Goodwill: A Myanmar Medicine for Mental Illness

She said no more but her words left me curious. I’d heard whisperings among the community that Ma Khin Khin’s daughter had been ‘hysterical’, taking her clothes off in public, and screaming when confronted with minor difficulties in day-to-day tasks. I’d asked what mental illness she had but nobody knew what I meant. Here, there was ‘mad’ and there was ‘not mad’—and the girl was ‘mad’.

I doubted that Ma Khin Khin’s daughter had become a nun of her own volition. I envisioned tear-wrenched scenes of a young woman shrieking appeals to her mother not to leave as the final cherished, jet black locks of hair fell to the floor and, head freshly-shaven, she was dragged by two monks through the monastery gates. Somehow, the scene didn’t befit the peaceful, pagoda-sown landscape of Buddhist Myanmar and the cheerful orange robes of its monks.

In fact, the practice of taking mentally-troubled family members to the monastery is not uncommon in Myanmar, where psychiatry and psychology are still in fledgling stages. There are less than 20 working clinical psychologists in the country of more than 53 million, and only two mental health hospitals—one in Yangon, the other in Mandalay—making access to mental health care both unaffordable and inaccessible to the majority. But there are monasteries everywhere.

“Monks are a built-in form of therapy in the culture,” Dr Thein Oak Sein, Clinical Psychologist at Parami General Hospital in Yangon later explained to me. “Buddhism is a supplementary basis for mental health care in a country where there is no mental health system and becoming a monk or nun is a way for a person to protect themselves mentally.”

This would become key to understanding the monastic role in mental health in Myanmar. As I encountered this landscape where psychology as yet held little sway in general understanding of mental health and treating it, my notions of Ma Khin Khin’s daughter’s violent subjugation to the cloister were soon dispelled.

The monastery Ma Khin Khin’s daughter now called home was no average Myanmar monastery and the approach of the monk who ran it—Venerable Ashin Ottamasara—towards those who came to him with minds blighted by undiagnosed disorders was unique even to its Buddhist culture. The name of his monastery and meditation center was Thabarwa, and that of the adjoining village, Goodwill.

Using modest funds raised from donors wanting to improve their karma, Ottamasara established the original Dhamma Hall of Thabarwa Meditation Center and Goodwill village in 2008 on a patch of muddy grassland, 45 minutes from downtown Yangon. His vision was to create a place “to perform good deeds”—fundamental to Buddhist practice—“without limits”, at the heart of which would be meditation. Nine years on, the center and village span 85 acres and together are home to over 10,000 people.

Whilst the meditation center provides permanent and temporary accommodation as well as two meals a day to over 2,500 people—including monks, the physically infirm and elderly, so-called ‘mental patients’, and volunteers from both Myanmar and abroad—the village is home to some 8,600 of Myanmar’s poor, who, in return for completing a seven day Vipassana meditation retreat, receive 15 ft.² of land. Anyone can come at any time and is free to leave as and when they please. Even if their side of the bargain is left unfulfilled, they are permitted to stay. Everything is received free of charge and, despite the numbers, there is no government subsidy. Thabarwa continues to run solely on public donations and the goodwill of its inhabitants.

It was in the first light of the 5am meditation that I met Ma Khin Khin’s daughter, dressed in her pale pink nun’s robes and orange sash; she was preparing tea in the one-room apartment she shared with her ordained aunt round the back of Thabarwa’s Dhamma hall. She stood to greet me with a large buck-toothed grin, but avoided eye contact. “I am San Thi Dar,” she announced to the wall behind my head.

Over a fried egg and noodle breakfast, San Thi Dar explained in cobbled English that she was “the second little granddaughter of the last king of Burma.” The more I listened to the ensuing stories of bleeding kings and dying countries, the more apparent it became that San Thi Dar’s wavelength was not in tandem with the majority’s. Ma Khin Khin’s daughter was a nun by all appearances and she was also, by anyone’s standards, mad. Soon enough her aunt intervened—“my niece crazy”—and ushered San Thi Dar away to wash the dishes.

By nature of my western conditioning, I wanted to be able to categorize San Thi Dar’s symptoms under a neat psychological label, but not being a psychologist and being in a place where psychology didn’t play any role in matters of the mind, I had to make do with the facts as they stood. San Thi Dar had been unable to behave in a way her society had found acceptable and she and her family had suffered for it.

