Health and holiness: Resources from Buddhist indigenous psychology for differentiating mental health and religion

Abstract

Theorists examining the relationship between mental health and religion such as Harold Koenig robustly differentiate these domains of human behavior. Other clinical practitioners such as Kin Cheung Lee propose interpretations where these domains are substantially identified. Similar to Lee, researchers Koneru Ramakrishna Rao, Padmal de Silva, and Padmasiri de Silva approach the Theravāda tradition of Buddhism from psychological and clinical perspectives, yet like Koenig these authors also differentiate the goals associated with the domain of mental health from the goals associated with the domain of religious practice. These researchers integrate the religio-philosophical psychology found in the ancient Pāli canon of Buddhist texts with modern theories of psychology and clinical psychotherapy such as those proposed by Sigmund Freud, Marie Jahoda, Les Greenberg, and positive psychology. The current essay explores the works of Rao, de Silva, and de Silva as resources that help differentiate mental health and religion—or, more broadly speaking, that help clarify the distinction between health and holiness.

Keywords

Buddhism cultural psychology mental health psychotherapy religion well-being

How does a person’s religious practice involving exercises such as meditation differ from learning similar skills in psychotherapeutic settings aimed at developing and maintaining mental health? More generally, how are mental health and religion to be differentiated? These questions may be perplexing if one notes that the English word “health” has an etymological relation not only to “wholeness” but also to “holiness” (Brüssow, 2013, p. 342). Is health the contemporary equivalent of holiness? If not, how are mental health practices and religious practices to be differentiated?

According to Koenig et al. (2012), health is “complete human flourishing across multiple domains and pertains to both the individual and the community” (p. 47). Koenig et al. (2012) acknowledge that some researchers might prefer to include “spiritual health” within overall human “health” understood in this way (p. 47). However, the World Health Organization has not yet adopted “spiritual . . . well-being” as a component of health interpreted as a multifaceted “state of . . . well-being” (Koenig et al., 2023, pp. 629–630, citing Nagase, 2012). One dimension of the multifaceted state of health or well-being concerns a person’s somatic health involving factors such as cholesterol level, diet, smoking, exercise, observance of safety, sexual practices, and sleep hygiene (Koenig et al., 2012, pp. 535–553). For the purposes of research into the relationship between health and religion, Koenig et al. (2012) contend that, “spiritual health must be kept separate from other dimensions of health since our goal is to better understand how spiritual health relates to those dimensions” (p. 48). Regarding the meaning of the phrase “spiritual health,” the authors state that religion can be understood in a modern sense as a particular kind of human “spirituality” (Koenig, 2018, pp. 3–4; Lucchetti et al., 2021, p. 7621, citing Pesut et al., 2008).

The authors describe mental health as a specific domain of overall well-being akin to somatic health: According to Koenig et al. (2012), mental health, on one hand, can be understood as negative mental health in terms of the absence of psychiatric “pathology,” whereas positive mental health in their definition is comprised of affective states such as “happiness, joy, feelings of fulfillment and completeness” that are also connected to the dimension of “social health” comprised of “meaningful and satisfying relationships” (p. 47). Koenig et al. (2012) elaborate further that “positive mental health” entails both affective and cognitive dimensions: “Positive emotions include the experience of peace, harmony, well-being, happiness, and joy. Positive cognitive processes include believing that life has purpose and meaning and also thinking in ways that are hopeful, optimistic, and adaptive” (pp. 298, 301–302).

Koenig (2018) elaborates that human behaviors can be interpreted (a) in relation to the realization of religious goals and also (b) in relation to the realization of positive mental health goals:

There is very little overlap between religion and mental health . . . Religion and mental health are two quite distinct and separate constructs. Religious beliefs, rituals, practices, importance, motivation, and centrality in life are different from emotional states, which religion may or may not affect. As noted earlier, good mental health is usually characterized by low levels of negative emotions, high levels of positive emotions, and the ability to function in social, recreational, and occupational settings. (p. 6)

Among other factors such as genetics, temperament, life experience, and environment, Koenig et al. (2012) also discuss the importance of certain transcultural human virtues (specifically, honesty, forgiveness, altruism, gratefulness, patience, and diligence) as factors that positively mediate religious practices to support one’s mental health (pp. 307–310).

Koenig et al. (2012) indicate that it would be helpful to explore how persons within religious traditions also understand the relationship between mental health and religion:

Does religious tradition influence the definitions of religion, spirituality, and the secular . . .? For example, how do mainstream Buddhists living in China understand these terms . . .? Philosophical understandings of Buddhism may [also] be very different from the way Buddhists in rural Japan practice their faith. (p. 49)

In other words, Koenig et al. (2012) express interest in how health might be understood from a perspective that is inside or endogenous (emic) to a religious tradition, in contrast with a research perspective that is outside or exogenous (etic) (on the emic-etic distinction, see Berry, 1989; for an overview of several etic models of the relationship between mental health and religion, see Levin & Chatters, 1998, p. 43).

In relation to the interest of Koenig et al. (2012) in giving consideration to endogenous viewpoints on the topic at hand, the current discussion aims to discern what resources are available to help clarify the distinction between mental health and religion as found in the works of authors writing in the field of indigenous psychology. As evident in the 1960s and continuing to the present (Deuck & Sundararajan, 2024; Sinha, 1965/2015; Sundararajan et al., 2020), the paradigm of indigenous psychology developed in order to cultivate contemporary approaches to scientific research from “within” cultural and philosophical traditions that involve different points of view from modern western or Anglo-American philosophical traditions (Heelas & Lock, 1981; Kim et al., 2006). Some indigenous psychologists note that the research paradigm focuses not only on geographical cultures but also on religious cultures (Yang, 2000, p. 259; that religions can be understood as cultures, see Geertz, 1966). Koenig et al. (2012) touch on this viewpoint when they observe that the definition, operationalization, and assessment of religion, spirituality, and secularity involve cognitive processes that all might be affected by the beliefs and values associated with a researcher’s religious tradition (p. 49).

