Meditation in a psychiatric hospital setting.

 This is an extension of another blog post I read from Ven. Thubten Jigme on the same subject. https://thubtenchodron.org/2016/12/rebalance-calm/   This one however is from the trenches. 
I actually work at a psychiatric hospital teaching meditation as an activity therapy. 
In May of 2022 I began at Denver Springs Mental Health Hospital.  Denver Springs is an inpatient facility that provides 'evidence-based, transformational care for a broad range of mental health and addiction concerns in a compassionate, comfortable environment' (From denversprings.com).  Facility has four wards with almost 100 beds.  It serves in one unit, 'Sunrise', children with acute mental health issues from the ages of 12 to 17, a second unit, 'Willows' for adults in the same predicament.  Then there is 'Cedars' for detoxification and addiction and finally the "Heroes" unit called 'Meadows' for active and retired military, police, fire, first responders and medical staff.  
The mission of Denver Springs is 'Changing People's Lives'.  and is its registered motto. 
The vision is to transform the delivery of behavioral health services and provide a solution to the largest challenge of this generation, access to mental health care.  Specifically by;
   

• Engage with patients, families, employees, communities, healthcare providers, and health insurers to increase access to behavioral healthcare

• Provide a continuum of care that delivers the right care, in the right place, at the right time, at the right cost

• Partner to integrate behavioral and medical healthcare to improve the health of populations and reduce the per capita cost of healthcare

• Be nationally known for providing high quality, consistent, evidence-based, and innovative care  

• Decrease suicide rates, decrease addiction-related deaths, reverse the decline in life expectancy, and improve productivity in the communities we serve

• Destigmatize mental illness and addiction, which are conditions that transcend race, gender, age, and socioeconomic class

Denver Springs' values (which I have on the back of my ID badge to work at the hospital are to...
We serve as compassionate healers for those suffering from mental illness and/or addiction
We respect patients, families, co-workers, and our communities
We provide a safe environment for our patients, employees, and visitors
We deliver quality services as defined by nationally recognized metrics and outcome measures

We strive for continuous improvement in all that we do
Compassion
Respect
Safety
Quality
Innovation

So what is it like working there? 

I teach in each of the wards once or twice a week.  I offer guidance as a secular meditation teacher even though I was classically trained by Buddhist monks and ordained as a lay priest in 2006.  I have taught, practiced and learned in Sri Lanka, Thailand, Japan, North Vietnam and the United States. 

I focus on the basics of Buddhist teachings and weave them into the practice in a way that does not alienate or trigger those whom are either agnostic, Christian, Muslim, Hindu, Jewish or even Buddhist.  Meditation is indeed found in each of these practices and not too far from Buddhist practice as I have observed and studied over the past 35+ years.

I focus my teachings on a few basic concepts of meditation and mindfulness; Observing the breath and mind patterns, empathy and compassion, the body scan, gratitude and unattachment.  

Sometimes the class is filled with motivated people that want to get better and find a new way to interact with their minds and the world using meditation as a possible tool.  Other times there are disturbances from some that are too ill at the time to practice or begin to find difficulty in sitting or being still during a session.  This is why I break the classes up into small bite-sized bits, focusing on returning to the breath, the realization and return to practice after a disruption and being intouch but not overtaken by the mind. 

In the class I often tell them the benefits of working together and practicing that way.  The mind is a rough neighborhood, I tell them, best to go with some backup.  

Although nearly all of the people I teach or guide have had some experience with meditation and mindfulness it is important that I start from the beginning each time.  Some used apps like 'Calm', 'Insight Timer', 'Headspace' etc. and others were exposed to the practice by teachers and therapists but few continued on with a practice. 

For that reason, I started holding classes at my private office.  Not necessarily for the people that attended Denver Springs but for anyone else that is interested.  I found quickly the only difference in the reasons TO meditate were in the location.  

The 10 things that slow your practice and their remedies.

The ten things that slow your practice and ability to find peace.  These are also things that can get in the way of (i.e. hinder) of your progression in pracatice.  

These are called he hindrances or fetters.  Fetter is like a shackle, you are bound to it and cannot move easily with them on.  A hindrance is something that slows your progress as well, like mud can hinder your movement.  They are kind of used interchangably in Buddhist teachings.  Generally there are The Five Fetters and The Ten Hindrances but the five fetters are actually covered in the hindrances and are known as the five lower fetters, 1 through 5. 