At Tharbarwa, as a nun, she was receiving psycho-social support and a level of acceptance and participation within a respected echelon of society. Meanwhile, the enthusiasm with which she demonstrated for my benefit meditation breathing, (“in way out way in way…”) and the precepts by which a nun must live, suggested that she was not bored or disappointed by a life confined to the monastery. In the end, she was safe and happy and—since no medication had been involved—what difference did knowing the name of the illness make in improving her situation?

Later that day, I met a student of Venerable Ottamasara’s, nun Khema Cari, a Switzerland native who had been following Ottamasara for five years. Sitting in the calmest corner of the Thabarwa compound, the administration office, before a golden Buddha gaudily back-lit with flashing LED lights and adorned with flowers and offerings, Khema Cari explained the center’s approach to receiving ‘mental patients’.

“In Venerable Ottamasara’s teaching of Buddhist Dhamma, we emphasize on detaching. This makes treating mental patients quite easy—we let them do and say what they want.” Khema Cari smiled before continuing. “We let them be, because if we attach to their behavior as something ‘bad’ or ‘unusual’, he or she will also attach to it, which makes it very difficult to abandon the state of mental problem.”

In Buddhism, attachments are objects and ideas for which we grasp (desires) or reject (dislikes) according to the ‘good’ or ‘bad’ feelings that arise when our senses make mental or physical contact with them. Think of the satisfaction of eating, contentment when lying in bed, or anxiety when losing money. It is these attachments, along with ignorance, that are, in Ottamasara’s words, “diseases of the mind.” The only way to free the mind—and therefore ourselves—from the pain and suffering caused by these ‘diseases’ is to train it to detach and stop grasping for or rejecting what life throws at us. Buddhism teaches us to do this through meditation.

The mind’s natural tendency to be in constant flux of attachment and rejection according to what it is fed by the senses renders us all, to varying degrees, mentally unwell. Only some individuals attach and reject with more force and longevity than others. Psychology says these individuals have a ‘mental disorder’; society says they are ‘mad’.

“Mental disorders are attachment to desires in the extreme,” explained Khema Cari. “Of course, meditation cannot cure mental disorders. It might take many years before a massive improvement is seen. But people can change and we help them.”

The Thabarwa logic is that by not distinguishing those who come to it as ‘mental patients’ from other people, and by teaching everybody else to detach from the dualistic ideation of ‘madness’ and ‘sanity’, a situation arises whereby the ‘mental patient’ is free to be in involved and included in their surroundings under their own volition and free of any stigma attached to their behavior. At Tharbarwa, this means immersion in helping others on a day-to-day basis, which gives individuals a sense of purpose and eventually leads them to abandon the attachments that were driving their ‘madness’.

“When you’re separated from your society inside a mental hospital, with everyone around you talking about your depression and giving you medication, how can you think about doing good things? Your mind is too attached to the idea that you are a mental patient,” explains Khema Cari. Therefore, the work lies not in changing the patient but teaching everyone else to change their attitude by detaching from the patient’s behavior.

“In society, someone becomes a mental patient when they act upon desires in a way that goes beyond what is considered acceptable behavior by the majority, for example taking their clothes off in the street. By judging this behavior as a symptom of a mental problem, we are attaching to ‘stable behaviors’ and causing them to attach to common reactions of their ‘unstable behavior.’”

The message seemed to be that mental illnesses were as much a fabrication of the collective mind as celebrities or fashion, and that if we stopped giving mental disorders a name and reacting to them as something exceptional, they would cease to exist as a problem.

Any new volunteer to Thabarwa is given the welcome tour, at the end of which they will hear something along the lines of, “And if the Vietnamese nun Sudasana starts shouting or acting crazy because she has come to you with an impossible idea to help others, then don’t worry. We do include her but sometimes it is difficult. She is a little bit schizophrenic.”

Apparently, San Thi Dar was not the only ‘mad’ nun in Thabarwa. Others, too, had sought mental and emotional protection beneath the orange, pink and brown robes of ordainment. This perplexed me. How was it possible for someone who had failed to adhere to day-to-day social expectations and accepted behaviors to fully adhere to the far stricter ones imposed by monastic life? Anyone could look and act the part of the nun or monk, but I wasn’t convinced all who claimed it could be the part. In San Thi Dar’s case, her mind wasn’t here and now. It was wandering in historical time warps and subjective imaginings, judging by the letters she’d written addressed to Queen Victoria asking to acknowledge her royal lineage and right to rule as a princess of Burma. As far as I understood, wasn’t the point in being a Buddhist nun to focus the mind on the here and now?

