My Practice Without Meds

After years of treating her depression with medication and therapy, Kiera Van Gelder turned to Buddhist practice to heal.

By Kiera Van Gelder

Illustration by Kim Scafuro.

When I lived at the dharma center, I slept in a room directly above the kitchen. Our center also had a meditation hall, a shrine room and a dining room on the bottom floor, but it was here, in my room above the kitchen, that I felt the deepest pulse of the community. In the mornings, the smoke offering seeped into my dreams, along with rhythmic chanting as a housemate with a melodic voice started her day. At night, I could hear the lama and other residents preparing food. The smell of sweet sautéed onions drifted up though the old floorboards, along with laughter and the occasional scrape of chairs and rattle of dishes.

An old, tarnished cowbell heralded dinner, and my typical response had been to burst from my room, moooo-ing like a hungry cow. Not anymore. Now it was hard to move from my bed. As soon as I came home from work, I crawled under the covers with the lights off and lay there, alternately sleeping and listening to the humming of the household. Shortly after the cowbell there was a knock at the door. A housemate, Sophia, wanted to know if I was coming down. I declined. Still under the covers, I listened as the voices receded into the dining room, and then the silence of the empty kitchen pulled me down into another long, aching sleep. When I woke up to go to the bathroom, I discovered a tray with dinner outside my door, and a small flower in a vase. I started to cry because I was hungry, but I couldn’t enjoy the food my sangha gave me.

I wasn’t ungrateful; I was depressed. Six months into my stay at the dharma center, I had decided to go off all my psychiatric medication. Despite my best efforts, my attempt at “unmedicated spirituality” was a spectacular failure. Yet I did everything right! I researched the withdrawal process and worked with a psychiatrist to titrate down, milligram by milligram, each of the pills. It had taken months to accomplish this. With each reduction of the chemicals, I increased my practices: an hour of yoga, an hour at the gym, daily mindfulness meditation and prayer, eating only whole foods, going on retreats. To help my brain, I added nutritional supplements, and with the direction of an herbalist, took pungent capsules that made my burps taste like compost.

Between all that and an acupuncturist, I spent more money in those six months than I had in a decade of intensive therapy. And it would have been worth every penny, had I not fallen between the cracks of Buddhism and psychiatry to such a degree that I was not only depressed and racked with anxiety, but suicidal again. And every time I walked out my bedroom and into the sangha, I felt like a failure.

“Personally, I don’t use medication, I use the dharma,” Sophia had said when I first told her of my decision to get off the drugs. She had assured me that it was working just fine for her. We were in the kitchen washing lettuce and making sure no little bugs got squashed in the process, and I had been slightly buoyed by her confidence; indeed when I was able to drag myself out of my room and participate in the practices with the sangha or listen to a teaching, I got a small charge, like a spiritual cup of coffee. Only it didn’t last.

There were many reasons I had decided to go off all meds: I’d been taking psychotropic drugs for more than a decade, and while the reasons for using them were legitimate, I worried about their long-term effects on my health. I was unhappy with some of the side effects. As I identified more seriously with Buddhism, I wanted to physically and conceptually distance myself from my past as a mental patient, and to align myself with the natural, holistic lifestyle I craved and believed was most authentic. My greatest motivation was the hope that Buddhist practice would show me the core of my afflictive emotions and mental distortions. Taught by my teachers that all thoughts and emotions were transitory and without substance, it had only made sense that I take off the training wheels and experience my mind in all its raw, naked power. Yet now, without the medication, I was more hostage than selfliberator and I’d come to a grand impasse: how could I be free from suffering when my mind naturally reverted to a state of self-destruction when left to its own devices?

This question haunted me as I sat in bed in the dark, forcing myself to eat cold stir-fry. And I wanted to know: Had I failed in practicing the dharma? Or had my Buddhist practice failed to help me? And if I returned to the drugs, would I ever discover my true buddhanature?

I came to Buddhism because I suffered and I wanted to stop suffering. Yet I didn’t initially seek out the dharma. One day in my early thirties, I found myself sitting in a quiet circle in a room while a woman at the front struck a metal bowl with a wooden dowel and told us to listen to the sound with our full attention. She had us follow our breath as we inhaled and exhaled, and gently reminded us to let go of any thoughts that arose. All these exercises were part of what she called “mindfulness,” and we did them doggedly week after week. In time I’d understand they were practices done daily in thousands of Buddhist communities, but my entranceway to the Buddhist path was not through a sangha. It happened when I was a patient at a mental hospital and my teacher was a psychiatrist, not a lama.

