that this might be brought about, nurtured,and strengthened. Again, since the Buddhist path aims at helping the persondevelop a clear understanding of reality as it is, it is not surprising thatlistening to, and pondering over, Buddhist teachings (that deal with the natureof reality) are important parts of this first stage.Having secured the molesabhägiya roots of good, the person must thenacquire the "moral qualities which make a perfect monk," or the "lineages ofthe Aryans" (nobles) (aryavantga-s) (Poussin 1925, 3:xiv). Although the textpresupposes that one must be a monk, this restriction does not matter much forthe purposes of this study since psychological changes are being consideredrather than specific religious requirements.The qualities or lineages are brought about by: keeping the precepts;reading or hearing Buddhist teachings; reflecting on them; and applyingoneself to meditation (AKBh, vi.5a-b, 911). The qualities that arise from theseare characterized by non-greed, and are: contentment with clothing;contentment with food; and contentment with bed and seat (AKBh, vi.7c-d,915). Thus one gains contentment here by abandoning greed for "worldly"goods and comforts. A fourth quality, to take delight in abandoning (namely,of the kle§a-s) and in the cultivation (of the path), is not referred to ascontentment, but rather only as non-greed (AKBh, vi.7c-d, 915). This lastquality is characterized solely by non-greed, because "it turns its back on49attachment to pleasure and attachment to existence" ["it turns away its facefrom desire for pleasure and desire for existence] (AKBh, vi.7c-d, 915).One can see that this stage involves both behavioral and emotionalelements. It is expected that people at this stage have "renounced their oldregimen and their old activities, [and] are engaged in searching outdeliverance" (AKBh, vi.8a-b, 915). The first three qualities of contentmentsupply a new regimen that changes both the way one thinks of possessions andcomforts, and the way one acts toward those things. This new perspective, andits qualities of contentment, gain force from the fourth quality, an emotionalcommitment to non-attachment and the path. At this early stage then, onegains contentment, whose nature is non-greed, which opposes the arising offurther desires (AKBh, vi.8b, 915). Again the importance of the commitmentor desire to change, is affirmed in the fourth quality.Having acquired these qualities, the person then begins the cultivationof mindfulness, through which entrance into meditation is possible (AKBh,vi.9a-b, 916). Here, the method to be used is chosen by considering the basicpersonality type of the meditator. If the person is dominated by discursivethinking, reflection, and reasoning (vitarka), mindfulness of breathing is used,but if craving (raga) dominates, then visualization of the loathsome is employed(AKBh, vi.9c, 917-918).3 Through practices such as these, the person becomesless driven by desire and less prone to distraction (Poussin 1925, 3:xiv).Concentration thus increases, and the person becomes capable of entering intodeeper meditative states and absorption (sameldhi) (Poussin 1925, 3:xiv).450In combination with the cognitive elements of the cultivation ofmindfulness, the practice of the four divine behaviors (brahmavihara), alsocalled the "four immeasurables" (apramtina) is often begun as well (Guenther1974, 106).5 These four immeasurables are: love or friendship (maitri);compassion (karund); joy (muditii) and equanimity (upeksei) (AKBh, viii.29a,1264). Cultivation of these qualities or attitudes opposes "ill-will (vyapack7), thetendency or readiness to harm (vihirnsa), dissatisfaction [apathy] (arati), andsensual craving (kamareiga) and hostility (vyetpadd)" respectively (AKBh,viii.29b, 1264).Love (maitri), is defined as non-hatred or non-malice (AKBh, viii.29c,1265). Unlike ordinary love it is constant, not based on passion, and thereforecounteracts feelings of ill-will and hatred (Guenther 1974, 107).6 The nature ofcompassion (karund) is also non-hatred or non-malice (AKBh, viii.29d, 1265),and as such, it counteracts the tendency or readiness to harm (vihimsa) (AKBh,viii.29b, 1264). One can see from this that it is largely cognitive and emotionalrather than behavioral at this point, representing (along with the otherimmeasurables) more of a philosophical generalized intellectual stance thatencourages compassion, rather than a set of behaviors or actions (AKBh,viii.30a-c, 1266). The nature of joy (muditä) is satisfaction [sympathy] (AKBh,viii.29, 1265). This sympathy, a state of being well-disposed towards others,counteracts apathy (arati) (AKBh, viii.29b, 1264). Finally, the nature of thefourth immeasurable, equanimity (upeksei), is non-greed, and therefore non-ill-will, for ill-will has its roots in greed (AKBh, viii.30a, 1265). As such,51equanimity opposes sensual craving (kämaraga) and hostility (vyapadd) (AKBh,viii.29b, 1264).The four immeasurables are said to "oppose" mental defilements (AKBh,viii.29b, 1264). However, this does not mean that these defilements arepermanently overcome or abandoned through the immeasurables, particularlyat such an early stage of the path. The immeasurables are cultivated in thepreparatory path, but only fully achieved or acquired later (AKBh, viii.31d,1268-1269).Given this, Conze describes the immeasurables as being not onlyqualities one gains, but "methods for cultivating the emotions," and notes thattheir main purpose "consists in reducing the boundary lines between oneselfand other people" (1951, 102). Thus as one uses meditations or exercises todevelop love, compassion, joy and equanimity, more negative egotistictendencies in thought, emotion and behavior are disrupted. When thesenegative tendencies or defilements (klega-s) are permanently overcome(abandoned) through meditation further along the path, the fourimmeasurables are then able to shine forth purely and fully, without anydefilements to darken or limit them.Following these types of meditations (visualization of the loathsome,mindfulness of breathing, cultivation of the immeasurables) and havingattained absorption (samadhi--see note 4) through them, the person begins tocultivate the foundations [concentration/fixation] of mindfulness(smrtyupastheina-s) (AKBh, vi.14a-b, 925). This is done by "considering the52unique [specific] characteristics (svalaksana) and the general characteristics(sameinyalaksarta) of the body, sensation, the mind, and the dharma-s" (AKBh,vi.14a-b,925). The specific characteristics are those that compose the self-nature (svabhäva), for instance the unique nature of the body is to be composedof "primary elements and physical matter derived from [based on] theseprimary elements" (AKBh, vi.14a-b, 925). Considering the "generalcharacteristics" means developing further insight or wisdom (prajfiti) into thenature of conditioned things (AKBh, vi.14c-d, 925).7 For example, Guentherdescribes well this process as it applies to emotions, attitudes, and the world:Inspection of our feelings reveals theunsatisfactoriness of even pleasurable feelings,because the unpleasurable feeling-tonereleases a new cycle of activity with allits harassing aspects of finding a solutionto the problem. Inspection of our attitudesshows that there is nothing static and nothingpermanent about them; and inspection of theelements that constitute our world, internallyas well as externally, makes it abundantlyclear that nowhere is a Self to be found (1974, 219).Such consideration or inspection thus leads to a deeper, yet still imperfect,understanding of the general and particular characteristics of the person andthe world (Poussin 1925, 3:xiv). In other words, although not perfect orcomplete, a clearer, more accurate, view of reality develops during this stage.The process of cultivating the concentration of mindfulness is designed tooppose four basic distortions or perversions, which are "to hold that which isimpermanent to be permanent, that which is suffering to be happiness, thatwhich is impure to be pure, and that which is not [atman] to be [titman]"53(AKBh, vi.15c-d, 929; v.8-9a-b, 780-781). It thus involves many cognitivechanges and demands deep concentration or absorption. Once theconcentration of mindfulness is achieved, the person then begins to acquire thefour "roots of good" (kugalamala), which are also called "leading topenetration" (nirvedhabhagiya) (Poussin 1925, 3:xiv). These form thepreparatory path [path of application] (prayogamarga) proper, as contrastedwith all that came previously, known as the distant preparatory path (Poussin1925, 3:xiv-xv).According to Guenther, prior to the preparatory path people split theirexistence into mental and physical aspects (1974, 220). Cultivation of theconcentration of mindfulness leads to a reintegration of these, since both thebody and mind are seen to be conditioned, impermanent, unsatisfactory, andandtman (Guenther 1974, 220; AKBh, vi.14c-d, 925). Therefore, given thisreintegration and the energy needed to produce it, it is not surprising to findthat heat (usman) represents the first indication of its successful completion(Guenther 1974, 220).The first nirvedhabhagiya root of good is a kind of heat (asmagata),which is both physical and mental (Guenther 1974, 220). It is "similar to [akind of] heat (usma), being the [early form] of the Noble Path, a fire whichburns the fuel which are defilements" (AKBh, vi.17a, 930). This heat thenmay be felt both bodily and mentally, as it "burns away" emotionalinstabilities, and later, the defilements (Guenther 1974, 220). This heat goes54through three stages--weak, medium, and strong--until finally the "summits"(mardhan) arise (AKBh, vi.17c-d, 930).Although they have a similar focus, the summits are said to differ fromheat because they are "more elevated" (AKBh, vi.17d, 931). As well, eventhough one can regress or "fall away" from them, one may also move beyondthem to the next stage (AKBh, vi.17d, 931). The summits have weak, mediumand strong states, and a person who moves through these reaches the nextstage, called patience [patient acceptance, receptivity] (ksanti) (AKBh, vi.18c,931; vi.19b, 933).Guenther describes the stage of patient acceptance (ksCtnti) as being anextremely important event, namely accepting "the validity of the Truths whichhave been directly experienced" (1974, 220). This would seem to emphasize theacceptance of some insight regarding the new world view, five skandha-s, fournoble truths, etc., that have previously been developing. This acceptance isthus a turning-point, and once reached, some maintain that one cannot fallaway from it (AKBh, vi.18c, 932). This is perhaps similar to Plato's myth ofthe cave, where once the cave-dweller has seen the brilliance of light, there isno returning to the darkness of previous ignorance.Out of this patient acceptance comes the experience called "supremeworldly dharma-s" (laukika agradharma-s) (AKBh, vi.19c, 933), or "highestworldly realization" (Guenther 1974, 220). This is momentary and one cannotfall away from it (AKBh, vi.19b, 933; vi.20a-b, 935). Here one gains highestrealization, or understanding, of the suffering (dulikha) that relates to the55world, to Kämadhau (the world or sphere of sensuality) (AKBh, vi.19c, 933).This experience is termed "supreme worldly dharma-s" because these dharma-sthat consist in insight (prajfiCi)are worldly, being impure; because they aresupreme dharmas; and because they are supremeamong the worldly dharmas. They are SupremeWorldly Dharmas because, in the absence ofany similar cause (sabheigahetu), by their ownpower, they manifest the Path of Seeing theTruths.