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The Urban Dharma Newsletter - October 6, 2008

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In This Issue: Buddhism and Health

1. Buddhism and Mental Health / Lecture by Master Sheng-yen
2. Buddhism, Health and Disease - Pinit Ratanakul, Ph.D.
3. Buddhism and Healing - by Alfred Bloom
4. Understanding & Managing Stress - by Professor Lily de Silva

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Hi,

I’ve been really busy as of late... But made time today to put together the UD Newsletter... I thought mental heath would be a good topic, considering how crazy the world seems right now.

I’ve posted some of my old and new videos on YouTube at:

http://www.youtube.com/user/revkusala

If you find the time, I’ve posted a video of a talk I gave a couple of months ago on ‘Karma’ at One Spirit in Simi Valley, CA along with a harmonica solo I did at the end of the service. And a feral cat video that gives you a bit of a glimpse into my day at the Buddhist Meditation Center.

My extension class ( http://urbandharma.org/udharma13/LMUfall08.html ) at LMU starts this week and I’m speaking at UCLA on Buddhist patient care to the new hospital chaplains.

Peace... Kusala



1. Buddhism and Mental Health / Lecture by Master Sheng-yen on October 25, 1990 at San Francisco General Hospital

http://www.chan1.org/ddp/channews/01-1992.html

Buddhism originated in India. It was there that Sakyamuni Buddha began to deal with the problem of illness. Illness begins at birth; when one is born, the peril of sickness begins. The person who has not suffered illness has yet to be born. Only after death does illness cease. We must suffer both mental and physical pain and illness in this life. Buddha said that we should see a doctor for physical illness, but mental illness should be treated with Buddhadharma.

Buddha saw that it was more important to save the mind than the body. One who has a healthy mind and a good attitude will be much less afflicted by physical difficulty than someone who has mental problems. If all of our mental problems are cured, that is liberation. One with a healthy body but a sick mind will suffer much more than someone who only has physical problems.

Physical illness is pain; mental illness is suffering. Buddhadhanna does not rid us of pain. It is not an anesthetic. It alleviates our suffering.

According to Buddhism, there are three causes of suffering:

1. Ignorance of No-beginning

Western religions talk about a beginning. Western science theorizes about the beginning of the earth and the universe. The problem of a beginning is quite difficult to solve. Buddha says there is no-beginning. Where is the starting point of a circle? Although there must be one, try as you might, you cannot find it. Thus we have no-beginning. If you ask, "Where does suffering come from?" a Buddhist will answer, "Suffering comes from no-beginning."

2. The cause/effect cycle of vexations

The effect that we suffer now stems from a previous cause. This effect in turn becomes the cause for a future effect. As we move forward in time, we incessantly create future causes.

3. Vexations themselves

The vexations from which we suffer arise from three sources:

A. The environment

On this visit I've really had a chance to see what a beautiful city San Francisco is. The climate is quite varied: there is fog and wind; the temperature moves quickly from chilly to warm. Much as we may think that San Francisco is like heaven, it is no surprise that people do get sick here.

Earlier today I was riding in a car with a householder. At one point she sneezed and I asked, "Are you sick?" She said, "No, I'm just allergic to cold air." Yes, there is sickness even in San Francisco. Obviously the great hospitals here were built for a reason. Even in such a place as this, with its clear sky and clean air, there may be pollutants or diseases in the air or microbes in our food that will cause us to become ill. The environment can be a great cause of our vexations.

B. Relationships

Relationships can cause us a great deal of suffering. Who is responsible for most of our vexations? Most people think it is their enemies. This is not necessarily the case. The culprit may be your husband, your wife, or your children. The people with whom we quarrel most are not our enemies but those closest to us. Each day we must deal not only with our close relations but many other people, some we know, some we don't. Some help us, some hinder us. People compete endlessly with one another.

Yesterday I gave a lecture at Stanford University. Someone came up to me and complained that academics are really petty. Of course academics are bright people. Ideally, they should help and support one another. The last thing they should do is tear each other down. However, even intelligence does not obviate the basic pettiness and competitiveness that exists in human nature. I often ask, "Is there anyone here who has never competed against others or felt another's competition? Anyone at all?" The answer is always no.