Some people are surprised to hear that psychiatric wards and therapy groups are breeding grounds for dharma practice, but when you think about it, what more logical place for the dharma to take root than where emotional and mental suffering is overwhelming and pervasive? Back in 1974, when Chögyam Trungpa Rinpoche declared to Daniel Goleman, then a Harvard psychology professor, that “Buddhism will come to the West as a psychology,” he foresaw that our deepest suffering would come dressed in the clothes of mental illness. And true to his words, in the past decade Buddhist practices and mental health therapies have increasingly joined forces. My introduction to mindfulness came through a type of psychiatric therapy called Dialectical Behavior Therapy (DBT), developed by Zen practitioner and psychologist Marsha Linehan. Other people find their way to the dharma through pain and stress management therapies such as Mindfulness-Based Stress Reduction pioneered by another Buddhist, Jon Kabat-Zinn, or through Mindful Self-Compassion therapy, developed by psychologist Christopher Germer, a Vipassana meditation practitioner.

The umbrella term for all these approaches is mindfulness-based therapy and what is so revolutionary about them, and what leads participants toward Buddhism, is their emphasis on acceptance, nonjudgmental awareness, and mindfulness of the present moment. My training in a mindfulness-based therapy taught me, after decades of talk therapy and six different psychiatric diagnoses, to successfully learn how to live with overwhelming pain and to manage my urges for self-destruction. After therapy ended, I wondered: “What next? Where can I further my recovery and continue to use the soil of my suffering to grow and help others?” It was then that I opened to the dharma. First intellectually, through books and audio tapes, then interactively though meeting teachers and joining a sangha. I came to Buddhism like an aching body inches into a hot bath: first my toe, then my leg, until I wanted total immersion. So I moved into a dharma center. While some of the language and the practices of Buddhism differed from what I was used to in therapy, the overall picture remained constant. I suffered; there were causes for my suffering; there were ways to be free from this suffering, and I was treading the path that would accomplish this.

Until I went off my medications.

Close to a year into my stay at the center, disturbing news arrived: One of our longtime members, who went rogue shortly after I arrived, was discovered dead in the woods of Vermont. A suicide. I’d met the young man only twice and he showed no signs of depression or self-destruction. He’d refused, however, to visit the center’s new residence; he insisted it was possessed by evil spirits and angry energies. Granted, it was an old building, with its double pantry and creaky servant’s staircase and an inherited out-oftune upright piano still wedged among the dining room’s mahogany and glass cabinets. But there were also ordained lamas, and the house was filled to capacity with the bright treasures and accoutrements of a full-bodied Tibetan shrine, providing most people with a sense of peaceful enclosure, if not outright protection.

We knew only certain facts: The young man’s suicide letter described evil spirits pursuing him all the way to Mexico, where he’d traveled to find some means of exorcism. Having failed at that and still tortured and hounded, he returned to the woods by his home to die. People at our center wondered how he could have done it. He was obviously in pain, but he was also a longtime practitioner who believed in the law of karma, who understood that the act of killing would result only in more suffering. In the Vajrayana tradition especially, there is a special class of hellishness reserved for those who kill themselves. No one in their right mind believing this could still be willing to die.

We all had our theories: Some felt he was spiritually delusional; they claimed the house was filled with protective, not harmful, deities. They pointed to the many blessings that visiting teachers had bestowed on the space, and the morning smoke offerings that worked to appease harmful spirits, especially the water serpents called nagas that lived downwind of us in the local lake. Other members felt he’d delved too deeply into the “secret” and “hidden” practice of Vajrayana without guidance, and had unleashed energies that wreaked havoc on him. Others thought, in retrospect, that he could have used more therapy and possibly some newfangled antipsychotics.

As a novice to the Tibetan tradition, I was still trying to learn the visible things, such as hand mudras. Talk of energies and deities and multiple world systems didn’t sit well with me. I had come into the tradition without the associated Tibetan culture, and gave talk of the invisible things a wide berth. Viewed from the outside, Vajrayana Buddhism’s complex amalgam of symbolism and ritual can easily come across as superstitious and dogmatic until it’s understood that all techniques are for the purpose of going beyond them. Without that understanding, the talk of wrathful deities, wisdom nectar, and house purifications sounds an awful lot like Catholicism on acid. It especially doesn’t translate easily into Western psychiatric disorders. In the case of our sangha-mate, the nature of his suffering stood in the cross hairs of dharma and psychiatry. He believed in the power of invisible but sentient forces, but so did many of the lamas and practitioners in the community. Who was to say one was spiritual, and the other not?