Now there are also remedies for each which I will aslo go over. This all comes from the Abidhamma Sutra and the Angittara Nikaya 10:13 

There are differing orders to this list depending on the source but I have kept it simple and from the most common teachings as I have seen them.   

1. (Sakkaya Ditthi) The belief that we are 'solid' and 'separate' beings.  The attachment of the ego and THE self.  The idea of 'I', 'Me', 'Mine' are also part of this.  The remedy is to learn and practice the Annata-Lakkhana sutra theory.  This is the second teaching of the Buddha, part of the Samyutta Nikay or 'grouped discourses'.  

2. (Vicikiccha) This is doubt and skepticism of the Buddha, Dharma and Sangha.  At times it also includes the disciplinary rules, the future (where will I go, what will I become), the past (what have I been?), both past and future (how am I changing?) and dependent origination.  This kind of doubt is like being lost, we need a map, that map is the teachings of the Buddha (The Dharma) as well as the development of faith.  The Advice to The Kalamas is a good source to work on this one.  https://www.accesstoinsight.org/tipitaka/an/an03/an03.065.soma.html

3. (Silabbataparamasa).  Attachments to rituals, rites and ceremonies. Thinking that participation or performing them can emancipate us is incorrect.  It is a tool, for sure, but it is our own effort that brings us to happiness, not prayer and offerings. (Anguttara Nikaya V, 43), To have a good life, one must not simpley pray but follow a path that is 'good'. 

4. (Kama raga), Sensual desire (known as Tahna) to have things different from how they ARE.  The practice to remedy this is letting go, non attachment. 

5. (Pathigha) 'to hit' or to have ill will, enmity, anger, hatred.  The remedy is to practice loving kindness (The Metta Bhavana). 

6. (Rupa raga), Being attached to form and to desire being reborn in (Rupaoka) or as a formed being. The practice of course is to work on the Annatalakkhana Sutra deeply. 

7. (Arupa raga), Being attached to the formless realms, i.e. heaven or 'Pure Land'. 

8. (Mana) Conceit or comparing one's self or pride or a feeling or superiority to others OR a feeling of inferiority to others as well.  The idea is that comparing and judging of others or one's self hinders you.  the remedy of this is not only sympathetic joy, but also metta. 

9. (Uddhavva) Being confused and restless, distracted (Dhammasangani 439).  The opposite of being 'on point' think of distractions of someone that suffers from ADHD or similar.  The remedy is mindfulness of thinking.  http://www.abhidhamma.com/Dhammasangani_Scan.pdf

10. (Avijja) Ignorance of the Four Noble Truths. The study of the first discourse of the Buddha is the remedy of this. (the Dhammacakkappavattana sutta) http://www.buddhanet.net/pdf_file/damachak.pdf

Now the first five of these have been eradicated (surpassed or eliminated) by those that are called  a 'non-returner' or Anagami.  Which is unusual because they are said to be reborn in a heanvenly realm and attains enlighenment there.   What about the 7th one?  Arupa Raga?  They themselves are NOT attached to that but it occurs to or for them because of their practice, actions (karma). 

The 'once-returner' or Sakadagami has eradicated the first three and have weakened the 4th and 5th ones.  They are reborn in either the human or heavenly realms (devas) and will go on to enlighenment from that point. 

The 'stream-enterer' of Sotapanna has eradicated the first three also and will have the opportunity to be born nor more than 7 more times as a human, or deva then go on to nirvana from there.

It is not only that eradication means to understand them and to logically accept the hindrances and their remedies but to really BE that, and stay within that ideal existence.  This is  why it is difficult to find people that have done this or are considered a stream enterer or once or non returner.  Almost never have I seen someone refer to themselves or others as those.  This is probably because of the 8th hindance of comparing or judging.   One does not want to be prideful and say they are a once-returner etc, or have lable someone else as those.  A good story is the Simile With Water, whcih explains the different attributes people have for practice.  https://suttacentral.net/an7.15/en/sujato?lang=en&layout=plain&reference=none&notes=asterisk&highlight=false&script=latin