1. World Health Organization. Constitution of the World Health Organization. Geneva: World Health Organization; 1948.
2. World Medical Association. WMA Declaration of Geneva: The Physician’s Pledge. Ferney-Voltaire: World Medical Association; 2017.
3. Ministry of Health New Zealand. Te Whare Tapa Whā model of Māori health. Wellington: Ministry of Health New Zealand; 2023.
4. Gee G, Dudgeon P, Schultz C, Hart A, Kelly K. Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, editors. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. 2nd ed. Canberra: Commonwealth of Australia; 2014. p. 55–68.
5. Health Canada, Assembly of First Nations. First Nations Mental Wellness Continuum Framework: Summary Report. Ottawa: Health Canada; 2015.
6. Yoeli-Tlalim R. Tibetan medicine and its Buddhist contexts. In: Barton J, editor. Oxford Research Encyclopedia of Religion. Oxford: Oxford University Press; 2020.
7. Siegel MD. To comfort always. Yale Medicine. 2018.
8. Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306(11):639–645.
9. Clark D. “Total pain”, disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Soc Sci Med. 1999;49(6):727–736.
10. Office for National Statistics. Religion, England and Wales: Census 2021. Newport: Office for National Statistics; 2022.
11. Ministry of Health New Zealand. Annual Update of Key Results 2023/24: New Zealand Health Survey. Wellington: Ministry of Health New Zealand; 2024.
12. Dhammacakkappavattana Sutta (SN 56.11), “Setting the Wheel of Dhamma in Motion.” Translated by Thanissaro Bhikkhu.
13. Sallatha Sutta (SN 36.6), “The Arrow.” Translated by Thanissaro Bhikkhu.
14. Sprevak M, Smith R. An introduction to predictive processing models of perception and decision-making. Top Cogn Sci. 2023. doi:10.1111/tops.12704.
15. Apps MAJ, Tsakiris M. The free-energy self: a predictive coding account of self-recognition. Neurosci Biobehav Rev. 2014;41:85–97. doi:10.1016/j.neubiorev.2013.01.029.
16. Piekarski M. Understanding predictive processing: a review. Avant. 2021;12(1):1–48. doi:10.26913/avant.2021.01.04.
17. Carhart-Harris RL, Friston KJ. REBUS and the anarchic brain: toward a unified model of the brain action of psychedelics. Pharmacol Rev. 2019;71(3):316–344. doi:10.1124/pr.118.017160.
18. Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165–1180. doi:10.1177/0269881116675512.
19. Hayes SC. Buddhism and acceptance and commitment therapy. Cogn Behav Pract. 2002;9(1):58–66. doi:10.1016/S1077-7229(02)80041-4.
20. Laukkonen RE, Slagter HA. From many to (n)one: Meditation and the plasticity of the predictive mind. Neurosci Biobehav Rev. 2021;128:199–217. doi:10.1016/j.neubiorev.2021.06.021.
21. Agin-Liebes G, Zeifman RJ, Mitchell JM. Self-compassion mediates treatment effects in MDMA-assisted therapy for posttraumatic stress disorder. Eur J Psychotraumatol. 2025;16(1):2485513. doi:10.1080/20008066.2025.2485513.
22. Wadji DL, Martin-Soelch C, Caclin A, et al. Can working memory account for EMDR efficacy in PTSD? A systematic review. BMC Psychol. 2022;10:245. doi:10.1186/s40359-022-00951-0.
23. Flückiger C, Del Re AC, Wampold BE, Horvath AO. The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy (Chic). 2018;55(4):316–340. doi:10.1037/pst0000172.
24. Jain L, Sarfraz Z, Karlapati S, et al. Suicide in healthcare workers: An umbrella review of prevalence, causes, and preventive strategies. J Prim Care Community Health. 2024;15:21501319241273242. doi:10.1177/21501319241273242.
- AI was used in the creation of this essay for editorial and referencing purposes.
>Dukkha as Resistance to Uncertainty and Resistance to Updating
Both of these fall under viparinama-dukkha. You note dukkha-dukkha (pain, loss etc) isn't addressed by buddhist training, which is right (we can just train to alleviate their surrounding causes more skillfully). This leaves sankhara-dukkha, which I feel is the most counterintuitive and real payload of buddhist training. The dukkha structurally inherent in fabrication of experience.
Hi Romeo, yes - Dukkha within the tradition is of course broader than the '2nd Dart' and I perhaps should have been more explicit around that. For anyone interested in Buddhism specifically, the teachings go much deeper than I have discussed here.
Good essay and a brave attempt to integrate Buddhist thought with modern cognitive and medical science.
I have a lot of first hand experience in reducing dukkha with the help of mettā meditation (loving kindness). Specifically, mantra chanting of the famous verse from Karaniya Mettā Sutta, sabbe sattā bhavantu sukhitattā (May all beings be happy!). Infact, I have dedicated my Substack blog for documenting my progress and insights in this mettā practice.
Over the past three years of continuous mantra chanting, I have managed to reduce dukkha to an signifficiant degree. My pain has been decreasing steadily; my reactivity to external events has been brought under control; the grip of lust and anger have decreased. There are other benefits which I have omitted.