The indigenous paradigm of psychological research has expanded to recognize that religious perspectives are also relevant for provision of clinical psychotherapy (Chang et al., 2005; Moodley et al., 2017) and clinical mental health counseling (Grayshield & Del Castillo, 2020; Stewart et al., 2016). Indigenous approaches to therapy might incorporate in some way a patient’s religious practices into clinical delivery of existing kinds of evidence-based treatment (Pargament, 2007, pp. 11, 18). The clinical incorporation of a patient’s religion and spirituality in this way is not an arbitrary choice on the part of a practitioner but is itself an evidence-based practice (Pargament et al., 2005). The clinical integration of religion and spirituality might occur in two general ways. First, clinical spiritual integration may occur in a way that remains extrinsic to the provision of a standard course of psychotherapy. In this approach, according to cognitive psychotherapist David Rosmarin (2018), not only is it the case that “spirituality and religion are often relevant to psychological functioning and mental health” (p. 3), but also a client’s religious practices may have some “clinical utility” for reaching therapeutic goals (p. 103, see pp. 32, 58). Religious “beliefs,” Rosmarin (2018) states, “can influence cognition and emotion in important and clinically relevant ways” (p. 145). Rosmarin (2018) indicates that such a “utilization” of a patient’s spirituality and religion can serve the purpose of “framing” delivery of evidence-based therapy (p. 123; Vachon & Agresti, 1992, pp. 512–513). Alternatively, the clinical integration of religion and spirituality might occur in an intrinsic way if the approach to psychotherapy and counseling inherently draws on religious teachings (Avants et al., 2005; Avants & Margolin, 2004; Lee & Ng, 2020; Margolin et al., 2007). This intrinsic approach to psychotherapy might especially occur in kinds of pastoral counseling that pursue the “dual goals” of maintaining mental health and promoting religious development (Rosmarin, 2018, p. 15).

My present focus is to discern how thinkers indigenous to the Buddhist religious tradition might approach the differentiation of mental health and religion. Contemporary thinkers in the human sciences have engaged the ancient Buddhist “religio-philosophical” psychology for more than a century (Rhys Davids, 1900, 1924, 1936, 2004; on the work of Rhys Davids, see Havens, 1964; on the phrase “religio-philosophical,” see Sinha, 1997, p. 138). A number of comparative studies contrast ancient religio-philosophical Buddhist psychology with modern scientific psychology (Aich, 2013; Fromm et al., 1960; Goleman, 1981; Johansson, 1969; Katz, 1984; Ray, 1986). An endogenous approach to the study of ancient Buddhist psychology and modern scientific psychology is proposed by Kin Cheung Lee (2023) who explicitly describes Buddhist psychology as an “indigenous psychology” (p. 1; Lee & Ng, 2020; Virtbauer, 2012, pp. 252–254, citing Kalupahana, 1987/1992 and Komito, 1987). Virtbauer (2012) calls attention to the presence of Buddhist teachings in clinical treatment modalities such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT), as well as acceptance and commitment therapy (ACT) (p. 255; on MBSR, see Lehrhaupt & Meibert, 2017; Woods & Rockman, 2021; on MBCT, see Hathaway & Tan, 2009; Segal et al., 2018; Williams et al., 2007; on DBT, see Koons, 2016; Pedersen, 2015; on ACT, see Hayes et al., 2004).

Some thinkers with a clinical interest in spiritual integration approach Buddhism in the extrinsic way discussed above where Buddhism is understood as a religion that may have “applications” in “mental health care” (Walley, 1986). This extrinsic viewpoint seems consistent with the remark of Koenig (2018) discussed above (“there is very little overlap between religion and mental health”) (p. 6). In terms of integrating elements from Buddhism into existing modalities of clinical psychotherapy (Germer et al., 2016), other scholars adopt hybrid approaches, such as Buddhist cognitive behavioral therapy (Tirch et al., 2016), Buddhist gestalt therapy (Gold & Zahm, 2018), and Buddhist psychoanalysis (Rubin, 1996). Still other Buddhist scholars such as Avants et al. (2005) and Lee (2023) propose original visions of intrinsically integrated Buddhist approaches to clinical intervention that integrate Buddhist teachings into psychotherapy in a substantive way (see Lee, 2018, 2020; Lee et al., 2017; Lee & Ng, 2020, pp. 153–162; Lee & Ong, 2018; Lee & Oh, 2019; Lee & Tang, 2023). In order to cultivate such an inherently Buddhist psychotherapy, Lee (2023) suggests that a clinical practitioner “redefine” Buddhism (at least for professional purposes) as a “theoretical orientation for counseling” and a “professional counseling model” where the practitioner does not understand Buddhism as a religious “faith” having applications for clinical mental health counseling, but rather interprets “Buddhism as a psychology instead of a religion” (p. 1; Lee, 2013, 2016, 2020). This approach thus seems to dissolve the definitions of mental health and religion proposed by Koenig (2018) quoted above (p. 6).

Buddhist scholar and translator of ancient Pāli texts Bhikkhu Bodhi (2002) calls attention to the clinical reinterpretation of the traditional religious exercises within modern psychotherapy:

What I am concerned about is the trend, among present-day Buddhist teachers, of recasting the core principles of the Buddha’s teachings into largely psychological terms and then saying, “This is Dhamma.” When this is done we may never get to see that the real purpose of the teaching, in its own framework, is not to induce “healing” or “wholeness” or “self-acceptance,” but to propel the mind in the direction of deliverance—and to do so by attentuating, and finally extricating, all those mental factors responsible for our bondage and suffering. We should remember that the Buddha did not teach the Dhamma as an “art of living”—though it includes that—but above all as a path to deliverance, a path to final liberation and enlightenment. (p. 7)

Bodhi (2002) indicates that the proposal of a path for the deliverance (vimutti) of the mind in the original Buddhist framework might be understood not as “therapeutic” in the sense of leading one’s mind toward mental health, but rather such a path is primarily oriented toward the mind’s ultimate salvation—that is, the original framework proposes a religious soteriology (Somaratne, 2022) that can be understood in association with a religious eschatology (Overmyer, 1972; Pas, 1987) or in association with certain beliefs concerning ultimate human outcomes.

In what follows, I review the work of three scholars in the field of indigenous Buddhist psychology, psychotherapy, and counseling who propose viewpoints that are in between Koenig (2018) and Lee (2023): Koneru Ramakrishna Rao (d. 2021), Padmal de Silva (d. 2007), and Padmasiri de Silva. I consider these three specific scholars for two reasons. First, akin to Lee (2023), these scholars all have a common interest in Theravāda Buddhism (the “view of the elders”) expressed in the ancient Pāli canon of texts (Crosby, 2013; for a similar project focused on Mahāyāna Buddhism and Sanskrit texts, see Kalupahana, 1987/1992, who draws specifically on the Yogācāra tradition found in the Vijñaptimātratāsiddhi of Vasubandhu and the Madhyāntavibhāga ascribed to Maitreya—see Mipham, 2021; Pandeya, 1999; Sharma, 2017). Second, the three indigenous psychologists under consideration all have an interest in placing the ancient religio-philosophical psychology associated with the Pāli canon in dialogue with modern scientific psychology and psychotherapy (for interpreting Pāli, see Nyanatiloka, 1970). After providing an overview of the perspective of these three authors, I offer some concluding reflections on the differentiation of mental health and religion.