C. Emotional turmoil

Our greatest enemy is not to be found on the outside, We are vexed most by our own minds. We constantly change how we feel. We may move from arrogance to regret, but we never look at something in the same way as time passes. Thus we are in conflict, and we feel powerless to make a decision. We worry about gain or loss, right or wrong, and we cannot decide what to do. This is true misery. And there are many people who suffer in this way and yet believe that they themselves have no problems. As they protest that they have no problems, they may jump up and down, throw tantrums, and work themselves into states of extreme agitation. I once asked someone like this why he had so many vexations. "It's not me!" he cried, "it's these other rotten people who are making me so miserable." Actually, he had many problems that were of his own making.

Yesterday I was riding in a car with four people who were involved in a heated discussion. One said to me, "Sorry that we argue so much, Shih-fu." I replied, "You're the ones arguing, it's really none of my business." Did I hear what they said? Yes, I did. But I was simply not part of the conversation. This morning another one of the four told me, "I cannot stand to hear people argue. The very sound of it upsets me." You might think that he is reacting to something outside himself. The fact is that he is causing his own vexation. It comes from within him.

In Buddhism there are five kinds of mental vexation: greed, anger, ignorance, arrogance, and doubt. When we are distressed, we can try to analyze the nature of our vexation. When we can determine into which category our vexation falls, and then reflect on it, we can greatly reduce its intensity. When we are distressed by greed, we may reflect: "I am greedy, I have strong desires." Then the vexation of greed will automatically diminish.

When we suffer from anger, we may reflect: "Why am I so angry? My distress is directly related to my anger." In this way the anger and distress will begin to subside. You look inward, not outward. It is not the problem but your own mind that you examine.

When we have done something stupid and we feel miserable about it, it is best for us to see what we have done for what it is. If it is something stupid, then reflect: "I have acted in a stupid way." Thus will your suffering and vexation lessen.

Similarly, arrogance is itself a kind of suffering. To be aware of such feelings when you have them, will enable you to overcome them.

Doubt is also a type of suffering. Doubt will prevent you from making decisions. You will not be able to trust others and you will not be able to trust yourself. This is suffering indeed. If you know you suffer from doubt, you should reason as follows: "I want to accomplish such and such task, so I had better believe that I have the ability and that it is the right thing to do." If you really believe this, you will be able to accomplish whatever you wish to do.

Doubt can be an invidious influence in our lives. Imagine a man who has decided to get married, but is plagued by doubt. He wonders if the marriage will end in divorce, will she abandon him after the marriage has begun, or did she lie or has she withheld something important from him. If this doubt is unchecked, he will be miserable at the prospect of marriage and miserable within the marriage. Even if there was no real cause for the couple to break up, the doubt itself can furnish the reason and result in marital problems.

If you have such doubts, you should say to yourself: "If I really have so many doubts, it would be foolish for me to marry. If I want to marry, I should accept her as she is and trust her absolutely." If you cannot maintain such an attitude, you would be better off single, for marriage would only bring you misery. Are there any of you who have no doubts? I have yet to meet someone who has absolutely none.

According to Buddhism, there are five general causes of mental disturbance:

1. Pursuit of a given objective without considering your strengths and weaknesses. A variation of this is that you are not aware of the resources that you have and that you are never satisfied. Or when faced with a situation that is beyond your control, you are constantly tormented by the desire to resist the inevitable. Many people, especially the young, believe that they have unlimited potential. What they see others have done, they believe that they, too, can do. But when adverse conditions arise, they feel personally wronged, and resist rather than understand what is happening.

2. An insatiable desire to expand and conquer. Someone with this disturbance always wishes to magnify what he or she has. Such people wish to extend their influence beyond all limits. Some strive for fame so that they will be known to the world. Others use power to directly conquer those who oppose them. Power struggles such as these may occur among nations or simply within families. A wife may try to conquer a husband, or vice versa. Such desire to overpower others is indeed a mental disturbance.

3. Having achieved a particular objective or station, arrogance sets in. This may lead to callousness and a general disregard for others. An arrogant person may believe that he or she has the right to hurt others or sweep them aside according to personal whim.

4. Failure to achieve a goal leads to despair. Someone with this disturbance may tend to be greatly discouraged and lose all confidence in himself or herself. There will be a tendency to blame others.

5. Doubt pervades the mind. There is a profound sense of insecurity. Confidence quickly evaporates.

I am neither a psychiatrist nor a psychologist. I do not have a deep knowledge of classical psychology nor am I versed in the standard classifications of mental illness. I only know the Buddhist point of view which divides mental problems into the five categories above. These five may generate a myriad of other mental problems. Note that Buddhism is not concerned with the causality or the pathology of the particular elements that lead to a person's mental distress. It is concerned only with the recognition and elimination of mental disturbances.