When I raised my doubts with Khema Cari, she responded with the patience teachers reserve for children who, yet again, have not understood the lesson. “But where is the problem if the good intention is there? If someone considered mentally ill wants to be a nun, that is a step that initiates change for the better.”

If Sudasana was what the foreign volunteers called “schizophrenic”, I would only encounter the sweeter side of her nature. Speaking one evening after meditation, Sudasana revealed she had become a nun because she wanted to “run away from the creations of the mind.” Relations in Vietnam with her parents and husband had become strained due to the adverse behavior she sometimes displayed, suggesting she’d never been diagnosed with schizophrenia, or any mental illness, but was misunderstood. It was in December 2016 that a trip to Thabarwa and a conversation with Ottamasara had confirmed what she already knew would be better for her: she would ordain and immerse herself in doing good deeds.

“Sometimes I still experience the mind’s creations,” said Sudasana, “For example, if I am making soup and a monk lifts his bowl to gesture he doesn’t want any, the mind imagines that he is about to hit me. This is a creation. I must not react. My feelings about it are real, but now I am aware of why they happen, so I can control them.”

A long-term volunteer, Carol, confirmed the change in Sudasana since she had ordained at Tharbarwa. “She was so aggressive when she arrived, shouting all the time. Now she is mostly as you see her, calm.”

So, I had met a nun for whom the Thabarwa approach seemed to be working. Sudasana, who only three and a half months earlier had been a married woman overwhelmed by what she described as “imaginary creations” and uncontrollable “hot feelings” had taken the step of good intention by becoming ordained. If at first her behavior had not befit that of a nun, by now the intention was manifesting. Sudasana participated as a respected member of the volunteer community as well as a nun, and she was a calmer individual less troubled by the anomalies of her mind.

The more I looked about me at Thabarwa, the more evident it was that here distinctions of identity and purpose were blurred. It was acceptable for people to slip in and out of nun or monk-hood as if it were simply a matter of changing their clothes, because the assumption was that good intention was there by the fact of being at Thabarwa in the first place. The distinctions continued to blur, first between nuns and volunteers and then volunteers and patients. Slowly, it dawned on me that Thabarwa was proving ‘mental patients’ of us all; without the brackets of psychology to label mental disorders, it really did become difficult to tell who here was not the ‘mental patient’.

For an outsider first arriving, the scene is chaotic. Forget the pleasant natural surroundings of a meditation retreat brochure, or the cautious hygiene of a resident mental hospital. Thabarwa provides little respite for tranquillity and even less hygiene. The noise is constant, of construction underway for the center’s expansion, of novices chanting, of loose street dogs barking; of loud music from weathered sound systems; of pots and pans clattering for the daily preparation of food for 2,500 people; of children shrieking and their parents arguing, and volunteers nattering into the night. The smell along the various muddy, card-paved walkways is of unwashed bodies and stewing litter. The whole place is a sensory minefield that under any other circumstances would be attributed to the breakdown of mental faculties.

It’s an overwhelming experience that either drives first-timers to recoil and run for the first taxi back to Yangon, or draws them irretrievably into it, bound in fascination—confused, afraid even, yet unable to resist the gross magnetism of humanity in one of its rawest, most unapologetic forms. Where many are bound to see incalculable need for improvement, Ottamasara sees incalculable potential for good deeds. From his perspective, the apparent privation of Thabarwa facilitates people’s potential to do good as they apply themselves in helping to improve it and, in the process, themselves.

“Thabarwa can be scary but strangely comforting because you realize how far very little can go, like a smile or a hello, and you realize the power we can have as individuals to make good for others,” explained Sophie James, a 27-year-old volunteer from the UK. “You strip back layer after layer of the physical aspects and each one is as raw and real as the last. It never stops being real.”

Sophie spent five days attending to elderly and immobile ‘yogis’—Myanmarese who had arrived there because they were physically sick and had no family to care for them. In this sense, Thabarwa performs the role of hospice as it provides a place for people “to come and die”, offering, on a rudimentary level, physical support and on a more complex one, mental and emotional care based on Ottamasara’s Dhamma teachings. The overall physical result of overcrowding, rats, bedbugs, infected bedsores and dirty diapers is one that those used to western healthcare sanitary standards find shocking. However, in Myanmar it’s not only accepted but respected because at the basis of this dirty, stinking collective of death approximation is goodwill. As Dr Thein Oak put it: “This culture’s resilience is because of Buddhism.” These people really know how to transcend physical discomfort with the power of the mind.

