Struggling to meditate: Contextualising integrated treatment of traumatised Tibetan refugee monks

Abstract

As a result of the recent resurgence of violence in the Tibetan Autonomous Region, the Boston Center for Refugee Health and Human Rights has an increased patient demographic: Tibetan refugee monks. Diagnosed by their amchis (traditional healers) as having a srog-rLung (life-wind) imbalance and presenting with posttraumatic stress disorder (PTSD), they struggle with their contemplative meditation, which—as a central focus of their daily lives—normally comes with ease. In this article, we consider the treatment implications of the highly relevant Buddhist context for this dual diagnosis. Specifically, we contextualise the classification of “religious impairment” as well as the significance of ongoing persecution of the devoutly religious for trauma therapy. We then draw upon spiritually oriented Eastern therapies as well as the confluence of specific paradigmatic practices to properly address these pathological intricacies in devising an effective holistic healing approach to the dual PTSD/srog-rLung diagnosis.

Keywords:

• meditation
• refugee trauma
• PTSD
• Buddhist refugees
• CSRI
• Tibetan monks
• complementary therapy

Acknowledgments

Many thanks to Dr Terrance Keane, Lama Gursam, Dr Tamdin, Dr Lobsang Rapgay, and Dr David Henderson for their guidance and valuable insights during the BCRHHR's investigative process, to Dr Gerald Koocher, Dr Lynn Piwowarczyk, Dr Sameer Sheth and Sarah Sidwell for their revisions and comments, and to Sabrina MacDuff and Megan Halmo for their general support.

Notes

Notes

1. This composite case study has been created to protect patient privacy, but is based on real patients at the BCRHHR.

2. The three types characteristically correlate to Sheldon's categories (ectomorph, mesomorph, and endomorph) (Zannos, 1997).

3. In spite of a number of language barriers presented by inconsistent transliteration of Tibetan pharmacopeia, the BCRHHR was able to identify the pills which had been given to the refugee monks by their amchis by matching up likely candidates with their correct indications. There were a total of eight different pills that had been given to the monks, namely Aru-10, Gur-gum 13, A-gar 35 with Li-khyung Rilbu, bSam-‘phel Nor-bu with Khyung-lnga, Se-‘bru Kun-bde, and Zla-shel Chen-mo (more commonly referred to as one of the eight “Precious Pills”). Aru-10 and Khyung-lna ceased to be used after consulting with a Tibetan physician (anonymous for security reasons, personal communication, 2 May 2008) who was able to identify the less appropriate ones. Using T.J. Tsarong's Handbook of Traditional Tibetan Drugs (Tsarong, 1986) to identify the ingredients of each, the final list of pills was found to be composed almost entirely of herbal substances, although a number of questionable—although, based on basic science literature searches, not discernibly harmful—animal products (such as wild yak's heart and elephant's gallstone) were included as well. The only exception to this was Zla-shel Chen-mo, alternatively referred to as Tso-tru Dashel Chenmo, which, like other “precious pills,” sometimes contains nominal amounts of detoxified mercury. Although medicinal uses of mercury are generally considered unsafe, a study examining the effects of mercury content in Tibetan medicines found that the toxicity was not great enough to be considered dangerous (Sallon et al., 2006). The Natural Standard substance reference search and interaction checker was subsequently used to match the nomenclature used in the Handbook with the substance's common name and search for any serious side effects the identified ingredients might specify for interaction with antidepressants and ibuprofen (Natural Standard, 2008), which were prescribed by the BCRHHR. No interactions which had any significance greater than the requirement that the combination of the substances only be taken under the supervision of a knowledgeable physician.