[are worldly, and they are supreme dharmas,because they are supreme among the worldly.Because, in the absence of any similar cause(sabhägahetu), by their own power, they attractthe Path] (AKBh, vi.19c, 933).In other words, this experience marks the end of the preparatory path.The wisdom (prarrid) gained from this experience of absorption, and theexperiences that preceded it, enables the person to begin the path proper(AKBh, vi.20a-b, 935-936). This last root of good, the supreme worldly dharma-s, is most important because it leads directly to this pure path (Poussin 1925,3:xiv).The four nirvedhabhägiya roots of good represent stages of increasedinsight and understanding, as well as the acceptance of such understanding.This, along with the dharma-s that consist in insight (prajliti) that arise fromit, is a turning-point for the person. One might say that the Buddhist worldview has now become a part of the person, for the four noble truths have beenthoroughly meditated upon, understood and accepted. As well, the person isnow capable of sustained contemplation (samadhi). The result is someone who56possesses great concentration and insight--a person who is ready topermanently abandon soteriologically negative qualities and take possession ofpositive ones.The path proper is composed of two main parts, the comprehension of thetruths (satyabhisamaya), and the path of meditation (bhävandmeirga) (Poussin1925, 3:xv-xvi). Comprehension of the truths involves sixteen "moments" ofthought (Poussin 1925, 3:xv). The first fifteen moments are called the path ofseeing (darganamtirga), when the person is engaged in developing furtherinsight (AKBh, ii.9a-b, 162-163). This marks the first pure (andsrava) seeing ofthe truths (AKBh,, 895). The sixteenth moment is also the first momentof the path of meditation (Poussin 1925, 3:xvi). The path of meditation may beworldly (impure), or pure (AKBh, vi.1c-d, 895). Since the pure path ofmeditation brings about the highest results, it will be the focus here.The path of comprehension of the truths consists of sixteen mentalstates, or moments: eight of pure patience [receptivity] (kseinti), and eight ofperfect or pure knowledge (jr-Ulna) (AKBh, vi.26d-27a-b, 946). The mental statesof receptivity are pure because they are the "cutting off of the possession of thedefilements" (AKBh, vi.28a-b, 949). The knowledges are pure because they"arise among the persons who are thus delivered from the possession of thedefilements, at the same time as does possession of disconnection from thedefilements" (AKBh, vi.28a-b, 949). Mental states of receptivity andknowledges differ from each other because at the moment of receptivity thedefilement is not yet abandoned, while the moment of knowledge arises when57the defilement has been abandoned (AKBh,, 1087). The relationshipbetween the states of receptivity and the knowledges is thus likened to "twoactions: expelling the thief, and closing the door" (AKBh, vi.28a-b, 950).As one may remember, the supreme worldly dharma-s marked the end ofthe preparatory path. The first moment of the path proper, here thecomprehension of the truths and the path of seeing, is a pure receptivity(ksCmti) whose object or focus is the unsatisfactoriness of the world ofsensuality (Kamadhätu) (AKBh, vi.25c-d-26a, 943; Guenther 1974, 221). Thisreceptivity "expels all doubts [about the unsatisfactoriness of Kamadhatu],because by nature it is an impassionate investigation into the nature ofreality" (Guenther 1974, 221). It is called "pure" because its result is thearising of pure knowledge that has the unsatisfactoriness or suffering ofKamadhatu as its object (AKBh, vi.26a-b, 943-945). Following this knowledge,there arisesone [Receptivity] of consecutive Knowledge.. .bearingon the Suffering of Rfipadhatu and Arapyadhatu...called dultkhenvayajfidnakseinti (the [Receptivity for]Consecutive Knowledge of Suffering).From this [Receptivity] there arises a consecutiveKnowledge which receives the name of ConsecutiveKnowledge of Suffering (AKBh, vi.26b-c, 945).One can see then that there are four moments of receptivity (iesanti) andknowledge (jñãna) that relate not only to the sensual world but also the highermeditative worlds and the cosmography. Here, the object is the nature ofsuffering or the unsatisfactoriness (first noble truth) of these worlds. Thisprocess of alternating states of receptivity and knowledges continues for the58other three noble truths as well, thus, in the end, there are sixteen moments(two moments of receptivity and two of knowledge for each of the four nobletruths relating to Kamadhatu, Rtipadhatu and Ariapyadhätu) (AKBh, vi.26-27a-b, 943-946; Guenther 1974, 222).The results of these sixteen moments are interesting. The result of thefirst moment, dispelling any doubt that the nature of Kämadhatu is suffering,makes the person an Aryan (Poussin 1925, 3:xv), a "spiritual aristocrat"(Guenther 1974, 222). Doubt is one of the six "latent defilements" (anugaya-s)(AKBh,, 767-768). As we shall see in a later section, the defilements(klega-s) arise when these basic latent defilements (anugaya-s) are notabandoned (AKBh, v.34, 828).Although there are a variety of ways of enumerating the latentdefilements (so that their number ranges from six to ninety-eight) (AKBh, v.1d-3, 768-772), the basic six are: attachment or desire, anger, pride, delusion,false views, and doubt (AKBh,, 768). Doubt and false views areabandoned during this comprehension of the truths, or, more specifically,during the eight moments of receptivity (AKBh v.5a, 773; v.43b-44, 838-839;Guenther 1974, 224). Doubt, that is not being certain as to the basicunsatisfactoriness of all that one encounters, leads to false or wrong views(AKBh, v.32c-d, 826). There are five such views:a belief in self (satkäyadrsti), false views(mithyddrsti), a belief in extremes(antagrähadrsti), the esteeming of views(drstiparamarga), and the esteeming of moralityand ascetic practices (gaavrataparamar§a)59fa belief in self (satkäyadrgi), falseviews (mithyadrsti), a belief consistingin taking up/holding onto extremes(antagrähadrsti), the over-esteeming ofviews (drstipardmarga), and the over-esteeming of morality and ascetic practices(Mavratapareimarga) (AKBh, v.3, 772).That "belief in self" is a wrong view is obvious given the context. "False view"here, is the taking up of, or holding onto, the idea that life is not suffering orunsatisfactory (AKBh, v.32d, 826). "Belief in extremes" is "the idea of theeternity or annihilation of the [Caman]" (AKBh, v.33a, 827). From such an ideaarises the over-esteeming of morality and ascetic practices, in other words, thevaluing of things that are "considered to be a means of purification" (AKBh,v.33b, 827). From this arises the over-esteeming of views, and from this,"attachment to one's views, and these views" as well as hatred withrespect to different views (AKBh, v.33c-d, 827).Comprehension of the truths thus enables a person to cut off or abandondoubt and such false views. As this is done, the person "takes possession" ofthis abandonment, therefore acquiring a clearer, more accurate, understandingof the nature of reality--the knowledge (j fieina) aspect of comprehension of thetruths. Having done all this, in the final sixteenth moment of thecomprehension of the truths, the person becomes a Srotaapanna (Poussin 1925,3:xvi), or "one who has entered the stream" toward Nirvana (AKBh, vi.34a-b).This sixteenth moment is also the first moment of the pure path of meditation(bhävanämärga) (AKBh, vi .28c-d, 950-952).60The Srotadpanna, although having abandoned doubt and false views, isstill bound by four basic or latent defilements-- attachment or desire, anger,pride, and delusion--which can only be removed or overcome through the pathof meditation (AKBh, v.5a, 773). The path of meditation is a process ofrepeated contemplation or meditation, and may be of two types: pure (whichwill be considered here), and impure (Poussin 1925, 3:xvii). The pure path ofmeditation can only be cultivated by a person who has gone through thecomprehension of the truths (Poussin 1925, 3:xvii). The impure path, orworldly path of meditation, yields results, but ultimately is said to only disturbor disrupt the defilements, and not to uproot them (Poussin 1925, ch. 2 note 33,328).On the pure path of meditation, the person does not have anything newto learn or to know, instead, in order to "cut off" the defilements that remain,that person repeats, or meditates upon, those truths into which they havepreviously developed insight (AKBh, ii.9a-b, 163). Through repeatedcontemplation of the truths, the person overcomes the defilements,' movingfrom the coarser, stronger, and more obvious defilements, to ones that are moresubtle, and therefore more difficult to abandon (Guenther 1974, 226-227). Inthe same way, it is said,when one washes a piece of cloth, thegreater stains are washed out first andonly lastly the subtle stains; so too agreat darkness is vanquished by a smalllight, whereas a great light is requiredto get rid of a small amount of darkness61[when one washes a piece of cloth, thecoarser stains are washed out first andonly lastly the subtle stains; so toothick darkness is vanquished by a subtlelight, whereas subtle darkness by astrong light] (AKBh, vi.33c-d, 957).This process of overcoming defilements occurs in each of the ninespheres: Kämadhatu; the four dhydna-s or stages of Rapadhatu; and the fourstates of the "'formless' or nonmaterial absorptions which make upArapyadhatu" (Poussin 1925, 3:xvii). In other words, the process is applied tohigher and higher states of contemplation or consciousness and cosmic spheres,ensuring that the defilements are completely eradicated.The assignment of different categories of attainment depends upon theextent to which the defilements, and the intensity of these defilements, areovercome. For instance, the person who has abandoned categories ofKämadhatu defilements so that only the three weak categories of desire, angerand delusion exist, is called "the once-returner" (Sakrdägdmin).9 If even theweakest (i.e. weak-weak) categories of these defilements are abandoned, theperson is a "non-returner" (Anägdmin).1° When the last (weak-weak) categoryof defilements attached to even the fourth Arapya, or highest sphere ofexistence, is abandoned, the person has then completed the destruction of allthe latent defilements and their outgrowths (AKBh, vi.44d, 981). The personthen "takes possession" of this destruction, and gains the knowledge that theyare destroyed, and is henceforth called an "Arhat" (AKBh, vi.44d-45b, 983).62The Buddhist Arhat is "the ideal man, the saint or sage at the highestlevel of development" (Conze 1951, 93). When Buddhism began, the term mayhave been applied to all advanced ascetics, but later, as a Buddhist technicalterm, it came to denote people who were "fully and finally emancipated," who,in other words, had attained enlightenment (Conze 1951, 93). Conze explainsthat the term Arhat may be etymologically derived in two ways,The Buddhists themselves derived the word,`Arhat,' from the two words 'An,' whichmeans 'enemy,' and 'Ilan,' which means'to kill,' so that an Arhat would be'A slayer of the foe,' the foe being thepassions. Modern scholars prefer to derivethe word from `Arhati,"to be worthy of,'and meaning 'deserving, worthy,' i.e. ofworship and gifts (1951, 93).The first is really a context-dependent 'folk' etymology. The second, more"modern," explanation is similar to the AKBh explanation of this term. Thereis also a second term which is applied to the Arhats--agaiksa.When this knowledge [of the destruction ofthe defilements] has arisen, the candidatefor the quality of Arhat has acquired thestate of Maiksa, the state of Arhat: heno longer has to apply himself (gas) witha view to another state; he is therefore anMaiksa. For the same reason, having achievedhis task with respect to himself, he isworthy (arhattva) to do good for others;he is worthy to receive offerings from allbeings who are still subject to desire.[When this knowledge has arisen, the onestriving for/aspiring to, the quality ofArhat becomes an Maiksa, and an Arhat,one who has obtained the fruit of Arhatship.There is nothing to be learnt for him with63a view to another fruit; he is therefore anAgaiksa. For the same reason, he is worthyto do good for others; and he is worthy toreceive veneration from all beings who arestill subject to desire] (AKBh, vi.45b, 983).From these explanations, one can see that the state of Arhat implies notonly the absence of defilements, but the presence of positive qualities in theirplace. Here, the direct knowledge that all the defilements have been destroyedis the most important of these qualities (AKBh, vi.44d-45b, 983; vi.75c-d, 1034;vii.46a, 1165). The Arhat is also said to win "complete sovereignty over hisown thought" (Conze 1967, 167); and the AKBh describes the Arhat as one whois "free from delusion" (AKBh, iii.27b, 409). This lack of defilements,sovereignty over thought, and freedom from delusion, may be contrasted withearlier descriptions of the ruined moments of mental consciousness as confused,not having power (over oneself), and being of decayed or ruined mindfulness(AKBh, iv.58c-d, 633-634).The idea that the state of health or enlightenment is characterized notsimply by the absence of negative qualities but the presence of positive ones, isfurther supported by the statement that the Arhat's "series is pure, since hispersonality [basis =body] has just been renewed [turned around, changed]"(AKBh, iv.56, 631). Although it may seem strange to speak of the"personality" in the context of Buddhism, the process of becoming an Arhatinvolves a number of shifts or changes in what is commonly called thepersonality. These changes--representing movement from the bondage ofdesire, suffering, defilements, etc., to the freedom of calmness, insight, and64wisdom--are so extensive and thorough that the entire personality may bethought of as made "new."The only beings in early Buddhism considered more perfect or completethan the Arhats, are the Buddhas (Conze 1951, 94). However, as indicatedpreviously, since distinctions between Arhats, Pratyekabuddhas, and Buddhasare not entirely based on differences in psychological characteristics (but ratherprimarily have their roots in Buddhist historiography, mythology, and, in asense, theology) they will not be examined here, although the AKBh'sexamination of the path goes on to include them.One can see then that if the Arhat is taken as representing a person whohas the ultimate state of (mental) health, this state is characterized not only bythe absence of defilements, or even the absence of suffering, but also byknowledge (of oneself, others, the world, and various states of consciousness),love, compassion, joy, and equanimity. Thus, given these qualities, one mayconclude that concepts of health in the AKBh go far beyond those found inDSM-III-R.SummaryThis examination of concepts of mental illness and mental health inDSM-III-R and the AKBh, reveals some basic differences. Firstly, oneimmediately sees that if the soteriological path in the AKBh is regarded as atherapeutic process bringing about (as a result rather than a primary purpose)some positive psychological changes in (what is commonly called) the person,65then the AKBh contains much more information about the nature of mentalhealth than does DSM-III-R. Secondly, as if it were almost a mirror-image,DSM-III-R contains much more information about mental illness than does theAKBh, and its definition of mental disorder is more rigorous and