It wasn’t surprising to me that we had many different opinions about the cause of his suicide. The dismay I carried with me afterward resulted more from our reluctance as a community to investigate our own role in the situation; how we—students, teachers, and a lineage itself— might prevent this from happening in the future, even if nothing could have been done about our young man. We avoided the question of how the Vajrayana vehicle could help or hinder someone with severe mental illness, and by extension, how the Buddhist practices themselves have been able to directly address this pervasive form of Western suffering. If Buddhism is entering our culture as psychology, as Trungpa Rinpoche foretold, to what degree will it also engage with the full spectrum of our psychological ills?

Whenever I came down from my room— disheveled, cranky, unmedicated, wanting nothing more than coffee and a quiet place to brood—my housemates understood that I struggled in ways beyond the usual bad mood. In fact, the sangha was unquestionably the most supportive and understanding community in my life. No matter how I’d berate myself for being deeply disturbed, they lovingly translated my self-disclosed psychiatric symptoms into a Buddhist vernacular that made each suffering—from addiction to anxiety to rage to self-hatred—a symptom of being human with a corresponding antidote, teaching me gentle and spacious ways of approaching myself.

At other times, however, the intractability and often-biological basis of my illness collided with well-meaning generalizations. To hear, in the midst of a psychiatric crisis, that “all is emptiness” and “what you feel is ultimately transitory,” or to be told “this is a way to purify your negative karma,” leaves those of us in the throes of such a crisis alienated and with the rawness of our distress untended.

Like so many others suffering emotionally, I’m drawn to the idea of the Buddha as doctor, the dharma as medicine, and the sangha as nurses and helpmates. The question that we, and I, don’t know how to address directly concerns the exact nature of psychiatric suffering and what “skillful means” are necessary to work with it. If any of us developed stomach cancer, no one would suggest prostration practice as the highest means of cure. But when brain chemistry and emotional suffering interact, the dharma immediately runs the risk of becoming a fuzzy, if not fatal, misapplication. With the best of intentions, I had misapplied the teachings to myself because I was adhering to an ideal, and often following others’ opinions, without reference to myself.

So I went back on my meds.

No one judged or chastised me; again, the sangha supported my effort. Indeed, if anyone treated me punitively, it was myself. Occasionally I still feel it—the same hovering sense of failure that arose as I became more questioning of the dharma in its traditional applications—as I move from one community to another, toeing the line between faith and doubt, tradition and innovation, medicine and spirituality.

I know I am not alone in this. This is the dilemma of our current times. We are not “lamas in the lab” but people in the midst of “full catastrophe living,” in the words of Kabat-Zinn. Deeply worn down from a life of chronic stress and constant change, our mental illness or just plain neurosis has its own quality and dimensions. Thich Nhat Hanh, the Vietnamese monk and teacher, cautions there are more factors to suffering than simply attachment. “To say ‘Life is suffering,’ is too general… We need to say, ‘The basis for this suffering is such and such an affliction,’ and then call it by its true name. If we have a stomachache, we need to call it a stomachache. If it is a headache, we need to call it a headache. How else will we find the cause of our suffering and the way to heal ourselves?”

It’s important to know what we experience, in all its formal and informal components, even if the antidote involves dismantling each part back into emptiness. To do this, the changing nature of Buddhism will involve teachers and students looking directly at the illnesses of the Western mind, not simply translating our illnesses into another framework. Buddhism is not only entering the West through psychology, but psychology, as its come to describe our emotional and mental suffering, is entering Buddhism.

Some of the most compelling images of wise and compassionate activity come from the Vajrayana tradition, such as the luminous thousandarmed Chenrezig, whose many arms reach out not only because of the pervasiveness of our pain, but because we all differ in our conditions of it. The exquisite Green Tara possesses numerous eyes, on hands, feet, and forehead, signifying that her wisdom sees in all directions. For those of us who seek to embody these qualities, it’s our responsibility as well to see in all directions and to reach for skillful means in all its forms so we can help ourselves and others.

For me, it is medication that allows me to be more fully human, and without it, I cannot practice. For another, this may not be true. But so long as we continue to work with the mind in all its manifestations, the four truths—we suffer, there are reasons for it, there are solutions, and there is a way to apply them—cannot be bound to absolute answers. It will be the questions and our willingness to ask them that will deepen our practice, and allow us to help each other.

Kiera Van Gelder

Kiera Van Gelder is an artist, educator, and mental health activist. She is the author of the recently published memoir The Buddha and the Borderline: My Recovery From Borderline Personality Disorder Through Dialectical Behavior Therapy, Buddhism, and Online Dating (New Harbinger Publications).