Basically, I have been going through a transformation of consciousness, fueled by mettā chanting. Miraculously it worked, in unpredictable ways. My nervous system has been changing. I can't imagine gaining the benefits of Buddhist path without going through a radical personal, internal transformation of mettā-sādhana.
As suffering is inevitable, the key selling points of any successful religion are solace and the promise of eventual escape.
Buddha didn’t know who Maslow was, but he understood the hierarchy of needs well. We spend most of our time satisfying our survival and shelter needs. Once those are met, we turn to our social and self-actualization needs, which take up the rest of our time. Very few reach self-realization, the top of the pyramid. But we could if we skipped the intermediate levels, learning to accept hardship and suffering as healthy and normal. The Stoics go for this in a big way, actively seeking out calamities that they can endure virtuously.
There’s doubt as to whether Fat Buddha was a realistic representation, or if the familiar statuette was a marketing pitch. Join up and say goodbye to starvation and shivering cold. Buddha regarded the eternal cycle of existence as a curse, not a blessing. Life was very hard in his day.
Hi Eckhard - this was not an argument for 'Buddhist Care', simply an attempt to understand a human aspect of suffering that all people, those with schizophrenia and without, suffer from and that this element of suffering shouldn't be ignored regardless of what other interventions and support may be required.
Well the mechanism is outlined and for a start empirical support. The solutions/implications are multi-dimensional, some existing interventions already target this mechanism the biggest issue I think though is resource - this kind of suffering responds to time, care, compassion etc - healthcare systems I have worked in, de-emphasise this aspect of the work in favour of focussing on 'pathology' - as Eric Cassel said (see quotes in essay) - failing to acknowledge the nature of suffering is problematic for medicine - even harmful.
Sorry, I misunderstood your second comment. There is no answer to your first question as Buddhism isn't a treatment for schizophrenia or really even a form of 'care'. That doesn't mean people with schizophrenia don't suffer in the way I have described or that we can potentially reduce that suffering.
References:
1. World Health Organization. Constitution of the World Health Organization. Geneva: World Health Organization; 1948.
2. World Medical Association. WMA Declaration of Geneva: The Physician’s Pledge. Ferney-Voltaire: World Medical Association; 2017.
3. Ministry of Health New Zealand. Te Whare Tapa Whā model of Māori health. Wellington: Ministry of Health New Zealand; 2023.
4. Gee G, Dudgeon P, Schultz C, Hart A, Kelly K. Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, editors. Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. 2nd ed. Canberra: Commonwealth of Australia; 2014. p. 55–68.
5. Health Canada, Assembly of First Nations. First Nations Mental Wellness Continuum Framework: Summary Report. Ottawa: Health Canada; 2015.
6. Yoeli-Tlalim R. Tibetan medicine and its Buddhist contexts. In: Barton J, editor. Oxford Research Encyclopedia of Religion. Oxford: Oxford University Press; 2020.
7. Siegel MD. To comfort always. Yale Medicine. 2018.
8. Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306(11):639–645.
9. Clark D. “Total pain”, disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Soc Sci Med. 1999;49(6):727–736.
10. Office for National Statistics. Religion, England and Wales: Census 2021. Newport: Office for National Statistics; 2022.
11. Ministry of Health New Zealand. Annual Update of Key Results 2023/24: New Zealand Health Survey. Wellington: Ministry of Health New Zealand; 2024.
12. Dhammacakkappavattana Sutta (SN 56.11), “Setting the Wheel of Dhamma in Motion.” Translated by Thanissaro Bhikkhu.
13. Sallatha Sutta (SN 36.6), “The Arrow.” Translated by Thanissaro Bhikkhu.
14. Sprevak M, Smith R. An introduction to predictive processing models of perception and decision-making. Top Cogn Sci. 2023. doi:10.1111/tops.12704.
15. Apps MAJ, Tsakiris M. The free-energy self: a predictive coding account of self-recognition. Neurosci Biobehav Rev. 2014;41:85–97. doi:10.1016/j.neubiorev.2013.01.029.
16. Piekarski M. Understanding predictive processing: a review. Avant. 2021;12(1):1–48. doi:10.26913/avant.2021.01.04.
17. Carhart-Harris RL, Friston KJ. REBUS and the anarchic brain: toward a unified model of the brain action of psychedelics. Pharmacol Rev. 2019;71(3):316–344. doi:10.1124/pr.118.017160.
18. Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165–1180. doi:10.1177/0269881116675512.
19. Hayes SC. Buddhism and acceptance and commitment therapy. Cogn Behav Pract. 2002;9(1):58–66. doi:10.1016/S1077-7229(02)80041-4.
20. Laukkonen RE, Slagter HA. From many to (n)one: Meditation and the plasticity of the predictive mind. Neurosci Biobehav Rev. 2021;128:199–217. doi:10.1016/j.neubiorev.2021.06.021.
