Sylvia Boorstein has made a reputation in the Buddhist world as a master of lovingkindness and a bearer of joy, a virtual walking anti-depressant. We sat down with her to discuss her views on the pros and cons of antidepressant medications for meditators. Boorstein is a vipassana teacher, a psychotherapist and a storyteller. She is a senior member of the Spirit Rock Teachers Council and a writer of many articles and books, including Happiness Is an Inside Job, Pay Attention, for Goodness’ Sake and It’s Easier Than You Think. In our conversation, she talked about the challenges in meditation when one is stuck in personal emotional struggles, and she told us about her own early experience with grief. As usual, her message was uplifting and full of common sense.
Inquiring Mind editors Barbara Gates and Kevin Griffin met with Boorstein in March at Spirit Rock Meditation Center.
Inquiring Mind: You have been teaching many years and you’ve worked with many students, some of whom have been on antidepressants. We’d like to discuss how medication has been helpful and how it might not have been helpful. In your assessment, what impact have antidepressants had on your meditation students and on the meditative process?
Sylvia Boorstein: Let’s start with an anecdotal report. I have a friend, a man I met at my first retreat thirty-five years ago. His father had struggled all his life with cycling depressive episodes and my friend, when he became an adult, began to experience them as well. In the early days of our retreat practice, he told me, “It’s been very helpful for me to have these techniques of mindfulness, because I can see when my mind is starting to cycle down. I tell myself, as Dr. Seuss used to say, ‘Here comes my mid-winter jicker.’ I cut back my hectic schedule and make sure to leave a lot of open time to rest or do whatever I need to take care of myself. I don’t give myself a bad time about having the depression. I know it is in my genes and I know it will pass.”
When selective serotonin reuptake inhibitor (SSRI) antidepressants became available, his doctor recommended them. He told me they had changed his meditation. He said, “I used to use my meditation to manage my depression, but now that my mood is steadier I don’t need to. I can relax. Sometimes, when I meditate, I feel such great ease of mind I think, ‘This is the Third Noble Truth. Peace is possible.’”
He also said, “It seems to me that I’m starting my meditation practice now where other people start, that I’ve leveled the playing field.” I thought that was an apt way to put it. We practice in order to see fundamental truths—that things come and go, that we are all interconnected, that form is emptiness, that everything is contingency, that struggling is always suffering. These are the spiritual insights that we all share. We all have personal insights—“my mother this” or “my father that”—but they are idiosyncratic to each person. People come on retreat to have a spiritual awakening, not for psychotherapy.
IM: Despite the benefits that some people report taking antidepressants, some still worry that there is a contradiction between taking an antidepressant and being a meditator.
SB: Yes, I’ve heard many people ask, “Can I take the Buddhist precepts and still be on these drugs?” On the first night of retreats, participants vow to follow ethical precepts that include abstention from drugs. Sometimes they think, “Wait a minute—what about my Prozac?”
The Buddha is said to have counseled, “Take the medicines you need.” I think of the SSRIs, the most commonly prescribed treatment for depression, as medicines. I do not think of them as drugs. As teachers, we could be more explicit that, when we offer the precept, “I am not going to take drugs or intoxicants,” we mean alcohol or recreational drugs. We counsel participants to take all of their prescribed medicines. Someone who has chronic esophagitis has to take Prilosec every single day whether or not he or she is on retreat. Diabetics take insulin every day because their pancreas doesn’t function in a way that maintains healthy sugar levels. The same goes for medicines like SSRIs that help to balance mood.
IM: Aside from the impact on a person’s ability to keep emotional balance, what are other potential impacts of SSRIs on one’s meditative life? Take, for instance, one’s ability to concentrate in meditation?
SB: In my observation, taking these medicines often makes it easier for people to concentrate. Their minds are not distracted by their discomfort. They have more mental energy available for practice. After people have been taking a medicine like Zoloft or Prozac, Lexapro or Celexa, they often say something along the lines of, “I feel like somebody washed the windows of my eyes. Somehow my world seems clearer.” This makes sense to me. When the mind is not preoccupied with inner angst, it’s able to have greater appreciation of the world around and within.