Three scholars in indigenous Buddhist psychology and psychotherapy

Koneru Ramakrishna Rao

Like Lee (2023), Koneru Ramakrishna Rao (1988) proposes “reformulating” the ancient Theravāda religio-philosophical psychology (p. 143) where it might become understood as a program aimed at the restructuring and reorganization of psychological functioning (p. 145; Rao & Paranjpe, 2016; Rao et al., 2008). Rao (1988) first provides an interpretation of the ancient Theravāda tradition expressed in the Pāli scriptures, highlighting the Dhammasaṅgaṇi, the first book of the Abhidhamma Piṭaka, as well as “The Expositor” (Aṭṭhasālinī), a philosophical commentary on the Dhammasaṅgaṇi authored by Buddhaghosa (d. c. 400 CE) (p. 124; for the Dhammasaṅgaṇi, see Rhys Davids, 1900; for the Aṭṭhasālinī, see Tin, 1976; for the transliterated Pāli of the Aṭṭhasālinī, see Müller, 1897). Rao (1988) also draws on three additional ancient sources of Buddhist philosophical psychology: (1) “The Questions of King Menander” (Milinda Pañha, c. 100 BCE–200 CE) (Pesala, 1998), (2) “The Way of Purification” (Visudhimagga) also ascribed to Buddhaghosa (Ñāṇamoli, 1991), and (3) the Abhidhammattha-saṅgaha, a condensed summary of the Abhidhamma, ascribed to Ācariya Anuruddha, a putative original disciple of Śākyamuni (d. 483 or 400 BCE), although the actual text is dated much later (c. 1000 CE) (p. 124; Aung, 1956; de Bary, 1969/1972, p. 15; Nārada, 1999). Gombrich (1988) describes Buddhaghosa as “Theravāda’s great scholastic” akin to Thomas Aquinas in the Catholic-Christian religious tradition (p. 154; Law, 1997). One might further note the resemblance of Buddhaghosa’s Visudhimagga to a different text, “The Way of Freedom” (Vimuttimagga) ascribed to the Theravāda monk Upatissa (c. 100 CE), existing now only in a Chinese edition allegedly translated by a Khmer monk named Sanghapāla (d. 524 CE) (Bapat, 1937, 1968, p. 363; Ehara et al., 1961, p. xviii).

Rao (1988) summarizes these ancient Buddhist texts, focusing on such psychological teachings as the general nature of mind (citta or mano) (pp. 125–128), cognition (pp. 128–130), the possible domains or locations of consciousness (pp. 130–132), the relationship between an action, its quality, and its result (kamma) (pp. 132–134), the nature of a mental factor (cetasika) or a mental combination of properties that “belong to the mind” (pp. 134–137), and the ultimate goal of attaining nibbāna interpreted in psychological terms as a state where one has extinguished (a) tendencies toward mental defilement (kilesa) requiring purification (visuddhi)—for example, tendencies toward greed (lobha), hate (dosa), or delusion (moha)—as well as (b) tendencies inclining one’s attention to cling to any aggregate or heap of experiential data (khandha) (pp. 137–138). Regarding the teaching on kamma, Rao (1988) remarks, “The root of kamma is volition and the states associated with it” (p. 132). Nyanatiloka (1970) explains that kamma pertains to “volitional action” (cetanā) where the action, deed, or performance (kiriya) has a “mental result” (vipāka) based on the action’s inherent quality (pp. 87, 196)—for example, a voluntary action may have a neutral quality (avyākata), or a quality of being wholesome, good, and profitable (kusala) leading to favorable mental results and merit (puñña), or an action may have a quality of being unwholesome (akusala) leading to evil mental results and demerit (apuñña) (pp. 8, 75, 80, 88–89). Nyanatiloka (1970) indicates that certain wholesome actions such as almsgiving (dāna), the observance of moral precepts (sīla), as well as acts of faith (saddhā) in Śākyamuni and his law (dhamma) enable one to abide in streams of merit (puñña-dhārā) (p. 146). Merit is amenable to being shared with or given to or transferred to others (pattānuppadāna) (Nyanatiloka, 1970, p. 146), as indicated—Gombrich (1988) claims—in certain Buddhist funeral rites (p. 125, citing Gombrich, 1971, p. 230). Regarding the nature of any aggregate, grouping, or heap (khandha), Rao (1988) describes five ways that one’s mind might cling to an aggregate, namely, one’s mind might cling to (1) an aggregate of bodily shape or material form (rūpa) comprised of some material element (dhātu) such as water or earth, (2) an aggregate of a feeling or sensation (vedanā), (3) an aggregate that is a perception or awareness of an object (saññā), (4) the aggregate of any synthesis or formation (saṅkhāra)—including syntheses of intentions and behaviors having the character of voluntariness and subject to kamma—and finally (5) the aggregate of consciousness or awareness as such (viññāṇa) that is broader in range than perception only and involves the mind operating or functioning in an active state—in contrast with the mind in a state of rest, a state understood as the mental “ground of becoming” (bhāvaṅga citta), in other words, a state where the mind is open to becoming “this or that” according to the intentionality of consciousness (pp. 126–129). According to Rao (1988), consciousness (viññāṇa) arises in orientation to four general domains or locations: (1) the domain of sensuality or pleasure (kāmaloka), (2) the domain of form or localized bodies (rūpaloka), (3) the domain of formlessness or the four heavens (arūpaloka), and (4) a transcendent supermundane domain beyond worlds (lokuttara) (pp. 130–131). One might note that in traditional Buddhist cosmology, kāmaloka, rūpaloka, and arūpaloka are all further differentiated into subdomains (Gethin, 1998, pp. 116–117). Similarly, the word lokuttara in its scope of reference is broader than (but can include) nibbāna as the highest state of attainment (Nyanatiloka, 1970, p. 91).