thoroughthan the AKBh's definition of ruined mental consciousness. Finally, thedefinitions that are provided in each text contain elements that, if examined,reveal specific cultural and religious value systems. An analysis of these valuesystems is important for understanding these texts and the lists they contain.66NOTES - CONCEPTS OF MENTAL ILLNESS AND MENTAL HEALTH'Others also note this problem. For example, both BenjaminPasamanick, M.D. in "What is Mental Illness and How Can We Measure It?"and John A. Clausen, Ph.D., in "Values, Norms, and the Health Called`Mental;' Purposes and Feasibility of Assessment," express dissatisfaction withdefinitions of mental health and mental illness, and doubt whether it ispossible to adequately define either. See The Definition and Measurement ofMental Health, ed. S. B. Sells, (U.S. Department of Health, 1968).'See also AKBh, vi.24c-25a, 941-943.'Mindfulness of breathing is said to cut off discursive thinking byturning attention inward and having an unvaried object with no color or shape.Visualization of the loathsome (a cadaver) counteracts cravings for color, shape,contact, and honors (AKBh, vi.9c, 917-918).4Conze notes that sameidhi (concentration, absorption) correspondsetymologically to the Greek word "synthesis."To "concentrate" consists in narrowing thefield of attention in a manner and for a timedetermined by the will. The result is thatthe mind becomes steady, like the flame ofan oil lamp in the absence of wind.Emotionally speaking, concentration resultsin a state of quiet calm, because one haswithdrawn for the time being from everythingwhich can cause turmoil (Conze 1951, 100).'See also AKBh, viii.note 162 on page 1301 for the placement of theimmeasurables on the path. The immeasurables are so called because,according to the traditional explanation, they "apply to an immeasurablenumber of beings" (AKBh, viii.29a, 1264).'See also AKBh, viii.29b, 1264. For methods of cultivating love (maitri)see viii.31d, 1268-1270.7The "general characteristics" signifies the fact that "All conditionedthings are impermanent; all impure dharmas are suffering; and that all thedharmas are empty (ganya) and not-self (arditmaka)" (AKBh, vi. 14c-d, 925)."The defilements are divided into nine categories or strengths. Thesecategories are made up of three main categories, weak, medium and strong.Each main category is also subdivided into weak, medium and strong, thus67giving nine categories or subdivisions of defilements in total. See AKBh,vi.33c-d, 957."Once-returner," because, "having gone to be among the gods, [thatperson] returns to be among humans, and has then no further rebirth" (AKBh,vi.35c-d, 964).""Non-returner," because that person will not be reborn in Kämadhauagain. Ibid., vi.36d, 965.68IV. VALUES AND NORMSIn the previous section we have seen that the AKBh and DSM-III-Rcontain very different ideas about mental illness and mental health. Many ofthese differences are simply due to differences in scope, or the perceiveddomain, of the texts. However, some of the differences are due to the influenceof general cultural values. Although Western science is often said to be value-free, a closer examination of DSM-III-R shows that, at least in its case, this isnot so. Buddhist values are explicitly stated in the AKBh. The existence, orinfluence, of value systems in each text means that certain standards or normsare being applied to arrive at concepts of what might be regarded as mentalillness and mental health. It is therefore important to examine thesesometimes subtle values and norms in order to gain a deeper understanding ofthe texts and their milieu, as well as to facilitate the later study andcomparison of individual lists taken from each text.Values Values are "the established ideals of life." They are the dominantthemes or assumptions of a given culture, religion, or world view (Paranjpe1984, 57). Values, or value systems, are constructed through history, with eachgeneration inheriting a certain value system. Although such systems mayalways be changed and adapted, inherited values have tremendous influence,even though they are often unstated and unrecognized.69Inherited value systems not only influence people, but science, religion,and many forms of knowledge, as well. The whole process of obtainingknowledge is often at least partially dependent on a particular history andvalue system:In most cases, the formulation of a problemby anyone is based on the precedence ofsomeone else having faced the same or asimilar problem. So each generation inheritsa set of problems formulated by the previousgeneration. The problems, as well as the datain light of which they are examined, areselected from among many that are known oravailable. The selection is normally basedon experiences and values in the life of theinvestigator. The problem is seen in acertain "perspective," composed of theaxiomatic assumptions and a priori categorieswith which an investigator begins to analyzea problem. These categories are independentof the nature of the data to be examined,and often predetermine the nature of theconclusions the investigator may draw (Paranjpe1984, 38).Clear examples of the above are found in both Indian Buddhism andmodern North American psychiatry. For instance, Vasubandhu clearlyinherited a specific idea of a problem--life is characterized by unsatisfactorinessor suffering--and describes various doctrines regarding the path through whichsuffering may be ended. These were based on the experiences of the Buddhaand the Buddhist community. As we have seen, the Buddha in turn hadinherited a number of concepts, techniques, etc., from his cultural and religiouscontext.70In North America, this idea of inheriting a way of understanding,approaching and solving problems, may be seen most clearly in the currentemphasis on psychopharmacology. Descartes' mind-body dualism is onefoundation of the nature-nurture controversy in psychology and psychiatry.Drugs are therapeutic interventions aimed primarily at the body and "nature."Thus the prescribing of these drugs can be said to represent an approach to,and solution (for some) of, the earlier mind-body, nature versus nurture,problems.The concepts of mental illness and mental health in DSM-III-R and theAKBh clearly reflect certain cultural or religious value systems. One maydivide the perspectives arising from these systems into three broad categories:individuality versus self-transcendence; rejection or acceptance of religiousgoals; and a basic external versus internal orientation.Both DSM-III-R and the AKBh focus, in some ways, on the individual.DSM-III-R is used to diagnose mental illness in individuals, and its definitionsof mental health and mental illness are in reference to individuals as opposedto societies, groups, or families. Although the AKBh includes a great numberof discussions on dharma-s, karma, etc., that cannot be regarded as referring tothe individual, it also, as we have seen, details the path that an individualmay follow to achieve enlightenment. However, even though both texts havesome focus on the individual, they also have very different value systems thatresult in differing conceptions about individuality.71Greek thought emphasized rationalism and the spirit of reason, andthese have remained dominant values in the West. As well, particularly inNorth America, the Protestant Reformation, and especially Calvinism, stressedthe value of mastery and function. Given this, it is not surprising that DSM-III-R reflects these values of rationality and mastery in its definitions ofmental illness and mental health.Mental illness, probably in most cultures, is associated with some formof irrationality. DSM-III-R mentions a number of forms that irrationalitymight take. For instance, there may be: impairment in reality testing, injudging, or in thinking; and/or the presence of delusions or hallucinations(DSM-III-R, 12). Indeed, the entire manual is really a listing of various formsof behavior, thinking, and feeling, that are considered to be irrational. Or, inother words, that do not represent "merely an expectable response to aparticular event" (Spitzer and Williams, 1987, xxii).The emphasis on mastery is clearly seen in the Global Assessment ofFunctioning Scale, the closest that DSM-III-R comes to providing a definition ofmental health. Health not only includes the absence of symptoms but also"good functioning in all areas," being "interested and involved in a wide rangeof activities," and also being "socially effective" (DSM-III-R, 12). In contrast,the general definition of mental disorders mentions "impairment in one ormore important areas of functioning" (Spitzer and Williams 1987, xxii).Thus the values of rationality and mastery are stressed in DSM-III-R.Emphasis on individuality in and of itself, is also seen in the association of72mental disorders with "an important loss of freedom" (Spitzer and Williams,xxii). Given such examples as these, one may conclude that the cultural andreligious (in the case of Calvinism) values of individuality, rationality andmastery, both shaped, and are expressed in, DSM-HI-R definitions of mentalillness and mental health.The AKBh contains a very different perspective on individuality.Paranjpe notes that one may regard Indian psychology as a whole as beingindividualistic, for "it focuses almost entirely on individual self-realization.The guiding principle of Indian psychology is to assist an individual in his ownspiritual advancement" (1984, 77). However, the emphasis on individualityends here, for the other "guiding principle" is that liberation, however it isconceived, and individuality--namely ego-based, ordinary individuality--aremutually exclusive (Reat 1990, 293).This second principle, as we have seen, is particularly evident in theAKBh, and Buddhist psychology in general. The path, as presented in theAKBh, really involves gaining insight into, and experience of, the four nobletruths as they relate to the world. This includes, of course, the acceptance andrealization of the doctrine of anCitman. Such acceptance and realization istermed wisdom (profile° and overcomes not only suffering or unsatisfactoriness,but all sorts of ego-based "defilements" such as attachment, anger, pride,ignorance, false views and doubt (AKBh,, 768). The result of this is the"renewed" state of the Arhat (AKBh, iv.56, 631).73Since the AKBh stresses the realization of the four noble truths, alongwith the doctrine of andtman, one may say that it strongly opposesindividuality as something to be valued in and of itself. Since the text doesemphasize self-transcendence and proposes some rigorous techniques to bringthis about, mastery would seem to be highly valued. However, this mastery ismastery over oneself, in order to free oneself, and is, of course, very differentfrom the value of mastery as reflected in DSM-Ill-R definitions.The values in the AKBh of mastery over oneself and enlightenment areclearly religious goals. This must be understood then, as a soteriologicalpsychology. Indeed, "Indian psychological theories are inseparable from thespiritual goals the theorists set out to pursue. Even brief accounts of Indianconcepts often lead us to the values and ethical issues that legitimize theirgoals" (Paranjpe 1984, 62).DSM-III-R lacks the presence of these obvious religious elements.Rejection of such elements is undoubtedly due largely to the aforementioned(perceived) conflict, in the Western traditions, between science and religion(Paranjpe 1984, 32). Since such a conflict was not present in India, "thedichotomy between science and religion and between logic and mysticism, orthe issue of value-free science, have not influenced Indian psychologicalthought as they did in the West" (Paranjpe 1984, 32). The absence or presenceof the science versus religion conflict, and the resulting acceptance or rejectionof religious goals as part of the mental healing tradition, thus account for someof the major differences between texts such as the AKBh and DSM-III-R.74A final basic difference between the value systems of the two texts istheir general orientation towards the external or internal. The externalorientation of DSM-III-R is seen in its emphasis on the above-noted mastery offunctions relating to the outer world. This stress placed on mastery of theexternal world is a general cultural value termed "Man Over Nature" byParanjpe (1984, 66). It represents,an ideal-typical mode of man's being in theworld, which manifests itself not only inbuilding dams on the rivers, highways onthe mountains, and satellites in space, buta lot more. ..this type of attitude is now sopervasive that it influences the way thepsychologist does his research and how heconceives his subject matter (Paranjpe 1984, 66).In particular, the psychologist (or psychiatrist) views problems and solutions asbeing separate and "out there" rather than within (Paranjpe 1984, 68-69). Thistype of approach is particularly evident in behaviorism and biologically-oriented psychiatry (the body being "out there" as opposed to the mind).Biologically or medically oriented psychiatrists represent the branch of theWestern mental healing tradition that makes greatest use of DSM-III-R.In contrast, the AKBh emphasis on self-transcendence represents a more"internal" approach. Both the problem, unsatisfactoriness or suffering, and thesolution, enlightenment, are tied to internal sources. Unsatisfactoriness, asnoted, is linked to desire and ignorance, which must be eliminated. Themethods used to eliminate them are largely internal--meditation,contemplation, visualization, etc. Morality, which is