Of course, SSRIs are not just for depression; sometimes they are prescribed for people who have panic attacks or high anxiety that impacts their ability to stay in relationships or in jobs, because they lose their tempers so easily. Medications can sometimes modulate these painful emotional states. Some people report that although the medicines are effective in modulating afflictive emotions, they feel uncomfortable. They lament not feeling as intensely, and say, “I feel that my emotions are blunted, not so available. I don’t feel my feelings as deeply.” Sometimes people decide to discontinue these medicines for that reason. For others, the relief they experience from the medicines offsets their dismay about their attenuated feelings.
IM: If practice is to address “what is,” including our suffering, are we possibly sidestepping that with SSRIs? If your emotions are flat or blunted from taking an antidepressant, mightn’t that sometimes impede the progress of insight? If you didn’t feel the pain of sadness, the intensity of anger or terror, how would that affect your possibilities for transformation?
SB: I’ll have to contemplate that, look at my own experience. At one point, I did go through a very hard time. When my mother died, I was twenty-three years old and I had two young children; it was a huge event for me. But I put her death out of my mind. Three years later, coincident with the birth of my fourth child, I began therapy because I was suddenly feeling overwhelmed by anxiety. I probably had what now would be diagnosed as a postpartum depression. In the safety of that therapy, I realized how much I missed my mother, how dear my children were to me, and how much I dreaded being separated from them. The transformational part of the therapy was a year or two into it when I really connected with how desperately grieved I was about my mother’s death. With the support of a compassionate witness, I was able to face, and talk about, the truth that we lose everything. I couldn’t figure out how people, knowing that everything dies, are able to continue to live their lives.
That was fifteen years before I met the Dharma. My essential question had become in essence a Buddhist question—how we can continue in this life knowing there is old age, sickness and death. That is everybody’s existential question. I kept thinking, How come all of my friends aren’t talking about this? So when I went to a Buddhist retreat and they talked about old age, sickness and death, I never left.
IM: Do you think you needed to be able to contact the grief from your mother’s death in order to eventually have transformative insight about impermanence? If you had taken an SSRI, might that have blunted your experience of the anxiety and the underlying grief?
SB: That’s a tough question. I didn’t take medicine because I wasn’t offered any. There wasn’t any to offer. I turned to talking therapy. Looking back, I sometimes am glad that they didn’t have any other way, any other recourse. After all, it was a powerful introduction to the truth of dukkha that I could not ignore. On the other hand, maybe even with medicine it would have been the same wake-up call but not as agonizing. I’d always, even as a child, thought a lot about death and losing people. My mother’s death brought that anxiety to a head. I think sooner or later, I would have had to pay serious attention and when I met the Dharma, I would have recognized it as my path.
I think that the people who dedicate themselves to practice, whether they’ve been bereaved in their young life or not, are people who know that there is in life a fundamental question of brokenness. Sometimes a shocking experience, a dire diagnosis, a battlefield in war, shakes the mind into alertness. A person realizes, “Wait a minute. There has got to be some way to know this and still live.” I am convinced that being able to deeply acknowledge my own suffering, and through it the universal truth of suffering, is what develops compassion. When I can connect with the pain (or joy, because that’s part of life too) I am liberated from the confines of self-preoccupation. Connecting with others requires a certain amount of balance in my mind. When I am overwhelmed by strong emotions, my ability to connect is held captive. To be able to look out into the world and genuinely realize that everyone is suffering—not because they don’t have enough to eat or they are the victims of wars, but because of the ubiquitous nature of never-ending desire—to see this insight profoundly takes balance.