Rao (1988) observes that on occasion, an aggregate or grouping (khandha) can be a mental factor (cetasika) composed of specific elements or properties that “belong” to the mind—for example, a feeling (vedanā) involving pleasure or pain (p. 135) or a perception (saññā) involving a distinct cognition or recognition—but these are distinct from other simple mental factors such as an impression (phassa) involving contact or touch (p. 134), directional intention or volitional action (cetanā) involving purposefulness (p. 135), the unification of one’s mind or “one-pointedness” (citt’ekaggatā) exemplified by an act of mental concentration, vitality (jīvitindriya) or having the ability for life (jīvita), and attention (manasikāra), the mental activity that unites one’s mind to an object (p. 136).

Rao (1988) indicates that he follows the work of Swedish psychologist Rune E. A. Johansson with respect to interpreting nibbāna in psychological terms “rather than [as] a metaphysical reality” (p. 137, citing Johansson, 1969; see also Johansson, 1978). While Rao (1988) notes that attainment of nibbāna traditionally understood in eschatological terms involves achieving “the cessation of rebirth,” his interpretation specifically proposes that nibbāna be understood in a non-eschatological “empirical sense” as denoting the psychological activity of an arahant, “the perfect or ideal human” according to the Theravāda tradition (pp. 137–138; Buddharakkhita, 1990, pp. 29–30; Carter & Palihawadana, 1987, pp. 18–19; Engelmajer, 2003). According to Katz (1982), an arahant literally means “one who is worthy” (p. 1). Gethin (1998) refers to an arahant as a Buddhist “saint” (p. 7). Nyanatiloka (1970) translates the word arahant as “holy one” (p. 20). Following the traditional “path of Buddhism,” Rao (1988) maintains that a person who becomes an arahant undergoes a “transformation” of mind (citta) (p. 137). With respect to acts of volition, an arahant rises above the lawlike effects of kamma (Rao, 1988, p. 133). With respect to cognitive functioning, an arahant attains “perfect knowledge” involving “intuitive comprehension”; with respect to affect, an arahant exhibits experiences “freedom from all suffering” as well as “unity, completeness, and timelessness” and positive qualities such as “happiness, peace, calm, contentment, and compassion”; with respect to personality, an arahant will be “stable” and (employing what seems to be psychodynamic terminology) is described as “unobsessed,” “devoid of ego compulsions,” and exhibiting normal psychological defense mechanisms (Rao, 1988, pp. 137–138).

Once Rao (1988) completes his exegesis of the ancient Theravāda texts (pp. 124–143), he proceeds by “reformulating” the ancient psychology as a contemporary “interpretation” or “theory” (p. 143) that he judges “fits well” with modern psychodynamic theory and depth psychology (p. 147). Rao (1988) contends that his reformulated interpretation will admit of “empirical verification,” where mental exercises such as meditation might be understood not only as oriented toward nibbāna (interpreted as a psychological “state of transcendence”), but also as benefiting one’s “mental health” (p. 147). Rao (1988) elaborates that his “theory” reformulates the ancient Buddhist psychology in such a way that allows for “empirical studies of meditation” that might explore “changes in consciousness” and “determine the associated psychophysiological states” (p. 147). Regarding such a scientific clarification, Rao (1988) further explains that

Such a determination would not only give us the needed objectivity to describe these phenomena, but would also permit a more precise application of the meditative techniques to aspects [of the psyche] perhaps less significant than transcendence but more immediately relevant—such as mental health. For example, much psychoanalytic groundwork is aimed at scanning the patient’s life history to identify those critical past experiences that seem to be causing the present symptoms . . . What could be more important in psychotherapy than to find a method of disarming or, better, destroying the disruptive effects of such past experience? Certain aspects of Buddhistic meditation do promise to accomplish just that. (p. 147)

In these remarks, Rao (1988) thus indicates that the same behavior can be oriented toward two distinct psychological goals, namely, toward mental health, but also toward nibbāna, where nibbāna is as stated previously interpreted in psychological terms: Nibbāna is a “state of psychological transcendence,” a “transego state” (Rao, 1988, pp. 146–147). There is thus in Rao’s Buddhist psychology, on one hand, a psychologization of the ancient teachings, but, on the other hand, a desire to preserve the unique religious psychology so to speak of an arahant as distinct from the health psychology of a person focused on the maintenance of “mental health” (regarding health psychology, see Straub (2019) and Gurung (2018).

Padmal de Silva

As the subtitle of his essay suggests, clinical psychologist Padmal de Silva (1993) is very clear that he is writing from “a therapeutic perspective,” or more specifically from a perspective that is focused on the “potential value of Buddhism for psychological therapy and mental health” (p. 225, citing de Silva, 1984; Goleman, 1976; Mikulas, 1981; Walley, 1986; see also d’Ardenne, 2008). In the introduction to his essay, de Silva (1993) elaborates:

the study of ancient concepts and practices may focus on their practical relevance and value in the present day. In the case of a religious or other system that is still flourishing, this kind of endeavor can take the form of examining, from the standpoint of modern science, the validity and usefulness of some of its practices for specific purposes in today’s world. (p. 221)

While it is clear that his perspective is primarily that of modern science, de Silva (1993) does not outline what specific criteria he references in order to assess the “validity” of ancient religious practices (p. 221), although he comments that, “it is the examination of the psychology of Buddhism from a therapeutic point of view that offers potentially valuable and exciting practical possibilities” (p. 225). Regarding his therapeutic point of view, de Silva (1986) indicates that psychotherapy is remedial when attempting to redress a psychiatric disorder or deficit, prophylactic in attempting to prevent a disorder or deficit, and promotive of the value of “well-being and functioning” (pp. 220–221). Buddhist psychology, de Silva (1986) contends, is especially therapeutic in this third promotive sense (p. 221), yet also clinically helpful in the second prophylactic sense (p. 230).

De Silva (1985) indicates that he has an interest in assessing whether “an early theory or treatise offers testable ideas and techniques in an area of current interest” (p. 437). He observes that, “Buddhism contains ideas and practices which bear close similarity to some of the theories, concepts, and techniques of 20th-century psychology” (de Silva, 1985, p. 437). This similarity would also seem to provide a helpful vehicle for mediating contemporary theories and techniques to contemporary Buddhist patients of psychotherapy and clients of counseling:

similarities between modern psychological concepts and techniques and the notions and practices of a religious system, ancient in origin but still adhered to widely, could be expected to make the acceptance of those psychological concepts, and compliance with advice derived from these, by that population more likely. (de Silva, 1985, p. 437)

Setting aside the topic of psychotherapists appropriating and coopting religious language for the purpose of “framing” delivery of a clinical psychotherapy (as discussed previously—see Rosmarin, 2018, pp. 123–143), this remark on the part of de Silva indicates that he examines the ancient Buddhist texts comparatively for the purpose of discerning where structural similarities appear in the description of behaviors found in the respective psychologies that he is contrasting. He does not outline the nature of his comparative methodology, but he calls attention to the model of Padmasiri de Silva who similarly contrasts Buddhist psychology with Freudian psychoanalysis (de Silva, 1985, p. 437, citing de Silva, 1973).