more externally oriented,75is also important, but the focus is primarily on introspective techniques. Oneshould remember though that in the final analysis, this introspective-phenomenological approach in Buddhism is said to not only give one greaterinsight into the true nature of oneself, but the world as well (Reat 1990, 183).The final state of enlightenment is also more internal than external, inthat it is something the person experiences. However, as noted, compassionand love are two means used to help one reach the state of the Arhat. Thismeans that there is some external orientation present. In the end, this type ofcompassion, though, is based on the absence of ignorance and the presence ofinsight or wisdom, which makes the nature of it more internal than external.Overall then, one may say that understandings of mental illness andmental health in DSM-III-R reflect a primarily external orientation, whilethose in the AKBh are mostly, but not exclusively, internal. Differing valuesregarding individuality, mastery, and acceptance or rejection of explicitreligious elements, are also reflected in the texts' definitions. Since the valuesevident in the definitions can be traced to previously existing cultural orreligious value systems, one may conclude that these general value systemswere important factors in shaping the definitions. In turn, the values presentin the definitions of mental health and mental illness in important texts suchas DSM-III-R and the AKBh, undoubtedly influence the value systems of thosethat come after.The preceding discussion of values evident in the concepts of mentalillness and mental health, calls into question the common idea of a value-free76Western science, and the purported objectivity and empirical nature ofdiagnostic manuals such as DSM-III-R. Values are evident not only in DSM-III-R's explanations of mental health and mental illness, but in the lists, whichmake up the bulk of the text, as well. As Paranjpe notes, "almost anydescriptive account of personality involves a hidden message that conveys to uswhich characteristics of personality are idealized or sought after and which arevilified" (1984, 96). Again, in the case of DSM-III-R, this is only noteworthybecause the text was supposedly designed to minimize inference and valuejudgments (Spitzer and Williams 1987, xxiii).Some maintain that even the idea of classifying or categorizing mentaldisorders, and hence the people who suffer from them, represents a valuesystem or judgment, and a negative one at that. It is stated in DSM-III-R that"there is no assumption that each mental disorder is a discrete entity withsharp boundaries (discontinuity) between it and other mental disorders, orbetween it and no mental disorder (Spitzer and Williams 1987, xxii). However,the presence, in the text, of a multitude of diagnostic categories largelycontradicts this internal value (Rothblum, Solomon, and Albee 1986, 177).More importantly, having such specific categories of mental disorders results inpeople being labelled ("pigeon-holed"), and once this is done, particularly withthe case of such labels as "schizophrenia," individuals are not seen as being onsome sort of continuum with normal behavior or "no mental disorders," butrather, very often, are stigmatized instead (Rothblum, Solomon, and Albee1986, 177-179).77The use of these specific diagnostic categories raises other concerns aswell. Studies show that people "readily believe personality descriptions ofthemselves made by others," even if these descriptions are negative andfictitious (Rothblum, Solomon, and Albee 1986, 178). This means that once aspecific diagnosis is made, the person is likely to believe it, even if thediagnosis is wrong. Whether right or wrong, the diagnosis may change theway a person perceives him/herself, and the way other people (if they areaware of the diagnosis) perceive him or her.This problem with diagnosis is particularly worrisome in the case ofchildren. DSM-III-R contains approximately fifty types of disorders that mightbe diagnosed in children. There are concerns that children given thesediagnoses might limit themselves in some way because of them (a phenomenoncalled self-fulfilling prophecy). As well, diagnosis or labelling tends to focuspeople's attention on the individual child, rather than that child's environment(Rothblum, Solomon, and Albee 1986, 177). For example, if a "non-labelled"childcomplains about his or her teacher or schoolday, we are likely to consider environmentalfactors as having caused this child's distress.If, on the other hand, we know that thischild has been diagnosed as having a learningproblem or as being hyperactive, we tend todisregard the problematic environment andattribute the source of the problem withinthe child (Rothblum, Solomon, and Albee 1986, 178).The same, of course, may also be the case for adults who are diagnosed withsome form of mental disorder.78As previously stated, this focus on the individual represents a strongcultural value. The result is that DSM-III-R, and particularly the morebiologically-oriented psychiatrists that use it, tend to only focus on diagnosis ofmental illness in individuals, and ignore important non-individualistic factors:Psychopathology clearly is associated withpoverty and powerlessness, but theserelationships are not acknowledged by themodel that seeks and finds causal defectsin individuals rather than societies(Rothblum, Solomon, and Albee 1986, 168).In effect, the emphasis on individualism may perpetuate mental distress insome individuals, because the social injustices that play a part in their distressare ignored.A final concern over the basic value of having and using diagnosticcategories, is based on the recognition that these categories will guide, ratherthan be guided by, future research. Evidence of this is already seen withrespect to funding:As classification systems evolve, funds forresearch and intervention seem to follow.Ironically, the majority of funding awardsby the National Institute of Mental Health(NIMH) are for specific areas of mentaldisorders, particularly for DSM diagnosticcategories (Rothblum, Solomon, and Albee 1986, 183).The trouble with this is that research into obscure DSM-III-R categories maybe funded, while more frequent and unclassified problems, such as stress, donot receive as much funding and attention (Rothblum, Solomon, and Albee1986, 183).79Thus the very existence of categories of mental disorders in DSM-III-Rreflect certain perspectives, value systems, and judgments. Further, the resultsof these may sometimes be more negative than positive.Values and value judgments are also implied in the terminology used inDSM-III-R. The word, "inappropriate," and other similar terms, are often usedin the diagnostic criteria. For example: "feelings of worthlessness or excessiveor inappropriate guilt" (Major Depressive Episode); "Unrealistic or excessiveanxiety and worry" (Generalized Anxiety Disorder); "inappropriate, intenseanger or lack of control of anger" (Borderline Personality Disorder).2It is expected that clinicians and researchers using DSM-III-R, will havespecialized training in the proper use of the criteria (DSM-III-R, xxix), andtherefore, that value judgments and subjectivity will be kept to a minimum.However, this is not necessarily the case, for:Appropriateness depends heavily on context,and what is proper in a given context is oftenhighly subjective. Appropriate behavior inCalifornia may be inappropriate in Boston. Whatone clinician views as inappropriate laughter,for example, may be anxious defensive laughteror a subculturally acceptable expression oftension or anxiety, as is peculiar to someAsian groups (Yager 1989, 1:556).Use of vague or judgmental terminology in DSM-III-R thus creates barriersagainst arriving at value-free, objective, diagnosis.Evidence of value systems is also seen in a number of specific diagnosticcategories. The most obvious example of this was the presence ofhomosexuality as a category in DSM-II, and its subsequent deletion (or80modification to only ego-dystonic homosexuality) in DSM-III. This change waslargely the result of a struggle waged by gay-rights groups and activistsagainst the American Psychiatric Association between 1970 and 1973 (Bayer1981, 153). Homosexuality was (and still often is), of course, vilified by manysegments of North American Society and Christianity, and therefore itspresence in DSM-II was, at least partially, due to cultural and religious factors.In turn, the deletion of, or change in, this diagnostic category was also theresult of certain cultural values.Feminists are currently waging their own struggle against certaincategories of mental disorders in DSM-III-R which they perceive to reflectsexist or male-oriented values. Two categories in particular "come under fire,"namely, Histrionic Personality Disorder and Dependent Personality Disorder.Some of the diagnostic criteria for Histrionic Personality Disorderinclude: "constantly seeks or demands reassurance, approval, or praise;" "isinappropriately sexually seductive in appearance or behavior;" "is overlyconcerned with physical attractiveness;" and "expresses emotion withinappropriate exaggeration" (DSM-III-R, 349). The explanations of thisdisorder include statements that, people with this disorder "are typicallyattractive and seductive," and "often act out a role such as that of 'victim' or'princess" (DSM-III-R, 348).With criteria such as this, it comes as no surprise that the "disorder isapparently common, and is diagnosed much more frequently in females than inmales" (DSM-III-R, 349). In fact, the prevalence and sex ratio are almost81guaranteed, given the wording of the criteria, and also that most psychiatriststoday are male. Some also note that any woman who fulfills society'straditional view of women--and indeed the view of women as presented in themedia--will be labelled Histrionic by the clinicians (Kaplan 1983, 789). Sincethis category relies so heavily on the value judgments of clinicians, it is notsurprising that field trials indicate the category has poor diagnostic reliability(Cooper 1987, 290).The second category, Dependent Personality Disorder, shows the samestereotyped, gender-biased view, and is also more prevalent in women thanmen. Diagnosis of this disorder is based on "a pervasive pattern of dependentand submissive behavior beginning by early adulthood and present in a varietyof contexts" (DSM-III-R, 353). For example, the person:"is unable to make everyday decisions without an excessive amount of adviceor reassurance from others;" "allows others to make most of his or herimportant decisions, e.g., where to live, what job to take;" "agrees with peopleeven when he or she believes they are wrong, because of fear of being rejected"(DSM-III-R, 354).Criteria such as this again express traditional stereotypes of women, andtherefore women who fulfill these stereotypes will be diagnosed as mentally ill--an almost "catch twenty-two" situation. The main criticism of this diagnosticcategory, is that it "singles out for scrutiny and therefore diagnosis the ways inwhich women express dependency but not the ways in which men expressdependency" (Kaplan 1983, 789). For example, while "feels devastated or82helpless when close relationships end" is part of the criteria (DSM-III-R, 354);there is no mention of "the dependency of individuals--usually men--who relyon others to maintain their houses and take care of their children" (Kaplan1983, 789). In this way, both men's dependency and women's dependency aresupported by society (and stereotypes), however, men's dependency is notlabelled as a mental disorder, while women's dependency is (Kaplan 1983, 790).Other controversies over diagnostic categories are also, at least partially,based on the issue of morality and its place in, or influence on, the DSMs. Theconflict over homosexuality as a category was a good example of this. Suchconflicts and concerns over the issue of morality continue, as DSM-III-Rincludes categories such as gambling, stealing (kleptomania), alcoholintoxication, and even "caffeinism," among its categories of mental disorders.DSM-III-R contains more of these socially-based behaviors, and less of theorganic disorders than did its predecessors, and some consider this trenddisturbing:By labeling such social behaviors aspsychopathological, we are revealing alessening tolerance for deviation in oursociety. At best, we are observing ametamorphosis in which medical practitionersare appointing themselves the arbiters ofdeviant behavior that was once the provinceof religious or legal institutions. Individualswho centuries ago might have been excommunicatedbecause of their behavior now face stigmatizationby the psychiatric profession (Rothblum, Solomon,and Albee 1986, 179).83This shift to including socially-based behaviors that were once the province ofmorality and/or religion among the diagnostic categories of DSM-III-R, mayreflect a trend toward secularism in North American society. Religion andmorality may be losing some power to regulate behavior, while science isexpanding its influence or "territory," and filling this vacuum.Thus we have seen that values, and value judgments, are present in thelists, as well as in the general concepts of mental health and mental illness inDSM-III-R. Some of these values are criticized, and certainly the existence ofcategories such as Histrionic Personality Disorder refute any idea that thismanual, taken as a whole, might be value-free.As mentioned, the AKBh, and Indian psychological theories in general,embrace religious or spiritual goals. Thus values, ethics, and morality all playa large, and obvious, role in this text. This is seen most clearly by comparingsome of the mental states (that is, dharma-s which belong to, and are of thetype of, consciousness or cognition) accompanying all defiled moments ofconsciousness (klegamandbhamika-s), with the dharma-s found accompanyingall good moments of consciousness (kugalamandbhamika-s). For instance, thedefilements include: ignorance or delusion (moha), idleness (kausrdya); anddisbelief (Ctgraddhya) (AKBh, ii.26a-c, 193). The dharma-s found in goodmoments of consciousness include: faith (graddhd); diligence (apramäda); andrespect (hri) (AKBh, ii.25, 191). These are openly religious and cultural values.Another discussion on ruined moments of consciousness in the AKBhalso highlights this important, and open, role of morality and values:84The person who troubles and deranges the mindof another through curses and formulas; theperson who causes another to drink poison oralcohol when he does not want to drink it;the person who frightens game, either in thehunt, or by setting the jungle on fire, orby the hollowing out of traps; and the personwho, by whatever means, troubles the memoryand the presence of mind of another, will havehis own mind troubled.