IM: I am still wondering whether insight into the universal might be less likely to come to a person whose feelings are “blunted” by medicines. Just to play devil’s advocate, I remember interviewing Stephen Levine many years ago when he talked about the movement from my pain to the pain. He described a dying woman who was in physical pain, and how she moved from being consumed with her pain to connecting with all people everywhere who were suffering pain. It seems to me that this woman had to truly experience her pain in order to connect with the pain.
SB: I agree. As I mentioned earlier, entering into our emotions allows us, I think, to connect empathetically with all beings in the realization that they feel as we do. Empathy is the basis for true compassion. When I said that balance was necessary in order to feel emotions strongly and not be overwhelmed by them, I should have added that equanimity in the mind is sustained by wisdom, which we hope to develop through practice. Equanimity is supported by knowing: that everything passes, that struggling with what cannot be changed is suffering, and that everything is lawfully caused. Think, for example, of times that we might say “take a breath” to someone experiencing terrible pain. If the person can take a breath, paying attention to that instruction for a moment, the pain is mitigated. Knowing that pain is not solid is a relief. My sense of the role of SSRIs is similar. When the pain of depression or anxiety is confusing to the point of overwhelm, appropriate medicine can rescue the mind from painful self-preoccupation. Paying attention on behalf of insight and wisdom becomes possible.
Here’s an example of a mind able to feel deeply and not be overwhelmed by the pain. In the early 1990s, I went to Lucknow, India, with James Baraz to meet the Advaita master Punja-ji. James was playing a tape recording of a young child describing life as a mystery. It was a touching recording that a lot of people we knew were listening to at the time. James loved it, so he played it for Punja but Punja could not hear it clearly. So James played it again, one line at a time, stopping the tape recorder and translating for Punja. When James finished the last line and said, “It’s a mystery,” Punja burst into tears. So fifteen or twenty of us were all sitting there with Punja crying away, face in his hands, cry, cry, cry, cry, cry, cry, cry. Then, suddenly, Punja sat up and looked at someone and said, “Were you able to change your train tickets to Benares yesterday?” His emotion was there and then it wasn’t there. It was an amazing moment. He felt something deeply and then he was finished. I was impressed.
One of the ways to describe wisdom (and psychological health) is malleability of mind, a mind that absorbs shock. You hear some news and feel profoundly saddened. You hear something else and you’re really tremendously elated. The healthy mind has a kind of a natural resiliency. Maybe there is some way that we can talk about those particular medicines that regulate the serotonin uptake of the mind as medicines to allow the mind—really the brain—to have its normal malleability so that it is not so easily shocked.
I notice I was using the word brain. Maybe it’s because I think the SSRIs are really medicines for the brain. And Dharma is a medicine for the mind.
IM: As we finish up, you seem to have been suggesting that, much as SSRIs can help our resiliency in resuming balance, they can’t relieve us from the First Noble Truth. I remember a story about the writer Flannery O’Connor who was asked if to be a novelist you had to suffer. She said that anybody who has survived adolescence has suffered enough.
SB: Adolescence is certainly a time that precipitates an awareness of the existential dilemma as an extension of the challenges of young adult life. But apart from developmental challenges— adolescence, parenthood, vocation, etc.—the end of suffering that the Buddha promised addressed the universal challenge of acknowledging inevitable loss, never-ending desire, and the pain in the mind that cannot accommodate the truth of its changing experience. I think the question of taking medicines (or not) can be part of the larger consideration, “What will support the development of wisdom?” Then everything that enhances insight could be included as valuable. Developing concentration, and mindfulness, and effort are supported by living ethically and choosing healthy lifestyles that support clarity. This could include exercising the body, eating food that fosters health and alertness, and taking appropriate medicines. I think the operative question to ask oneself with any choice (should I do this or not do it?) is, “Toward what end am I doing it? What do I hope will happen?” And, having chosen, or not chosen, any particular action, one needs to weigh the consequences: “Is this helping me move toward my goal of freedom?” With antidepressants, since they are not vital to sustain physical life (as, for example, insulin is), in the end it is everyone’s personal choice. Choosing becomes a practice too.