Now I will talk about how we can deal with balancing the mind and the treatment of mental illness.

People often confront their own mental disturbances by using two ineffective methods. The first is denial: "I am not sick. I have no problems. There is nothing wrong with me." The second is self-treatment: a continual review in one's mind of a list of faults and what one believes to be their remedies. This builds one false assumption on another. Both of these methods only make matters worse and more serious.

Psychiatrists and psychologists use a talking method to analyze and help explain their patients' problems. Although it is true that the aim of this method is to have the patient come to his or her own realization, from the standpoint of Buddhadharma this is incomplete and temporary. This is because the doctor can discover only a part of your problem and you yourself can only know a part but not the complete picture of your illness. And it often happens that problems reoccur after counseling, and sometimes a patient continues in therapy for ten or twenty years with no real resolution. This might be enough to make the doctor sick.

The Buddhist method of healing is divided into two broad categories: change of concepts and methods of practice.

A. Change of concepts

1. The concept of cause and effect

While this concept is a religious belief, it is also a fact. It is a fact because throughout our lives, no matter what we do, there will be a response or an effect to our actions. Through faith we believe that there was a life before this life and one before that and so on through innumerable past lives. Much of what we experience now may seem unfair, but it is simply a consequence of actions we have performed in the past. To the extent that we believe this, we will be willing to accept what befalls us, good and bad.

2. The concept of causes and conditions

All phenomena arise and pass away because of the accumulation and interaction of different factors. The cause of a flower is the seed, but soil, water, and sun must be present for the plant to come into existence. Time, or uprooting, or lack of water or sun will cause the plant to wither and die.

When we have succeeded in something, there is no need for us to be particularly excited or arrogant. No matter how much we have accomplished, it was not without the direct or indirect help of many other people. And since we know that which is now coming into being will one day pass away, there is no need to despair when we encounter adverse or unfavorable conditions. As the proverb says, "It is always darkest before the dawn."

A calm mind will get us past unhappiness or elation. This is a sign of psychological health.

3. Compassion

People usually wish others to be compassionate towards them, but the idea seldom occurs to them to be compassionate towards others. There are those who when they make a mistake demand to be forgiven: "Don't measure me against the standards of a saint!" they say. But if they see someone else err they will say, "You're incompetent. Why couldn't you do it right in the first place!"

Compassion requires four criteria:

* Understanding of one's own conflicts and the development of inner harmony.
* Sympathy for other people's shortcomings.
* Forgiveness of other people's mistakes.
* Concern with other people's suffering.

The first criterion is especially important. In order to be at peace with yourself, you must have a calm and peaceful mind.

To do this, keep in mind the concepts of cause and effect and cause and conditions. This will give you a calm and peaceful mind. You will then be able to be compassionate, sympathetic, forgiving, and caring towards others.

B. Methods of practice.

1. Mindfulness of the Buddha. This consists of chanting the Buddha's name.

There are two reasons for this practice. First, reciting the Buddha's name in order to be reborn in the Pure Land will provide you with a sense of hope for the future and consequently make it easier for you to let go of the present. Second, reciting the Buddha's name can help alleviate your mental problems. When you are psychologically off balance, you can remove anger, doubt, or others mental disturbances by concentrating on Buddha's name. I often tell people, "When you get angry and want to yell at someone, chant Amitabha's name." You will be sending your anger to Amitabha. It will be Amitabha's problem.

2. Meditation

Sitting meditation can collect the scattered mind and stabilize a disturbed mind. There are many methods of meditation as well as levels of attainment, which we do not have time to go into in great detail. However, I can give you an idea of some of the more profound stages you might experience:

When you reach the point where there are no wandering thoughts in your mind, that is called samadhi. In that state there is no one and no problem that can bring you vexation. From the point of samadhi you can develop the wisdom of no-self. This is enlightenment in Ch'an, or Zen, Buddhism. To reach enlightenment is to be free of mental disturbance and illness. At the point when you are always in this state and you do not fall back, that is called Great Enlightenment. Short of that is Small Enlightenment. Your old problems may arise after you have reached this point, but you will know how to deal with them. Even Small Enlightenment is a significant step. But remember that even when you first begin to meditate that is a very important step, also.