[People who ruin the mind of others throughsubstances and formulas; people who causeanother to drink poison when he does not wantto drink it; who frighten in the hunt etc.,or set fire in forests, or let fall from acliff; and the people who, by whatever meanscause to be ruined/decay the presence of mindof another, will have their own mind ruinedby the ripening of this karman in the future](AKBh, iv.58b, 633).This quote indicates, in accordance with the law of karma, that the person maybe responsible in some way for his/her own moments of ruined consciousness.As well, here one can see the emphasis placed on non-violence (avihirnsä),which is also one of the dharma-s found in all good moments of consciousness(AKBh, ii.25, 191), and which is a value upheld by many Indian traditions.The whole process in the path, representing movement from ignorance towisdom, reflects a strong cultural and religious value. Knowledge and wisdomare valued, not solely for their own sake, but rather because they serve aspiritual and soteriological purpose; they are the means to an end (Halbfass1991, 243). The North American mental healing traditions also stress theimportance of gaining knowledge or insight; however, this stops withknowledge into one's own psyche, behavior, etc. The knowledge or insight is85an end in itself, or only a means of improving one's mental health. Knowledgeas a means to achieve some religious or spiritual goal plays little, if any, role.Thus values, morality, and ethics, are all important influences on theAKBh, and are openly recognized and stated in the text. Not all of thesevalues may be regarded as "positive" today. For example, while a woman mayattain the state of supreme worldly dharma-s, it is expected that thisattainment will lead to her (better) rebirth as a male (AKBh, vi.21a-b, 937).Many modern women would find this idea of "necessary" rebirth as a maledisturbing.As we have seen, values and value judgments exist in both DSM-III-Rand the AKBh. Each text contains values that some might regard as negative,as well as upholding values that many would view as positive. The largestdifference between the two texts, again seems to be a result of the acceptanceor rejection of religious goals. DSM-III-R contains values, but these are lessopenly stated than those in the AKBh, and they do not really include obviousreligious or soteriological elements, although some influence(s) from Christianmorality may exist. While some would regard the DSM-III-R approach asobjective and sophisticated, one might wonder whether the AKBh approachdoes not represent itself more fairly, for its values are openly stated andrecognized, rather than hidden or embedded.86NormsIf, as we have seen, values are present in the two texts and theirconcepts of mental health and mental illness, then we must logically concludethat some standards or norms are being applied to arrive at such concepts. Anunderstanding of the nature of mental illness depends on some understandingof the nature of mental health, and vice versa. Illness, of any kind, is usuallyperceived when there is some change, or shortfall, from what is considered tobe normal. The interesting issue in the case of DSM-III-R and the AKBh isthis idea of "normal." Or, specifically, who or what is the norm against whichmental illness and mental health are measured and understood?DSM-III-R, and most of the North American mental healing tradition,use the concept of the "average norm," to determine mental illness. That is,"whatever is markedly deviant is abnormal" (Wig 1990, 196). The idea ofnormality as average, "is based on the mathematical principle of the bell-shaped curve. This approach.. .conceives of the middle range as normal and ofboth extremes as deviant" (Offer and Sabshin 1980, 1:609). Related to this, isthe perspective that normality is healthy, which isbasically the traditional medical approachto health and illness. Most physiciansequate normality with health and view healthas an almost universal phenomenon. As aresult, behavior is assumed to be withinnormal limits when no manifest psychopathologyis present. If one were to put all behavioron a continuum, normality would encompassthe major portion of the continuum, and87abnormality would be the small remainder(Offer and Sabshin 1980, 1:608).DSM-III-R reflects this definition of normality. For example, a numberof criteria for various diagnostic categories mention that specific behaviors orbeliefs would be "inconsistent with subcultural norms," (SchizotypalPersonality Disorder), or, in the case of events, that they would be "stressful toalmost anyone in similar circumstances in the person's culture" (Brief ReactivePsychosis) (DSM-III-R, 342, 207).This definition of normal as average and healthy is also found in theintroduction to DSM-III-R:When an experience or behavior is entirelynormative for a particular culture--e.g.,the experience of hallucinating the voiceof the deceased in the first few weeks ofbereavement in various North AmericanIndian groups, or trance and possessionstates occurring in culturally approvedritual contexts in much of the non-Westernworld--it should not be regarded aspathological (Spitzer and Williams 1987, xxvi).As these quotes indicate, this concept of the norm is culturally dependent,although more extreme cases of mental illness are almost universallyrecognized (Kende11 1986, 38). Consequently, a great number of ethnographicalstudies are conducted in order to test the validity of DSM-III-R diagnosticcategories and criteria, and, of course, to find out what is "normal" forparticular cultural and sub-cultural groups. Clinicians are thus cautionedabout using DSM-III-R to diagnose mental disorders in people from ethnic orcultural groups different from their own (Spitzer and Williams 1987, xxvi).88A further difficulty with the DSM-III-R approach of the norm as average,is that the idea of the norm, or average, may not only be culture-specific, butgender-biased as well. Some maintain that categories such as HistrionicPersonality Disorder, may be largely based on the use of male behavior as thenorm or standard for health (Kaplan 1983, 788).In contrast to the idea of the norm as average, the AKBh upholds theideal as the norm or standard. In this approach, "whatever is less than ideal isinadequate and thus, in a sense, abnormal" (Wig 1990, 196). We have seenthat the Arhat is upheld as the ideal in the AKBh, and certainly asrepresentative of a state that one should strive to attain. For instance, withregards to fasting, the text speaks of "embracing a way of life conforming tothat of the Arhats" (AKBh, iv.28.i, 596).This idea of the norm as ideal is found not only in the AKBh, but in theIndian traditions generally. Liberation, whether termed moksa orenlightenment, is considered to be the "ultimate potential of the human being"(Reat 1990, 25). The people who attain such states are fulfilling their potentialand are therefore regarded as the standard against which others are measured,although this does not mean that those who have not attained the ideal areconsidered to be mentally ill or abnormal. Again we see here the primaryemphasis on religious or soteriological goals.While the norm as ideal approach is frequently found, there is also somesuggestion or recognition, in different contexts, of the norm as average as well.For instance, in a discussion on karma, it is noted that "when a person walks,89stands still, eats, or dresses himself in a manner other than that which heshould, this action.. .is improper, for this person acts contrary to received usage(ayoga) (AKBh, iv.94c-d, 677). An opinion presented in the AKBh such as this,may reflect those more universally recognized cases of mental illness, or maysimply uphold the status quo.Understanding the norm as average or ideal leads to a number ofimplications. Some problems with the norm as average have already beennoted--the possibilities of being culture-bound and gender-biased. As well, theminority (by definition) who are not the norm or average may facestigmatization. Even more serious is the possibility that the norm or averageitself may not be healthy or "normal." This possibility has been addressed,perhaps most eloquently and forcefully, by Erich Fromm:It is naively assumed that the fact thatthe majority of people share certain ideasor feelings proves the validity of theseideas and feelings. Nothing is furtherfrom the truth. Consensual validation assuch has no bearing whatsoever on reason ormental health... .The fact that millions ofpeople share the same vices does not makethese vices virtues, the fact that theyshare so many errors does not make theerrors to be truths, and the fact thatmillions of people share the same forms ofmental pathology does not make thesepeople sane (Fromm 1955, 23).If what is average is not healthy or sane, the norm which is defined as averagewill be negatively skewed and will not represent true health or sanity.90Consequently, all concepts or criteria of mental health and illness will besimilarly affected.Positive results of defining the norm as average are seen in DSM-1TI-R'sstrengths. Namely, those (people, behavior, or mental states) that fall short ofthe norm, or are not average, may receive a greater amount of attention. Thediagnostic categories of DSM-III-R are a result of focussing on differences fromthe norm, and reflect a specific understanding of various mental disorders.This understanding may encourage more precise diagnosis and treatment.In contrast to this, if the ideal is upheld as the norm or standard, thenthe majority who fall short of this standard are "lumped together" despitedifferences. Such an approach may ignore differences between disorders, anddifferences in the severity of specific disorders. It would be naive to concludethough that, simply because the AKBh sometimes upholds the ideal as thenorm or standard, these clinical deficiencies are found in the Indian traditionas a whole. Rather branches of the Indian healing tradition, such asAyurveda, may have examined specific disorders and their severity andtreatment in greater depth. Indeed there is little likelihood that Buddhismever opposed the Ayurvedic system of medicine (Demieville 1985, 92). As well,some problems are culturally taken care of within the family, extended family,or community in a way that may not necessitate clinical diagnosis andtreatment.The most positive implication of having the norm as ideal, is that, whileit may also be culture-bound, etc., it offers a clear picture of the ideal state, in91this case health. One would assume that something is easier to achieve ifthere is a clear view or perception of it. As well, since the standard is theideal, and not the average, it would not be as easily influenced or corrupted bynegative societal changes.Summary We have seen that values and norms influence conceptions of mentalhealth and illness in the AKBh and DSM-III-R. Perhaps the most importantelement we have examined here is the presence or absence/rejection of religiousvalues in the texts. This presence or rejection seems to account for the greatestdifferences in language, scope, and content of the texts. Connected with this isthe understanding of the norm as average (for DSM-III-R, which rejectsreligious values) or as ideal (for the AKBh, which is based on religious values).The Arhat or the average becomes the standard against which mental healthor mental illness are measured (although, as stated, in the case of the Arhat asideal this does not mean that the majority are abnormal or mentally ill), andthus we may regard religious values and goals, or the absence of such, asprimary influences on texts of this nature.NOTES - VALUES AND NORMS'Gage Canadian Dictionary, s.v. "values."2DSM-III-R diagnostic criteria for: Major Depressive Episode (A-7, p.222); Generalized Anxiety Disorder (A, p. 252); and Borderline PersonalityDisorder (4, p. 347).9293V. THE LISTS: MAJOR DEPRESSIVE EPISODE,ANUSAYA-S AND KLESA-SWe have now explored the historical background of DSM-III-R and theAKBh; examined their concepts of mental illness and mental health; and foundthat these concepts (as well as some specific diagnostic categories in DSM-III-R)were influenced by certain cultural or religious values and norms. Theprevious section in particular noted that, not surprisingly, the acceptance orrejection of religious