Over ten days, I worked with Sophie and a handful of other non-medically trained others from Europe and North America treating wounds beyond what any of us had experienced outside of television, from ant-infested bedsores to fist-wide, bone-deep holes in the flesh. Most did it for the challenge, some to try and make a change to others’ lives. We cried with compassion and pity for those in our care, despaired at our ignorance and the futility of our efforts to help them, then laughed at the same, and then, one by one, we detached. We shed our volunteers’ identities, with their phobias, self-doubts and delusions of grandeur and became steel-faced medical workers doing a basic job where it was most needed. We wondered at our newfound lack of compassion and if perhaps the work had flipped us to the other side. What had become of our emotions? Where were our tears? Had we been driven mad in the face of the human condition?

Speaking at the end of my stay to Andrea, a 34-year-old Italian man who had been at Thabarwa eight months and seen hundreds of volunteers come and go, he revealed: “You learn that all the volunteers here are ‘mad’, but it’s the ones who focus all their time on helping other people and don’t give time to themselves who in the end can’t cope. The people who are helping are suffering most themselves.”

His words shed light on our progression from emotional wreckage to ice-cold equanimity. Sophie, faced with what she had first seen as inexcusable physical suffering, had beaten herself up for not helping enough, which fed the strength of the emotions with which she responded to the situation. It was only when she paused to acknowledge the peace in the eyes of those she was treating, a peace whose roots had nothing to do with any fresh gauze or diaper but a deeper understanding that their pain was impermanent as the twilight hour, as were the volunteers who tried to relieve it, was Sophie able to change her mentality.

She realized that she was as dependent on the patients’ goodwill towards her as they were on hers. She was just as much their patient because helping them restored her self-worth and helped her to confront her own issues of depression. “Even by being there, you’re admitting something about yourself. Participating in it as a patient or volunteer is an acceptance of your condition and therefore it becomes a healing process. You’re saying ‘Okay, I’m not stable so I’m going to go to a place where not being stable is okay.’ In a place where everyone is vulnerable, there is strength.”

Our newfound emotionlessness was not because we’d detached from our intentions to do good. Our intentions were still there, but we were no longer attached to the idea that what we did could make a difference. Whatever we did, the suffering would exist outside of us. Speaking for myself, I found that at the heart of my ‘good deeds’ in treating the infirm of Thabarwa was the desire for recognition from others for doing a ‘difficult job’ and for proving to myself that I could. It was a self-serving issue of validation. On realising I could not make a difference, my mind let go of the notion that I deserved any recognition for my actions. The false intentions were gone and with them the imbalance of emotions. Only the action remained as an action of goodwill in its own right.

It was as Sudasana had said, “I do good deeds only because they are necessary. I follow them like the wind.” In other words, don’t go looking to do them, do them as and when the need arises and when they’re done, let them go.

After ten days, it felt as if doing good deeds at Thabarwa should come with a label of instructions and a dosage warning just like any other medication. Though I had met the ‘mad’ nuns who had benefited from Ottamasara’s mental treatment of good deeds immersion, they had come from cultures that had provided them with a base understanding of Buddhism and its practises. Those of us approaching Thabarwa’s goodwill message from a western perspective had misperceived where our goodwill came from and until we realised this, doing endless good deeds was emotionally damaging.

This year the Venerable Ottamasara has bought land near Lake Elsinore in California, on which he will establish the USA’s first Thabarwa Meditation Center. Plans are underway to do the same in Western Europe. These too will employ the same open door policy, but the emphasis will, by necessity, be of a different nature.

“In Myanmar, they understand meditation. The need for help here is physical. They need shelter and food, so Ottamasara provides it; the mental care through meditation and good deeds is already in their cultural make-up,” explained Michael Baptiste, a Swiss national who wants to help set up Thabarwa in Europe. “In Europe and the U.S., it’s the other way round. We do not have physical needs but our minds are very cluttered and there is little in our culture that can offer a way out to calmness, which drives people to become dependent on medication, especially towards the end of their life. So, we will focus the attention in Europe on providing mental care that does not involve medication.”

In one of his Dhamma talks, Ottamasara stated, “Here, we solve the biggest problems. If we solve the biggest problems, the rest is easy.” Our biggest problem, he is about to tell the West, is that whether we are writing letters to dead monarchs or signing a mortgage contract, we are all, without exception, the mental patient.