21. Agin-Liebes G, Zeifman RJ, Mitchell JM. Self-compassion mediates treatment effects in MDMA-assisted therapy for posttraumatic stress disorder. Eur J Psychotraumatol. 2025;16(1):2485513. doi:10.1080/20008066.2025.2485513.
22. Wadji DL, Martin-Soelch C, Caclin A, et al. Can working memory account for EMDR efficacy in PTSD? A systematic review. BMC Psychol. 2022;10:245. doi:10.1186/s40359-022-00951-0.
23. Flückiger C, Del Re AC, Wampold BE, Horvath AO. The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy (Chic). 2018;55(4):316–340. doi:10.1037/pst0000172.
24. Jain L, Sarfraz Z, Karlapati S, et al. Suicide in healthcare workers: An umbrella review of prevalence, causes, and preventive strategies. J Prim Care Community Health. 2024;15:21501319241273242. doi:10.1177/21501319241273242.
- AI was used in the creation of this essay for editorial and referencing purposes.
- Views expressed are my own (Liam Baker).
>Dukkha as Resistance to Uncertainty and Resistance to Updating
Both of these fall under viparinama-dukkha. You note dukkha-dukkha (pain, loss etc) isn't addressed by buddhist training, which is right (we can just train to alleviate their surrounding causes more skillfully). This leaves sankhara-dukkha, which I feel is the most counterintuitive and real payload of buddhist training. The dukkha structurally inherent in fabrication of experience.
Hi Romeo, yes - Dukkha within the tradition is of course broader than the '2nd Dart' and I perhaps should have been more explicit around that. For anyone interested in Buddhism specifically, the teachings go much deeper than I have discussed here.
Good essay and a brave attempt to integrate Buddhist thought with modern cognitive and medical science.
I have a lot of first hand experience in reducing dukkha with the help of mettā meditation (loving kindness). Specifically, mantra chanting of the famous verse from Karaniya Mettā Sutta, sabbe sattā bhavantu sukhitattā (May all beings be happy!). Infact, I have dedicated my Substack blog for documenting my progress and insights in this mettā practice.
Over the past three years of continuous mantra chanting, I have managed to reduce dukkha to an signifficiant degree. My pain has been decreasing steadily; my reactivity to external events has been brought under control; the grip of lust and anger have decreased. There are other benefits which I have omitted.
Basically, I have been going through a transformation of consciousness, fueled by mettā chanting. Miraculously it worked, in unpredictable ways. My nervous system has been changing. I can't imagine gaining the benefits of Buddhist path without going through a radical personal, internal transformation of mettā-sādhana.
Thanks for the feedback Buddhi. I think the bramhivaharas/4 immeasurables are so important and transformative. I am planning to write about them from the predictive processing perspective and started here with compassion/Karuna which may be of interest - metta is coming soon! https://liambaker677130.substack.com/p/the-computational-mechanism-of-compassion?utm_source=share&utm_medium=android&r=6tdtsz
As suffering is inevitable, the key selling points of any successful religion are solace and the promise of eventual escape.
Buddha didn’t know who Maslow was, but he understood the hierarchy of needs well. We spend most of our time satisfying our survival and shelter needs. Once those are met, we turn to our social and self-actualization needs, which take up the rest of our time. Very few reach self-realization, the top of the pyramid. But we could if we skipped the intermediate levels, learning to accept hardship and suffering as healthy and normal. The Stoics go for this in a big way, actively seeking out calamities that they can endure virtuously.
There’s doubt as to whether Fat Buddha was a realistic representation, or if the familiar statuette was a marketing pitch. Join up and say goodbye to starvation and shivering cold. Buddha regarded the eternal cycle of existence as a curse, not a blessing. Life was very hard in his day.
There are certainly some similarities with stoicism with the approach to suffering, although some pretty big differences overall too.
Interestingly Maslow in his later years added a layer to the top of his pyramid - 'Self-Transcendence'.
What percentage of chronically schizophrenic patients receiving Buddhist care remain in their jobs, earn a living, and support their families?
Hi Eckhard - this was not an argument for 'Buddhist Care', simply an attempt to understand a human aspect of suffering that all people, those with schizophrenia and without, suffer from and that this element of suffering shouldn't be ignored regardless of what other interventions and support may be required.
and the answer was…
Well the mechanism is outlined and for a start empirical support. The solutions/implications are multi-dimensional, some existing interventions already target this mechanism the biggest issue I think though is resource - this kind of suffering responds to time, care, compassion etc - healthcare systems I have worked in, de-emphasise this aspect of the work in favour of focussing on 'pathology' - as Eric Cassel said (see quotes in essay) - failing to acknowledge the nature of suffering is problematic for medicine - even harmful.
Have been working as a psychiatrist in both inpatient and out patient settings since 1978. I asked a specific and pracical question.
Sorry, I misunderstood your second comment. There is no answer to your first question as Buddhism isn't a treatment for schizophrenia or really even a form of 'care'. That doesn't mean people with schizophrenia don't suffer in the way I have described or that we can potentially reduce that suffering.
simply suffering as such… I am still remembering the Bangladesh-concert… Biafra-children… the human condition- something we all so often forget???