elements led to many differences in topic, scope, goals,etc., between the two texts.It is now time to narrow the study and focus on one or two lists fromeach text. One may remember that, in some ways, this study has been likehypothesis testing, unraveling the historical backgrounds and cultural/religiousinfluences present in the texts (on the topic of mental health and illness), inorder to find out if one may observe such influences in specific lists, and also tolearn if this type of methodology or approach facilitates understanding of, andcomparison between, the lists.If evidence of the influences of general cultural/religious values andnorms can be found in the specific lists, then we have learned something(certainly not everything) about the formation of lists. Further, even ifcomparison between the lists is not justifiable, the approach of this study willhave given us some clues as to why this might be.94Major Depressive Episode: DSM-III-RThe term, "depression," is used frequently, and may variously describe"an emotional state, a syndrome, and a group of specific disorders" (Yager1989, 1:574). None of these terms is exclusive: a person may experience adepressed emotional state; have a number of other symptoms accompanyingthat state; and be diagnosed as having a depressive disorder.Depression has been called "the world's number one public healthproblem," and is so widespread "it is considered the common cold of psychiatricdisturbances" (Burns 1980, 9). Some have noted that the "experience ofdepression is so common as to be almost part of the human condition" (Sternand Drummond 1991, 172).Since this disorder is so common, "almost part of the human condition,"it seems best to choose the diagnostic criteria for this disorder as therepresentative list from DSM-III-R for the purposes of this study. As we shallsee, anugaya-s and klega-s are thought to be found in most moments ofconsciousness which are defiled. Therefore, given the extreme differences inthe topics and mandates of DSM-III-R and the AKBh, a list from the formerwhich represents the greatest number of people is the most logical choice, andperhaps the only one, if any comparisons are to be made. For, although notdealing with the same disorder or topic, at least the lists are both addressingcommon, and negative, human conditions.Most people have the experience, at some time(s), of feeling sad. Whensadness becomes "severe it merges into depression" that may require treatment95(Stern and Drummond 1991, 172). In this case, some classification is needed todecide if the depression is severe enough to warrant treatment, and also, todetermine the type of depression (Stern and Drummond 1991, 172). In NorthAmerica, this is the point when DSM-III-R may be used by a clinician.DSM-III-R divides the general category, Mood Disorders,' into two basicsubclassifications: Bipolar Disorders and Depressive Disorders (DSM-III-R,214). The essential difference between the two is the presence of "one or moreManic or Hypomanic Episodes (usually with a history of Major DepressiveEpisodes)" in the former, while in the latter the essential feature is "one ormore periods of depression without a history of either Manic or HypomanicEpisodes" (DSM-III-R, 214).2Once this basic distinction has been made, the subclassification ofDepressive Disorders is further divided. There are various subtypes ofDepressive Disorder which take into account whether or not the depression is:episodic or chronic; associated with seasonal changes (Seasonal AffectiveDisorder); contains psychotic features; etc. (DSM-III-R, 218-233). Here, forreasons stated above, we shall consider the most common and basic category ofDepressive Disorders, namely, the diagnostic criteria for a Major DepressiveEpisode.The Diagnostic criteria for Major Depressive Episode are found inAppendix 1. Following these criteria, are codes noting the severity ofsymptoms, presence of psychotic features, and whether or not the episode is inpartial or full remission (DSM-III-R, 223).96As one can see, most of the criteria for a Major Depressive Episode areclear and need little explanation or elaboration. The preamble to the criteriathough, offers some rather useful examples of the symptoms associated withdepression. Its explanations of two of the criteria, namely, "depressed mood"(A-1), and "diminished interest" (A-2), are worth examining, for at least one ofthese two must be present in order for the diagnosis of Major DepressiveEpisode to be made (DSM-III-R, 222).Depressed mood is usually, but not always, experienced by the personwith this disorder as some sort of negative or aversive emotional state. Aperson with such a mood,will usually describe feeling depressed, sad,hopeless, discouraged, "down in the dumps,"or some other colloquial equivalent. In somecases, although the person may deny feelingdepressed, the presence of depressed moodcan be inferred from others' observing thatthe person looks sad or depressed (DSM-III-R, 219).The feelings associated with this state (sad, hopeless, discouraged, etc.) arecommon ones. It is the severity and duration of these feelings (as well as thepresence or absence of some of the other diagnostic criteria), that determinewhether or not the person is suffering from a Major Depressive Episode. Hereit is important to note that others may observe or infer the presence of adepressed mood from a person's behavior and demeanor. It is not essentialthat the person be aware of the depressed mood, or be willing or able to stateits presence.Loss of interest or pleasure is considered to be97probably always present in a Major DepressiveEpisode to some degree, and is often describedby the person as not being as interested in usualactivities as previously, "not caring anymore,"or, more rarely, a painful inability toexperience pleasure. The person may not complainof loss of interest or pleasure, but familymembers generally will notice withdrawal fromfriends and family and neglect of avocationsthat were previously a source of pleasure(DSM-III-R, 219).This description highlights two elements of this criterion. The first is thesubjective feeling or emotion, which may actually include a lack of feeling,such as the "inability to experience pleasure." This lack of feeling itself isexperienced, in some way, as painful. The second element present isbehavioral. Again, whether or not the loss of interest or pleasure is stated,generally this mood is manifested by the presence or absence of certainbehaviors (for example, a withdrawal from activities and people) and may beinferred from such.One can see that the above two criteria, and their explanations, considerboth subjective-psychological and external-behavioral elements of the disorder.These aspects are also present in the rest of criterion A.One may divide the subjective or psychological elements into affectiveand cognitive categories. Specifically, depressed mood (A-1); diminishedinterest or pleasure (A-2); and feelings of worthlessness and guilt (A-7); areprimarily emotional or affective in nature. Diminished ability to think,concentrate, or make decisions (A-8), and recurrent thoughts of death or suicide(A-9) are more cognitive. Of course, feelings and cognitions are often98intertwined and influence each other greatly, so these divisions should not beconsidered absolute.The more behavioral or external elements are: the loss or increase ofweight (A-3), insomnia or hypersomnia (A-4), and psychomotor agitation orretardation (A-5). Fatigue or loss of energy (A-6), seems to involve bothsubjective-psychological and behavioral elements.Thus elements of general psychology (dealing with the subjective person--feelings, thoughts, etc.) and behaviorism, which are two of the basic influenceson DSM-III-R that we have noted in previous sections, are found in section A ofthe diagnostic criteria for a Major Depressive Episode. The third generalinfluence, medicine, may be seen in section B-1 of the criteria, whichestablishes that an organic factor did not initiate or maintain the depression(DSM-III-R, 223).Regarding specific values and norms, these criteria do not seem to beglaringly culture-bound or gender-biased in nature. As we saw with conceptsof mental health and illness in DSM-III-R as a whole, the criteria areindividualistic in nature and do not appear to include any religious elements.However, the internal versus external orientation is not as clear.One may regard the criteria for the Major Depressive Episode asindividualistic because they certainly focus on the individual, and measure theindividual and his/her feelings, cognition, behaviors, etc., against some norm.As stated earlier, this norm is understood as the "average" in DSM-III-R. Hereone can clearly see that deviations in either direction from the norm or average99are regarded as negative. For instance, there is significant weight loss or gain;insomnia or hypersomnia; and psychomotor agitation or retardation (DSM-III-R, 222). Consequently, two people who have Major Depression may appearvery different from each other (Kupfer and Thase 1987, 33). However, bothpeople would be similar in that they would exhibit some of the above noteddeviations from the norm (as well as depressed mood and/or loss of interest).The cognitive and behavioral elements of the criteria highlight thevalues of rationality and mastery or function respectively. As well, in regardsto mastery and function values, the preamble to the criteria notes that "thereis always some interference in social and occupational functioning" (DSM-III-R,221). Thus one can clearly see that the criteria are part of the over-allindividualistic approach, or values, of the text in general.As mentioned, the criteria for a Major Depressive Episode do not includeany religious elements (unless one regards the emphasis on mastery andfunction as having roots in Calvinism). The issue of an external versusinternal orientation is less clear. The subjective, or cognitive and emotional,elements relate to the "inner person," and so may be considered internal inorientation. The criteria that deal with behaviors, mastery and function, aremore external in orientation. Given this, and particularly since etiology andtherapeutics are not considered here, one cannot, from the criteria alone,determine a clear external or internal orientation.Examination of the list of diagnostic criteria for a Major DepressiveEpisode thus reveals a number of interesting factors. This list (unlike some100others we have briefly examined), in accordance with the stated mandate andpurpose of DSM-III-R, truly seems objective and descriptive. It does not containelements that are theoretical, religious, or gender-biased, in nature. However,we have previously seen that the rejection of religious goals can be consideredas part of a cultural value-system. The criteria also reflect individualism,rationality, mastery and function--other important and basic values. The normas average also clearly provides a basis for this list.Therefore, we might make one of two conclusions. The first conclusionwould be that, due to the presence of cultural values and norms, the list is nottruly objective and descriptive. For the criteria examined here, this conclusiondoes not seem plausible, particularly since studies have shown that thiscategory has excellent diagnostic reliability (Klerman et al. 1987, 8). Instead,we may conclude, more accurately, that an objective and descriptive approachdoes not necessarily preclude the presence of cultural values and norms.Indeed, it may well be impossible to form any type of list on a topic of thisnature without being influenced by values and norms of one form or another.Klega-s And Anugaya-s In The AKBhThroughout this study, the defilements (anugaya-s or klesa-s) have beenmentioned. Out of the numerous lists provided in the AKBh, the lists of thesedefilements will be examined. The reason for this is due more to the nature ofDSM-III-R than the AKBh. Since DSM-III-R lists focus on descriptions ofmental disorders, or what may be regarded as negative mental states,101comparison--or even parallel analysis--will only be possible if similar types oflists are chosen from the AKBh. Even given this condition, one may still findnumerous AKBh lists regarding negative consciousness-related factors orelements.' However, here only the basic lists of klega-s and anugaya-s will beconsidered.Consciousness or cognition (citta, manas, vijfilina) and its consciousness-related factors or elements (caitta) are generated together, they areinterdependent (AKBh, ii.34a-b, 205; ii.23a, 188). In the AKBh, five types ofconsciousness-related elements are enumerated, of which theklegamahabhamika-s are one (AKBh, ii.23c-d, 189). "Bhami" is "sphere,"meaning place of origin or occurrence. This sphere is called "great" (mahat)becauseit is the sphere, the place of origin, ofgreat dharmas (that is, dharmas of greatextension, that are found everywhere).The dharmas that are inherent in themandbhdmi are called mandbhdmika, that is,the dharmas that are always found in allminds.