Referring to the ancient Pāli writings, Padmal de Silva (1993) observes that, “Some parts of the canonical texts, as well as later texts, are examples of explicit psychological theorizing, whereas most of the others include psychological assumptions and much material of psychological relevance” (p. 224). De Silva (1993) observes that the Pāli canon written in Sri Lanka around 100 BCE contains “three baskets” (Tipiṭaka) of texts: (1) a collection of discourses (Sutta Piṭaka), a collection of rules of monastic discipline (Vinaya Piṭaka), and a collection of philosophical commentaries (Abhidhamma Piṭaka) (pp. 222–223; he cites Saddhatissa, 1976, for dating the Tipiṭaka and he cites Webb, 1975 for an overview; see also Nayanatusita & Webb, 2012). One might note that the collection of discourses (Sutta Piṭaka) contains five sub-volumes: a volume of long discourses (Dīgha Nikāya) (Walshe, 1995), a volume of middle-length discourses (Majjhima Nikāya) (Ñāṇamoli & Bodhi, 2001), a volume of connected or linked discourses (Saṃyutta Nikāya) (Bodhi, 2000), a volume of gradually enumerated discourses (Aṅguttara Nikāya) (Bodhi, 2012), and a volume of minor discourses (Khuddaka Nikāya) (for translations of the Dhammapada, the second book of the minor discourses, see Buddharakkhita, 1990; Carter & Palihawadana, 1987; for a translation of the Suttanipāta, the fifth book of the minor discourses, see Bodhi, 2017). De Silva (1993) calls specific attention to the “empiricist/experientialist” character of certain discourses in the Aṅguttara Nikāya (p. 231) and to the “psychological analyses” found in the Abhidhamma (pp. 222–223).

In his comparative discussion, de Silva (1993) begins by outlining teachings such as the Four Noble Truths (caturāriyasaccāni), the Noble Eightfold Path (ariya aṭṭhaṅgika magga), the teaching that promotes awareness of the “impermanence” (anicca) of the things found in the sensible world of cyclical change (saṃsāra), and the teaching that promotes adopting a posture of non-commitment with respect to the existence of an enduring self (attā) (p. 223). De Silva (1993) observes that the Eightfold Path is also called the “Middle Path” as a mean between living “a sensuous and luxurious life” at one extreme and living a radical ascetic life of “self-mortification” at the other (p. 223). When Buddhist meditative exercises are understood in the context of their original religious teleology, they are practiced in accordance with the Eightfold Path—the way (magga) toward the cessation (nirodha) of suffering (dukkha) and dissatisfaction (the fourth Noble Truth); one might recognize that suffering and dissatisfaction (dukkha) are pervasive and universal (the first Noble Truth), that the craving or desire (taṇhā) for impermanent things is the origin (samudāya) of such suffering (the second Noble Truth), and seek the cessation (nirodha) of such desire by seeking to become an arahant oriented toward the state of nibbāna (the third Noble Truth) (de Silva, 1993, p. 223, citing Katz, 1982). A person who follows the Eightfold Path should cultivate specific proper, complete, correct, or right states of psychosocial activity, namely, (1) a right understanding or viewpoint (sammā-diṭṭhi), (2) right thought, resolve, or aspiration (sammā-saṅkappa), (3) right speech (sammā-vācā), (4) right bodily action (sammā-kammanta) (a state arguably related to abstinence from certain behaviors such as murder and theft, as well as observing virtuous moral precepts—sīla), (5) right livelihood (sammā-ājīva), (6) right effort, diligence, or vital exertion in emphasizing good over evil (sammā-vāyāma), (7) right mindfulness or watchfulness (sammā-sati), and (8) right concentration, where there is a proper unification or collection of one’s mind (sammā-samādhi), a state arguably to be cultivated by the practice of meditation (de Silva, 1993, p. 223).

Within a traditional Buddhist religious eschatology, de Silva (1993) notes that “upon death” an arahant “ceases to be reborn” in saṃsāra, attaining instead to an ultimate cessation (nirodha) and emancipation (p. 223). The Buddhist “religious endeavour,” according to de Silva (1986), is focused on this “attainment of Nibbana” as the ultimate goal and ultimate concern; the realization of this goal may be associated with “the state of being an arahant” (p. 224). Asking “What does it mean to say that someone is an arahant?,” de Silva (1986) elaborates on the eschatological, psychological, and developmental aspects of this religious state (p. 224). In terms of the eschatological aspect of this religious state, he remarks that, “Arahants are those who have extinguished the cycle of births and deaths. They have severed the cankers and fetters that bind one to the cycle of dukkha, or suffering” (de Silva, 1986, p. 224). In terms of the psychological aspect of this religious state where one finds release from cankers or defiling influxes (āsava) such as sense desire (kāmāsava) and from fetters or shackles (samyojana) that bind the mind to “the wheel of existence” or to “perpetual wandering” (saṃsāra) (Nyanatiloka, 1970, p. 23 and pp. 160–161), de Silva (1986) focuses specifically on the moral qualities of an arahant:

In psychological terms, arahants’ actions no longer emanate from the common motives of greed or lust, malice and delusion, though they are capable of joy or positive sentiment. They have loving kindness (mettā) to all, and compassion (karuṇā). They indulge in nothing, and are restrained in their behaviour. Nine standards of behavior are given which arahants can not and do not transgress (Anguttara Nikaya): taking life; stealing; sexual contact; uttering falsehoods; enjoying comforts of wealth; and going astray through desire, through hate, through delusion and through fear. They contribute to society by being teachers and advisors, and they are no burden to their fellow beings. (p. 224, citing Goleman, 1976; Katz, 1982; Nārada, 1977)

Developmentally, de Silva (1986) notes that the state of an arahant is the culmination of a person’s progress through certain stages oriented toward nibbāna: (1) the state of a person who is uninitiated in the Eightfold Path (puthujjana), (2) the state of a person who has some understanding of Buddhist teachings and who has “entered the stream” of following the Eightfold Path (sotāpanna), (3) the state of a person who has become partially purified of sensory attachments but who will be reborn in the sensory world a final time, thus being called a “once-returner” (sakadāgāmi), and (4) the state of a person who has become fully purified of sensory attachments and who will not be reborn in the sensory world, but rather in a pure land or pure abode (suddhāvāsa), thus being called a “non-returner” (anāgāmi) (p. 225). A person’s progress through these five developmental states when following the Eightfold Path is supported by performing mental exercises such as tranquility (samatha) and insight (vipassanā) meditation (de Silva, 1986, p. 225).