[it is the sphere, the place of origin, ofdharmas (that is, dharmas of great extension,that are found everywhere). The dharmas thathave a maheibhilmi are called maheibhilmika, that isthe dharmas that are found in every (moment of)consciousness] (AKBh, ii.23c-d, 189).The term, "klegamahäbhamika" thus refers to the mental factors or elements(which are dharma-s) that belong to all moments of consciousness which aretherefore defiled (AKBh ii.23c-d, 189).102In the AKBh, the six dharma-s which are basic defiled consciousness-related elements (klesamahabhamika-s) are: delusion (moha); non-diligence(pramiida); idleness (kausidya); disbelief (agraddhya); torpor (stycina); anddissipation (auddhatya) (AKBh, ii.26a-c, 193). Delusion is defined asignorance (avidyä), non-knowledge and non-awareness (AKBh, ii.26a-cl, 193).Non-diligence (pramäda) is "the opposite [counteractive] of diligence, isthe...non-cultivation of good dharmas" (AKBh, ii.26a-c2, 193). Idleness(kausidya) is the counteractive of energy (vi-rya), which is the endurance ofthe mind (AKBh, ii.26a-c3, 193; ii.25.10, 193; see also note 135 on page 337).Disbelief (tigraddhya), is the counteractive of faith (graddhei), which isvariously defined as: clarity, translucency of consciousness; or, belief and trustin: the doctrine of the results of actions; the Buddha, the Dharma and theSangha; and the four noble truths (AKBh, ii.26a-c4, 193; ii.25.1, 191). Torpor(stytina) is the opposite of dexterity, agility (pragrabdhi) (AKBh, ii.26a-c5,193; ii.25.3, 191). Finally, dissipation (auddhatya) is non-calmness of theconsciousness (AKBh, ii.26a-c6, 194).The second chosen list is composed of the anugaya-s or latentdefilements (AKBh, v.1, 767). Various klega-s may arise from anugaya-swhich are lying dormant and have not been abandoned through the Path(AKBh, v.34, 828). The anugaya-s are thus basically proclivities or latentdispositions of the consciousness (Chaudhuri 1976, 163). Stcherbatsky explainshow these klega-s and anugaya-s affect our moments of consciousness:The elements of moral defilement (klesa) are103always present in a life (santana), in alatent or patent condition. When latent theyhave the form of "residues" (anusaya), theystick to the other elements, pollute them,bring them into commotion and prevent theircoming down to rest. This influence ofthe disquieting elements in life is termed"general cause" (sarvatraga-hetu) becauseit affects the whole of the stream oflife (santana), all its elements becomesoiled. The primary cause of this unhappycondition is "illusion" (avidya), the firstfundamental member in the wheel of life[pratityasamutpada] (1923, 30).From the above discussion, we can now see why delusion (moha=avidya orignorance) is listed first among the klesamahabhamika-s, and also why theBuddhist path places so much emphasis on acquiring wisdom and insight.These are "antidotes" to the klega-s and anugaya-s.There are six basic anugaya-s, although, as stated, other enumerationsare given as well. The six basic ones are: desire (raga); anger or hostility(pratigha); pride (mäna); ignorance (avidyä); false views (drsti); and doubt(vicikitsii) (AKBh,, 768; Chaudhuri 1976, 163). Ignorance and doubthave some overlap with delusion (moha) and disbelief (Caraddhya), on theklesamahabhamika list. It must be remembered though that the anugaya-sare klega-s which are non-manifested, "in a state of sleep,' thus overlapbetween the lists is no cause for concern.It seems only logical that, when so much emphasis is placed on ignorance(moha, avidyet) as a root cause of suffering, unsatisfactoriness, etc. (dulikha),ignorance at least would be acknowledged as both a latent and more active element.104Analysis of the lists of klega-s and anugaya-s immediately revealsthat the elements on the lists are all consciousness-related. If there is anyobvious difference between the two lists (other than, as mentioned above, thedistinction between anugaya-s and klega-s), it would be that the anugayalist seems to include elements that relate more strongly to the emotions--anger,pride, doubt (to a certain extent), and attachment. The klesamaMbhilmika-s,especially as defined in the AKBh, are more strongly cognitive.The klesamahelbhiimika list again shows that this is psychology (if itcan be called that) within a soteriological and religious framework, and thesame holds true for the anugaya list. Guenther has noted though that whilethis is true for lists that consider healthiness and unhealthiness, there are alsolists that give a more purely descriptive and phenomenological view of the mind(1974, 95). An example of such a list would be the consciousness-relatedelements that are said to accompany all momentary states of consciousness(mandbhamika-s): sensation (vedanCt); volition (cetanCt); concepts or notions(samjfiCt); desire for action (chanda); contact (sparga); discernment or wisdom(prajlid); memory (smrti), the act of attention (manasleCtra); approval [faithfulconviction, liking] (adhimukti); and absorption or concentration (samddhi)(AKBh, ii.24.1-10, 189-190). With the exception of prafful and adhimukti,none of these elements are largely religious.The lists we have examined though, do contain elements that stronglyrelate to religious and soteriological goals. Most notable here is the inclusion ofignorance or delusion on both lists. While the lists may be105phenomenological, and in that way might be considered as focussing on theindividual, the fact that these states are said to exist in all defiled moments ofconsciousness, etc., shows a less individualistic approach. General (althoughnegative) moments of consciousness are emphasized in these lists because,having the ideal or Arhat as standard, most "normal" people would have these(defiled) consciousness-related elements. This again relates to the ideas ofseeking transcendence and the acceptance of religious or soteriological valuesand goals in the text.From the phenomenological approach of these lists, one can see that theinternal orientation is very strong here. No behavioral or external elementsare included. These lists focus on the consciousness-related factors or elementswhich arise in the moments of consciousness of people who have not yetreached the ideal state of the Arhat.Summary - Comparison Of The ListsWe have now come to the last part of this study. Having examined thespecific lists and the values and norms that form and/or underlie them, we areready to see if any direct comparison (i.e. identifying similarities) between thelists is justifiable.A surface level comparison of the lists in DSM-HI-R and the AKBhwould indeed show some similarities in items. For instance, diminished abilityto think or concentrate (DSM-M-R, A-8, 222) might be likened to dissipation(auddhatya) or torpor (styana) (AKBh, 26a-c, 193-194). Fatigue or loss of energy106(DSM-III-R, A-6, 222) might be compared to idleness (kausfdya) which is said tobe the opposite of energy (AKBh, ii.26a-c3, 193).However, by doing this type of surface level comparison, one canimmediately see that the only result is a "hash," a mixture of items that, ifthey were examined more closely, within the context of their systems ortraditions, would be recognized as not having any similarities at all. The basicreasons for the lack of similarity in items is, as we have seen repeatedly in thisstudy, that both lists and texts come from very different traditions. Thesetraditions have certain value systems and norms that are quite different fromeach other. The values and norms, along with other factors, influence the textsand their lists. Unless these values and norms are identified, and the listsunderstood within this context, then mistakes such as the "surface levelcomparison" given in the paragraph above, would be all to easy to make.This discussion, however, reflects only one narrow understanding of theword "comparison." If comparison means comparing one item with another,then this is not justifiable. But if comparison means comparing broadstructural similarities and differences, then this is justifiable and possible.Indeed, this entire study reflects this second understanding of comparison. Wehave examined or compared historical backgrounds of the texts, their conceptsof mental health and illness, the values and norms found in the texts as awhole, and in this last section, have identified some of these values and normsin the lists. It is possible then to compare the lists if broad structural107similarities and differences are examined, rather than specific items on eachlist.The specific lists from DSM-III-R and the AKBh have provided goodexamples of the general concepts, influences, values and norms that wereexamined earlier. The diagnostic criteria for a Major Depressive Episodehighlight the values of individualism, rationality, mastery and function, asomewhat external orientation, and a rejection of religious or soteriologicalgoals. The criteria also, quite obviously, reflect the concept of normal, or thenorm, as average. The criteria, as we saw, also showed elements of generalpsychology, behaviorism, and medicine--the three basic influences on the NorthAmerican mental healing tradition.The AKBh lists were also congruent with the concepts, values and normsthat were previously identified. The lists were phenomenological, reflecting aninternal orientation. Unlike DSM-III-R, no behavioral elements were listed.The klega-s and anugaya-s, as defilements, are obviously consciousness-relatedelements or factors that one should strive to transcend. This emphasis ontranscendence, as we saw, is very common in the Indian traditions, and, ofcourse, is due to the presence of religious or soteriological goals. Since we findthat transcendence is the goal, we may conclude that the value-ladenterminology (eg. defilement, idleness, dissipation, etc.) used in the lists, reflectsthe idea that the norm is the ideal. Whatever is not included in this ideal is,indeed, negative and may validly be expressed as such.108There are no clear similarities between the lists, except for the fact thatboth focus on unwanted or aversive mental states which are common to manypeople. Even this bit of similarity must be qualified, for although the criteriafor Major Depressive Episode apply to a great number of people, these people,by definition of the norm as average, form a minority in society and the world.In contrast, the lists of anugaya-s and klega-s would apply to the majority ofpeople who have not attained the ideal norm of enlightenment.109NOTES - THE LISTS1DSM-III-R  defines Mood Disorder as the following:The essential feature of this group of [mood]disorders is a disturbance of mood, accompaniedby a full or partial Manic or Depressive Syndrome,that is not due to any other physical or mentaldisorder. Mood refers to a prolonged emotionthat colors the whole psychic life; itgenerally involves either depression orelation. In DSM-III this diagnostic class wascalled Affective Disorders (DSM-III-R, 213).'Explanations of Manic and Hypomanic Episodes are given in DSM-III-Rand might be useful here as a contrast with the other subclassification of MoodDisorders (Depression).Regarding the Manic Episode, the essential feature is,a distinct period during which the predominantmood is either elevated, expansive, or irritable,and there are associated symptoms of the ManicSyndrome. The disturbance is sufficientlysevere to cause marked impairment inoccupational functioning or in usual socialactivities or relationships with others, or torequire hospitalization to prevent harm to selfor others. The associated symptoms includeinflated self-esteem or grandiosity (which maybe delusional), decreased need for sleep,pressure of speech, flight of ideas,distractibility, increased involvement in goal-directed activity, psychomotor agitation, andexcessive involvement in pleasurable activitieswhich have a high potential for painfulconsequences that the person often does notrecognize. The diagnosis is made only if itcannot be established that an organic factorinitiated and maintained the disturbance(DSM-III-R, 214-215).A Hypomanic Episode includes,a distinct period in which the predominantmood is either elevated, expansive, or irritableand there are associated symptoms of the ManicSyndrome. By definition, the disturbance isnot severe enough to cause marked impairment110in social or occupational functioning or torequire hospitalization (as required in thediagnosis of a Manic Episode). The associatedfeatures of Hypomanic Episodes are similar tothose of a Manic Episode except that delusionsare never present and all other symptoms tendto be less severe than in Manic Episodes(DSM-11I-R, 218).'One could consider in the AKBh, for example, an expanded list of theklegamaheibhamika-s (ii.1, 194); of the anugaya-s (v.3-5d, 772-774); or thewrappings (paryavastMna-s) (v.47-48, 841-843) and the filth of the klega-s(klegamala-s) (v.49c-50b, 844), which are both produced following the klega(upaklega - literally meaning found near the klega) (v.46, 84).4Stcherbatsky, in his analysis of the klegamahäbhiimika-s helps tofurther clarify these explanations and definitions. He defines the termklegamahabhilmika-s, slightly differently, calling them the universallyobscured elements present in every unfavorable moment of consciousness.Stcherbatsky notes that error (moha), as ignorance, is the primordial cause of"commotion" (duhleha--unsatisfactoriness, suffering, etc.) in the world. Hetranslates non-diligence (pramada) as the faculty of carelessness; idleness(kausielya) as mental heaviness and clumsiness; disbelief (dgraddhya) as thedisturbed mind; torpor (styana) as sloth, indolence, inactive temperament; anddissipation (auddhatya) as being addicted to pleasure and sports, or having asanguine temperament (Stcherbatsky 1923, 87).'This is Vasubandhu's own standpoint (Sautrantika) which, in this sectionof the AKBh, is termed the "best" (AKBh, v.1, 770).111VI. CONCLUSIONThis study has focussed on two texts: DSM-III-R, which is aNorth American, largely secular, manual dealing with mental disorders; andthe AKBh, which is a Buddhist text that contains what might be regarded as asoteriological psychology. As consequences of the fundamental differencesbetween the texts, comparisons, and even the use of contextually appropriateterminology, have been difficult. Some North American terminology andcategories have been applied to the AKBh, and this should be avoided if at allpossible in future studies. The difficulty of using contextually accurate andappropriate terminology highlights one of the main problems of comparativework. Nevertheless, in spite of such difficulties and differences, someconclusions from the present study may be drawn.Throughout this study, we have seen that the general topic of mentalillness and mental health in the AKBh and DSM-III-R may be addressed ontwo levels. The first level deals with content--the ideas and concepts of mentalillness and mental health as presented in the texts. The second level is moregeneral and structural--an attempt to unravel the broad factors that form andunderlie list literature. These two levels of analysis continually overlap, whichis interesting in and of itself.If, as has been done in the present study, we restrict the focus on theAKBh and DSM-III-R to (what might be regarded as) concepts of mental healthand mental illness, we find that the contents of these texts are nearly mirrorimages of each other. DSM-III-R identifies and delineates a great variety of112mental disorders. The AKBh, on the other hand offers only brief statementsabout, and lists of, soteriologically negative consciousness-related factors.Conversely, if we presuppose that the Global Assessment Of Functioning Scalein DSM-III-R, and the characteristics of the Arhat in the AKBh, arerepresentative of some states or concepts of mental health, we discover that theAKBh contains a great wealth of information while DSM-III-R contains verylittle.We have also seen repeatedly that the concepts of mental illness andmental health in the texts, whether presented in the form of statements orlists, are formed and/or influenced to a great degree by values and norms. Thisindicates that it may well be impossible to formulate any concept of mentalhealth or mental illness without such influences. If this is the case, then thelargely atheoretical, empirical, and descriptive approach which DSM-III-R aimsto offer, is not necessarily any more accurate or less value-laden than theapproach taken by texts such as the AKBh.The issue of values and norms present in the texts and their concepts ofmental health and illness had great relevance for the second level of analysiswhich dealt with the phenomenon of list literature of this particular kind. Wesaw that, for these two texts, it is methodologically and conceptuallyunjustifiable to attempt a direct comparison of items given in the lists.However, three broad categories of values, which may be regarded as part ofthe structure of the lists, were identified and here some comparison waspossible. These values or structures were: individuality versus self-113transcendence; rejection or acceptance (presence) of religious or soteriologicalgoals; and a basic external versus internal orientation.Of these three, rejection or acceptance (presence) of religious orsoteriological goals accounted for the greatest differences between the texts.This, of course, is because the AKBh contains a soteriological psychology, whileDSM-III-R represents a more secular approach. We saw that this secular orsoteriological approach is linked to basic concepts of the norm (against whichmental illness and mental health are measured) as average (in the case ofDSM-III-R), or ideal (in the case of the AKBh). Lists and concepts of mentalillness and mental health, are both based on some sort of normative concept(s),so here we see the primary reason for this study's overlap in analysis ofcontent and broad structural factors.This final point leads to one last observation about the two texts, theirlists, and their concepts of mental health and mental illness. It is interestingto find that a text such as DSM-III-R, which presupposes the norm as average,focuses overwhelmingly on characteristics of the minority (that is, thecharacteristics, behaviors, etc. of those who are afflicted with mental disorders).Similarly, at least on the topics examined here, the AKBh, which has the idealas the norm or standard, also focuses on characteristics of the minority.However, here the minority might be viewed as representing a state of mentalhealth rather than illness.In this sense, both texts, at least with regards to the areas examined inthis study, may be said to focus on "minority groups." The reason for this is,114undoubtedly, largely due to the perceived scope, mandates, etc. of the texts, aswell as the underlying values and norms that we examined here. However,human nature might also play a role in this, for we--no matter in which cultureor century we live--seem always more curious about those things which are"out of ordinary," as opposed to those which are mundane.115REFERENCESPrimary Sources:American Psychiatric Association. 1987. Diagnostic And Statistical Manual OfMental Disorders. (DSM-III-R) 3d rev.ed. Washington: AmericanPsychiatric Association.Poussin, de La Vallee, trans. 1988. Abhidharmakogabhäsyam. (AKBh)  Englishtranslation by Leo M. Pruden. 3 vols. Berkeley: Asian Humanities Press.Dictionaries:Gage Canadian Dictionary.  1983.Secondary Sources:Akiskal, Hagop Souren, M.D. 1989. "The Classification Of Mental Disorders." InComprehensive Textbook Of Psychiatry/V. Vol. 1. See Kaplan andSaddock 1989.Bayer, Ronald. 1981. Homosexuality And American Psychiatry: The Politics ofDiagnosis. New York: Basic Books.Bromberg, Walter, M.D. 1975. From Shaman To Psychotherapist: A History ofthe Treatment of Mental Illness. Chicago: Henry Regnery Co.Burns, David D., M.D. 1980. Feeling Good: The New Mood Therapy New York:Signet.Chatterjee, Satischandra, and Dhirendramohan Datta. 1960. An Introduction ToIndian Philosophy. 6th ed. Calcutta: Univ. of Calcutta.Chaudhuri, Sukomal. 1976. Analytical Study Of The Abhidharmakoga.  Calcutta:Sanskrit College.Clausen, John A. 1968. "Values, Norms, and the Health Called `Mental;'Purposes and Feasibility of Assessment." In The Definition and Measurement of Mental Health. See Sells 1968.Conze, Edward. 1951. Buddhism: Its Essence and Development. New York:Harper and Row.1161967. Buddhist Thought In India: Three Phases Of Buddhist Philosophy.Ann Arbor: Univ. of Michigan Press.Cooper, Arnold M. 1987. "Histrionic, narcissistic, and compulsive personalitydisorders." In Diagnosis and Classification in Psychiatry. See Tischler1987.Demieville, Paul. 1985. Buddhism And Healing: Demieville's Article "By6" from HeibOgirin. trans. Mark Tatz. New York: Univ. Press of America.Ehrenwald, Jan, M.D., ed. 1976. The History Of Psychotherapy: From HealingMagic to Encounter. New York: Jason Aronson Inc.Fancher, Raymond E. 1979. Pioneers of Psychology. New York: W.W. Norton.Freedman, Alfred, M.D., Richard Brotman, Irving Silverman, and DavidHutson, eds. 1986. Issues In Psychiatric Classification: Science, Practiceand Social Policy. New York: Human Sciences Press.Fromm, Erich. 1955. The Sane Society. New York: Fawcett Premier.Guenther, Herbert V. 1974. Philosophy And Psychology In The Abhidharma.2d ed. Delhi: Motilal Banarsidass.Halbfass, Wilhelm. 1991. Tradition and Reflection: Explorations in IndianThought.Haldar, Aruna. 1981. Some Psychological Aspects Of Early BuddhistPhilosophy: Based On Abhidharmakaa Of Vasubandhu.  Calcutta:Asiatic Society.Hiriyanna, M. 1949. Essentials of Indian Philosophy. 3d ed. (1985). London:George Allen & Unwin.Johansson, Rune E. A. 1969. The Psychology of Nirvana. London: George Allen& Unwin.---. 1978. The Dynamic Psychology of Early Buddhism. Scandinavian InstituteOf Asian Studies Monograph Series No. 37. Oxford: Curson Press.Jones, W. T. 1970. The Classical Mind: A History of Western Philosophy.  2d ed.New York: Harcourt Brace Jovanovich.117Kaplan, Harold I., M.D., Alfred M. Freedman, M.D., and Benjamin J. Saddock,M.D., eds. 1980 Comprehensive Textbook of Psychiatry/III. 3d ed. 3 vols.Baltimore: Williams and Wilkins.Kaplan, Harold I., M.D., and Benjamin J. Sadock, M.D. eds. 1989Comprehensive Textbook Of Psychiatry/V. 5th ed. 2 vols. Baltimore:Williams and Wilkins.Kaplan, Marcie. 1983. "A Woman's View of DSM-III." American Psychologist: Journal of the American Psychological Association. Vol 38. #7.Kende11, R. E. 1986. "What Are Mental Disorders?" 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New York: Plenum Press.Paranjpe, Anand C., David Y. F. Ho, and Robert W. Riber. eds. 1988. AsianContributions To Psychology. New York: Praeger.Pasamanick, Benjamin, M.D. 1968. "What is Mental Illness and How Can WeMeasure It?" In The Definition and Measurement of Mental Health. SeeSells 1968.118Poussin, Louis de La Vallee. 1913. "Introduction." InAbhidharmakogabhäsyam. Vol. 1. See Poussin 1988. engl. trans. LeoM.Pruden.---. 1925. "Forward." In Abhidharmakogabhäsyam. Vol. 3. See Poussin 1988.engl. trans Leo M. Pruden.Pruden, Leo M. 1988. "Origin and Growth of Abhidharma." InAbhidharmakogabhasyam. Vol. 1. See Poussin 1988.Rao, S. K. Ramachandra. 1962. The Development Of Psychological Thought InIndia. Mysore: Kavyalaya Publishers.Reat, N. Ross. 1990. The Origins of Indian Psychology.  Berkeley: AsianHumanities Press.Reisman, John M. 1991. A History Of Clinical Psychology. 2d ed. New York:Hemisphere Publishing.Rothblum, Esther D., Laura J. Solomon, and George W. Albee. 1986. "ASociopolitical Perspective of DSM-III." In Contemporary Directions inPsychopathology: Toward The DSM-IV. See Millon and Klerman 1986.Safaya, Raghunath. 1975. Indian Psychology. New Delhi: MunshiramManoharlal Pub.Sartorius, Norman, Assen Jablensky, Darrel A. Regier, Jack D. Burke, Jr., andRobert M. A. Hirschfeld. eds. 1990. Sources and Traditions ofClassification in Psychiatry. Toronto: Hogrefe and Huber Publishers.Sells, S. B. ed. 1968. The Definition and Measurement of Mental Health. U.S.Department of Health.Spitzer, Robert L., M.D., and Janet B. W. Williams. 1987. "Introduction." InDiagnostic And Statistical Manual Of Mental Disorders.  See AmericanPsychiatric Association.Stcherbatsky, Th. 1923. The Central Conception Of Buddhism: And TheMeaning Of The Word "Dharma".  3d ed. (1961). Calcutta: Susil Gupta.Stern, Richard S., M.D., FRC Psych., and Lynne M. Drummond. 1991. ThePractice of Behavioral and Cognitive Psychology. Cambridge:Cambridge Univ. Press.119Taylor, Eugene. 1988. "Contemporary Interest In Classical EasternPsychology." In Asian Contributions To Psychology.  See Paranjpe et. al.1988.Tischler, Gary L., M.D. ed. 1987. Diagnosis and Classification in Psychiatry.Cambridge: Cambridge Univ. Press.Warder, A. K. 1970. Indian Buddhism. Delhi: Motilal Banarsidass.Wig, N. N. 1990. "The Third World Perspective on Psychiatric Diagnosis andClassification." In Sources and Traditions of Classification.  See Sartoriuset al. 1990.Yager, Joel, M.D. 1989. "Clinical Manifestations Of Psychiatric Disorders." InComprehensive Textbook Of Psychiatry/V. Vol. 1. See Kaplan andSadock 1989.120APPENDIX IDiagnostic Criteria For Major Depressive Episode(DSM-III-R, 222-223)Note: A "Major Depressive Syndrome" is defined as criterion A below.A.^At least five of the following symptoms have been present during thesame two-week period and represent a change from previous functioning;at least one of the symptoms is either (1) depressed mood, or (2) loss ofinterest or pleasure. (Do not include symptoms that are clearly due to aphysical condition, mood-incongruent delusions orhallucinations,incoherence, or marked loosening of associations.)(1) depressed mood (or can be irritable mood in children and adolescents)most of the day, nearly every day, as indicated either by subjectiveaccount or observation by others(2) markedly diminished interest or pleasure in all, or almost all activitiesmost of the day, nearly every day (as indicated either by subjectiveaccount or observation by others of apathy most of the time)(3) significant weight loss or gain when not dieting (e.g., more than 5% ofbody weight in a month), or decrease or increase in appetite nearly everyday (in children, consider failure to make expected weight gains)(4) insomnia or hypersomnia nearly every day(5) psychomotor agitation or retardation nearly every day (observable byothers, not merely subjective feelings of restlessness or being sloweddown)(6) fatigue or loss of energy nearly every day(7) feelings of worthlessness or excessive or inappropriate guilt (which maybe delusional) nearly every day (not merely self- reproach or guilt aboutbeing sick)(8) diminished ability to think or concentrate, or indecisiveness, nearlyevery day (either by subjective account or as observed by others)(9) recurrent thoughts of death (not just fear of dying), recurrent suicidalideation without a specific plan, or a suicide attempt or a specific planfor committing suicideB. (1) It cannot be established that an organic factor initiated and maintainedthe disturbance(2) The disturbance is not a normal reaction to the death of a loved one(Uncomplicated Bereavement)Note: Morbid preoccupation with worthlessness, suicidal ideation, markedfunctional impairment or psychomotor retardation, or prolonged durationsuggest bereavement complicated by Major Depression.121C. At no time during the disturbance have there been delusions orhallucinations for as long as two weeks in the absence of prominentmood symptoms (i.e., before the mood symptoms developed or after theyhave remitted).D. Not superimposed on Schizophrenia, Schizophreniform Disorder,Delusional Disorder, or Psychotic Disorder NOS.


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