De Silva (1993) next transitions to consider “from a therapeutic point of view” how these various Buddhist teachings and practices might benefit persons today with respect to the goal of maintaining “mental health” (p. 225). Implicitly connecting his discussion of mental health benefits to the threefold purpose of psychotherapy mentioned previously (remediation, prophylaxis, and promotion of wellness—de Silva, 1986, pp. 220–221), de Silva (1993) focuses on the pursuit of clinical goals such as (a) behavior modification (pp. 230–234, citing Mikulas, 1978, 1981 see de Silva, 1984, 1985), (b) the cultivation of mental hygiene practices through the practice of mindful “self-monitoring” and “self-regulation” (pp. 234–235, citing Kazdin, 1974/1976; Thoresen & Mahoney, 1974), and (c) promoting “stress reduction” through the practice of tranquility (samatha) and insight (vipassanā) meditation (pp. 226–230, citing Benson, 1975; Goleman, 1976; see also Goleman, 1977). In his use of language, de Silva (1993) is clear that he differentiates his clinical viewpoint from how these Buddhist practices—such as tranquility (samatha) and insight (vipassanā) meditation—would be understood in their original religious context (where the purpose of such exercises involves the aim of reaching religious salvation or a state of liberation): In the original Buddhist religious context,

The aim is to achieve total and immediate awareness of all phenomenon. This leads, it is claimed, eventually to the full and clear perception of the impermanence of all things and beings. It is held that samatha meditation by itself cannot lead to enlightenment or perfection; vipassanā meditation is needed to attain this goal. (de Silva, 1993, p. 227)

As distinct from the religious goal of attaining insight and enlightenment, de Silva (1993) therapeutically reframes the meditative exercises under consideration where the Buddhist practices become directed also toward immediate clinical goals: “From a therapeutic perspective, this means that Buddhist meditation techniques [focused on samatha and vipassanā] may be useful as an instrument, or strategy, for achieving certain psychological benefits” (de Silva, 1993, p. 227, emphasis added).

De Silva (1993) explicitly contrasts pursuit of a clinical goal oriented toward psychological benefits with pursuit of a “religious goal” within traditional Buddhist practice:

The importance of the presence of these techniques in the Buddhist texts is manifold. First, it reflects the fact that Buddhism is not concerned only with the individual’s endeavors to achieve the ultimate religious goal by a process of self-development. As noted above, [Buddhism] also has something to offer in the area of day-to-day management of behavioral problems, often as a goal in its own right, for reasons of the individual’s own and his or her fellow beings’ benefit and happiness. Thus these techniques are applicable irrespective of whether one has committed oneself to a life devoted to the aim of personal development and, ultimately, [devoted to the aim] of the state of arahanthood. Second, being clearly behavioral, these techniques are well defined, easy to use, and—above all—empirically testable. (p. 233)

Thus, like Rao’s Buddhist psychology, de Silva also contrasts pursuit of mental health goals with religious goals such as becoming an arahant, where the former goals are understood in terms of behavioral health (Brannon et al., 2021). Elsewhere, de Silva (1986) makes the same point referring not to behavioral health, but rather to pursuit of well-being:

the Buddha also considered the well-being of oneself and of one’s fellow-beings as an important aim in a layperson’s life. This [consideration of Śākyamuni] was not merely . . . an early prelude to the preparation for arahanthood, but as a goal in its own right . . . The Buddhist concepts and strategies of behaviour change are not confined to the major spiritual training that is required in a committed religious life, with the ultimate aim of attainment of arahanthood . . . (pp. 225–226).

The discussion thus returns to the point that clinical psychotherapy might facilitate a person’s realization of improved well-being as a health goal that is distinct from the religious goal of becoming an arahant (de Silva, 1986, pp. 220–221). However, de Silva (1986) then blurs these careful distinctions by stating that while the path to becoming an arahant may have no relevance for psychotherapy in terms of remediation, it can have relevance for psychotherapy in serving a prophylactic function (p. 230). This is because “arahanthood” is “a perfect state where the person is free from vulnerability to psychological afflictions, and is thus an ideal state of mental health” (de Silva, 1986, p. 230, citing also Goleman, 1976).

Padmasiri de Silva

Padmasiri de Silva (2014) is trained in the philosophy of mind and practices as a professional clinical mental health counselor (pp. x–xi). His numerous publications include an overview of Buddhist psychology (de Silva, 2014), a comparison of Buddhist and Freudian psychology (de Silva, 2010; see de Silva, 1973, 1974) as well as focused studies on Buddhist ethics (de Silva, 1998, 2002, 2017), emotions (de Silva, 1976, 1992, 2018b; see de Silva, 2014, pp. 162–163 citing Greenberg, 2008, see Greenberg, 2022), and the psychotherapeutic applications of Buddhism (de Silva, 2018a, 2020; in general see de Silva & Thompson, 1988). Because it is not possible to engage all of these works, at present I will focus primarily on de Silva’s overview of Buddhist psychology (de Silva, 2014). Like Padmal de Silva (1993) who emphasizes the importance of the Abhidhamma in the Pāli canon (pp. 222–223), Padmasiri de Silva (2010) also calls attention to the systematic psychology found in the same ancient texts, giving special emphasis to the “most valuable analysis” found in the “Book of Origination” (Paṭṭhāna) in the Abhidhamma that discusses the teaching on interdependent causation or dependent co-arising (paṭiccasamuppāda) (p. 5, citing Lee & Ng, 2020; Nyanatiloka, 2008 p. 142, citing Bornaetxea et al., 2014; Karunadasa, 2013, p. 87).

Like Koenig et al. (2012), de Silva interprets mental health in a twofold way. De Silva (2014) interprets negative mental health in a way that is endogenous to the Buddhist tradition, stating that there are certain “hindrances” (nīvaraṇa) that impede one’s mental development in the practice of meditation (bhāvanā) that also serve as “obstacles to the attainment of mental health,” namely, hindrances such as sensual desire (kāmacchanda), “ill-will” or malicious intent (vyāpāda), “sloth and torpor” (thīna-middha), “restlessness and worry” (uddhacca-kukkucca), and “sceptical doubt” (vicikicchā) (p. 80).

De Silva (2014) interprets positive mental health in a way that is also endogenous to the Buddhist tradition (pp. 78–81). With respect to interpreting positive mental health, de Silva (2014) adopts a twofold orientation: (1) there is the goal of living in an environmentally adapted manner—“we can talk of a well-adjusted and balanced life as well as living a righteous life (sama-cariya, dhamma-cariya)”—and (2) there is the religious goal of becoming an arahant where only an arahant can be said to have overcome all mental disorder (p. 78). Overcoming all mental disorder in this second religious sense seems much more intensive in scope than the clinical remediation of specific psychiatric disorders such as those outlined in the DSM-5 (American Psychiatric Association, 2022). In terms of the first more limited dimension of positive mental health, a person might, for example, be at the stage of a “stream-enterer” (sotāpanna) where that person lives in a state of quietude or calm (samacariyā) and observes the Buddhist moral teachings (dhamma) that enable that person to live a life of righteousness (dhammacariyā), yet that person has not attained to the state of an arahant. The twofold dimension of positive mental health described here by Padmasiri de Silva thus seems to correlate with the discussion of Padmal de Silva (1986) who similarly differentiates (a) the completely prophylactic state of mental health exhibited by an arahant from (b) a state of general well-being, as discussed previously (pp. 220–221).

When developing his description of positive mental health, Padmasiri de Silva (2014) dialogues with the theoretical framework of European social psychologist Marie Jahoda (d. 2001) (pp. 78–79; Jahoda, 1958). Jahoda (1958) describes positive mental health as involving positive self-attitude, self-growth, functional integration, autonomy, accurate reality sense, and environmental mastery (p. 23)—an account that complements the proposal of Koenig et al. (2012) discussed previously (pp. 298–302). De Silva (2014) then interprets the positive traits outlined by Jahoda in Buddhist terms, noting the cultural differences between Jahoda’s European context and a Theravāda Buddhist religious context: The practice of right mindfulness (sammā-sati), for example, might contribute to a Buddhist person’s realization of self-growth (de Silva, 2014, p. 79).

In addition to considering positive mental health, de Silva (2014) also discusses “mental well-being” (pp. 82–92) which he describes as maintaining “mental balance” (p. 82). He does not clarify the difference between mental health and mental well-being, although other authors contend that mental health is one component of a person’s overall well-being or state of wellness (Tremblay et al., 2021, p. 5) in a manner that is evocative of how Koenig et al. (2012) describe mental health as one feature of a person’s overall health, discussed previously (p. 47). With respect to the meaning of mental “well-being,” de Silva (2014) draws on psychological research exploring happiness that may be associated with the contemporary positive psychology movement (p. 84 citing Nettle, 2005, as well as Wallace & Shapiro, 2006, who in turn cite Haidt, 2006; Kahneman et al., 1999; Ryan & Deci, 2001; Seligman, 1998, 2004). Following Wallace and Shapiro (2006) who consider the cognitive, affective, conative, and attentional aspects of well-being, de Silva (2014) states that the Buddhist tradition promotes the realization of “equanimity” (upekkhā) as a kind of “right balance” in each of these four psychological domains, where the mean of balance might be different for a Buddhist “householder” in contrast with a Buddhist monk (pp. 82–83, p. 89). Conative well-being for de Silva (2014) focuses on “intentions and volitional activity” as well as achieving balance with respect to “desires”—such as the desire for sensual pleasure (kāma-taṇhā) and the “desire to become” this or that (bhava-taṇhā) as exemplified by a person’s ambition to assume a certain prestigious role or office (pp. 82–83). De Silva (2014) may be interpreted to state that equanimity (upekkhā) or “right balance” can have three functions in Buddhism: (a) equanimity can help regulate one’s sensuous craving or desire for pleasure (kāma-taṇhā) in relation to one’s overall well-being, (b) equanimity might be cultivated as a “divine abode” (brahma vihāra) or a psychological state in which one might abide, alongside of cultivating other affections such as loving kindness (mettā), compassion (karuṇā), and sympathetic or “appreciative joy” (muditā), or (c) equanimity might be understood as a meditative state or a mental absorption (jhāna) involving, for example, the right balance of specific factors such as (1) a thought object (vitakka), (2) discursive thinking (vicāra), (3) rapture (pīti), and (4) joy or bliss (sukha) (p. 89). Regarding the first meaning of equanimity as pertaining to well-being, de Silva (2014) notes that the “right balance” associated with well-being in this respect is evocative of ancient teachings in other cultural traditions concerning the balance of humors related to temperament as discussed for example in ancient Indian medicine (ayurveda) and in ancient Greek medicine (p. 91). By this reference, de Silva may have in mind the ancient Greek medical philosophy proposed by Hippocrates (c. 400 BCE/2022) and developed by Galen of Pergamon (c. 195/2020; Stelmack & Stalikas, 1991).

That one’s pursuit of religious goals is distinct for de Silva (2014) from one’s maintenance of mental health becomes more clear when he elaborates on the character of Buddhism as a “contemplative philosophy” (pp. 108–115). Regarding contemplation, de Silva (2014) first explains the etymology of the Pāli word anupassanā as exercising “attentive examination” (p. 114). De Silva (2014) then describes three kinds of attentive examination or contemplation, namely, (1) considering one’s body as impermanent (aniccānupassanā), (2) considering one’s body and bodily experiences as resulting in dissatisfaction (dukkhānupassanā), and (3) considering the Buddhist teaching on non-self (anattānupassanā) (p. 115). On one hand, de Silva (2014) notes that in relation to mental health goals, “Contemplative practice can lead to well-being through the alleviation of tensions and anxieties” (p. 88). On the other hand, de Silva (2014) also describes how the contemplative practice of considering non-self (anattānupassanā) differs in clinical psychotherapy from a person’s practice to realize religious goals:

These [religious] standpoints [on non-self] are in a sense even deeper than what happens in a good therapeutic transformation. In therapy, the not-self idea works by getting the client to drop identification with, for instance, grief, and look at it from a distance; get used to the notion of separation and loss, and the embracing of pain without reactivity. The spiritual transformation goes beyond a therapeutic transformation. (de Silva, 2014, p. 115)

Keeping with the example of the contemplative practice at hand (anattānupassanā), emphasis on not-self (anattā) might be understood in a psychotherapeutic setting in terms of how de Silva (2014) translates the word elsewhere as reducing “egoism” (p. 79)—thus where the emphasis is more so psychological (practicing selflessness) rather than ontological (for an argument that anattā is inherently to be understood as a pragmatic psychological “strategy” in Buddhism and not in a metaphysical or ontological way, see Hoang, 2019, p. 19). However, Nyanatiloka (1970) contends that interpreting anattā as a denial of “a self-existing real Ego-entity” is “the central doctrine of Buddhism, without understanding of which a real knowledge of Buddhism is altogether impossible” (p. 12; see pp. 12–14 and p. 25). Regarding the contemplation of not-self understood only as a therapeutic effort to minimize egoism, de Silva (2014) also quotes social psychologist and psychoanalyst Erich Fromm (d. 1980) who states that the therapeutic attainment of well-being involves overcoming narcissism (p. 79, quoting Fromm et al., 1960, p. 91).

When referring to a “spiritual transformation” that is “deeper” and that “goes beyond” what clinical psychotherapy can offer, the meaning of the contemplative exercise of considering not-self (anattānupassanā) changes; regarding this change, de Silva (2014) may have in mind a person who shifts focus from seeking well-being to following the Eightfold Path in order to become an arahant and experience nibbāna (p. 115), a religious goal that de Silva (2010) elsewhere describes as attaining “a holy state” (p. 1; see p. 58). This discussion of de Silva (2014) concerning the cultivation of Buddhist contemplative practice for the sake of personal spiritual development seems similar to his reference to persons observing Buddhist “morality” as a religious “practice” that establishes “the very foundation of a spiritual life,” in contrast with persons interested in “the commercialisation of meditation” which might remove “the practice from the moral base which nourishes it” (p. 114). As an example of a similar philosophy of moral self-cultivation that exemplifies what de Silva (2014) has in mind, he points to the moral philosophy of Aristotle (p. 114; that Aristotle might be interpreted as proposing a religio-philosophical teaching, see McClymont, 2010; see Aristotle c. 325 BCE/1996, Book III, Ch. 3, pp. 474–477; see also Gowans, 2021). Corroborating this observation, Symons and VanderWeele (2024) similarly call attention to “the dual account of flourishing that Aristotle offers” (both “temporal” and “contemplative”) where the former can be associated with “secular and naturalistic accounts of flourishing” and the latter with “religious accounts of flourishing” such as those found in Christianity and Buddhism (p. 8). Performing exercises to achieve conative well-being for the purpose of maintaining one’s temporal mental health might thus be differentiated from the practice of a religious morality or virtues (sīla) oriented toward contemplative religious goals. In this way, one might again, then, differentiate health and holiness (or differentiate a health psychology from a religious psychology).

Closing reflections

One sees in various ways in the work of Rao, de Silva, and de Silva a corroboration of the insight of Bodhi that a health psychology associated with practices oriented toward mental health and wellness can be differentiated from a religious psychology involving moral and spiritual practices oriented toward a soteriology and the search to realize a “holy state” (Bodhi, 2002, p. 7; de Silva, 1993, p. 233, 2010, p. 1, 2014, p. 115; Rao, 1988, p. 147). These three authors all employ an inexplicit comparative methodology when contrasting ancient Buddhist texts with various forms of modern psychology (e.g. Freud, Jahoda, Greenberg, and positive psychology). Although Rao (1988) states that he follows the work of Johansson (1969), it is not clear that Rao adopts the psychosemantic method that Johansson highlights as his own approach (p. 13, citing Johansson, 1965; Osgood et al., 1957).

With respect to clarifying the distinction itself between mental health and religion, one might find helpful a theory proposed by Chinese indigenous psychologist Kuo-Shu Yang (d. 2018) concerning the association, disassociation, and reassociation of behaviors with psychosocial functions (pp. 80–83). One feature of the theory of Yang (1998) involves a description of how functions can be preserved but the associated behaviors changed: For example, the same traditional function of Buddhist chanting may be realized either by the traditional behavior of verbal chanting or by the modern behavior of listening to a recording, or the same instrumental function of Buddhist ritual observance may be realized either by the traditional behavior of lighting a candle or by the modern behavior of using an electronic light (pp. 90–91). By reversing the variables in these examples, one might contend that the present discussion has focused on situations where traditional or ancient kinds of Buddhist behaviors such as meditation (samatha and vipassanā) or the contemplation of not-self (anattānupassanā) are being clinically reassociated with new modern functions involving mental health goals (prophylaxis and the promotion of wellness). If a patient or client continues to associate the behavior also with its traditional religious function, then the behavior at hand might be interpreted as exhibiting multifinality in terms of being oriented simultaneously toward mental health goals and religious goals (Yang does not discuss this particular combination of variables in his theory). The actions performed at a Buddhist funeral rite, for example, might serve mental health goals associated with the bereavement process (Gilewski et al., 1991; Ott, 2003) and simultaneously serve faith-based religious goals such as transferring merit to the deceased (as cited previously, Gombrich, 1971, p. 230). These observations reconnect the present discussion to the insight of Rosmarin (2018) mentioned previously that “pastoral counseling” can simultaneously be oriented toward the “dual goals” of (a) supporting a person’s mental health and (b) promoting a person’s religious development (p. 15). When clinical practitioners lack training in the latter domain, Gonsiorek et al. (2009) indicate that practitioners may encounter a competency boundary (p. 386). With respect to the Buddhist religion, there may be need, for example, for a clinical practitioner to refer a Buddhist patient or client to the guidance of a Buddhist Temple “master” (Lee & Ng, 2020, p. 153).

A further helpful consideration that might contribute to the clarification of the differentiation of mental health and religion might be found by exploring the history of the emergence of “mental health” and “mental hygiene” as American cultural values (Bertolote, 2008, p. 115). Mental hygiene as originally discussed in an American context involved the medical proposal that persons cultivate certain behaviors as life skills, practices, and exercises that might serve the function of preserving organismic integrity (Beers, 1921; Gorton, 1873; Ray, 1863; Sweetser, 1843; White, 1928). According to Beers (1908), the purpose of the organization that would become the National Committee of Mental Hygiene would be to work toward “the spreading of a common-sense gospel of right thinking in order to bring about right living” (p. 295). There can be a variety of religious and philosophical motivations for learning life skills oriented toward healthy living; a person’s exercise of such skills can thus be oriented not only toward health goals but also toward religio-philosophical goals such as those proposed in the Buddhist religion.

Footnotes

ORCID iD

Matthew R McWhorter

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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