2. Buddhism, Health and Disease - Pinit Ratanakul, Ph.D. / Director of the College of Religious Studies, Mahidol University, Salaya, Puthamoltoll 4, Nakornpathom, 73170, Bangkok, Thailand / Eubios Journal of Asian and International Bioethics 15 (2004), 162-4.

http://www.eubios.info/EJ145/ej145b.htm

Health and disease are among the common experience of human life that is the special concern of religion. Religion, in every society, in every stage of history, upholds the value of well-being and health as necessary for a meaningful life, and provides its adherents with ways and means to enhance their health and to enable them to deal creatively with human vulnerability to disease, pain and suffering.

There is a consensus that health and well-being does not mean only or simply the absence of pain and suffering or the lack of disease, disability, defect and death, but has a positive meaning. There is much debate today over what this positive meaning is. This article is a short introduction to the Buddhist approach to health and disease. After all Buddhism has over 2,500 year history of involvement in medical theory and practice. As a living religion its teachings have much influenced the ways Buddhists think and act in matters of life and death. Since health is a human value that all of us are concerned with, it is hoped that this introduction will serve as a Buddhist contribution to the ongoing discussion on how to define health and therefore the role and function of the modern health care professionals who represent and serve this crucial human value.

Buddhist worldview, dependent origination, and kamma

The Buddhist worldview is holistic and is primarily based on a belief in the interdependence of all phenomena and a correlation between mutually conditioning causes and effects. This belief is formulated by the principle of dependent origination, also referred to as the law of conditionality, the causal nexus that operates in all phenomena - physical, psychological, and moral. In the physical realm, for example, all things in the universe are intimately interrelated as causes and effects without beginning and end. And the world is an organically structured world where all of its parts are interdependent. Similarly in human society every component is interrelated. The same is also found in the psycho-physical sphere, in which the mind and the body are not separate units but an interdependent part of the overall human system1.

The Buddhist worldview also comprises a belief in kamma, the correlation between deed and its subsequent consequences, as in the moral realm this principle of dependent origination operated by the name of the law of kamma stating the conditionality of this causal relation2. This implies that the Buddhist law of kamma does not entail complete determinism. If such a determinism were accepted there would be no possibility of the eradication of suffering. A man would ever be bad for it is his kamma to be bad. But this is not so and the effect of kamma can be mitigated not only in one life but even beyond, as, according to Buddhism, life is not limited to a single, individual existence. Present life is only a part of the round of existence (samsara) which stretches out across space and time. A single existence is conditioned by others proceeding it and in turn conditions one or a series of successive existences. Existence is thus at the same time and effect in one respect and a cause in another. This imprisonment in the round of existence is the result of one's own deeds (kamma), good or bad. Conditioned by deeds, the present form of existence can be changed or dissolved by deeds. This is possible because the present is not the total effect of the past. It is simultaneously cause and effect. As an effect, we are conditioned by the causal matrix made up of the social and biological continuities of life themselves and thus are the effect of our past deed. What we are now is the result of what we have been before. But as a cause, we are the absolute master of our destiny. The present, though elusive, is the building block of the future. What we shall be depends on what we are and shall do, with our own choice.

Dependent origination, health, and kamma

Within this worldview, health and disease involve the overall state of a human being and are interwoven with many factors such as economics, education, social and cultural milieu. All these conditional factors need to be seriously taken into account in the understanding of health and disease. Health is therefore to be understood in terms of holism. It is the expression of harmony - within oneself, in one's social relationships, and in relation to the natural environment. To be concerned about a person's health means to be concerned with the whole person, his (her) physical and mental dimensions, social, familial, and work relationships, as weel as the environment in which he (she) lives and which acts on him (her). Therefore the tendency to understand health only in relation to particular parts of the human organism such as the defects in unacceptable to Buddhism. In the Buddhist holistic perspective, disease is the expression of the disturbed harmony in our life as a whole. By its physical symptoms, disease draws our attention to this disturbed harmony. Hence healing in Buddhism is not the mere treatment of these measurable symptoms. It is more and expression of the combined effort of the mind and the body to overcome disease than a fight between medicine and disease. Its real aim is to enable the patient to bring back harmony within himself and in his relationships with the others and the natural environment. In this context healing is not an end in itself, but rather a means by which medicine helps to serve the value of human health and well-being.

Apart from this holistic approach, Buddhism attributes kamma as an important contributing factor to health and disease. In the Buddhist perspective good health is the correlated effect of good kamma in the past and vice versa. This interpretation of health and disease in terms of kamma is to emphasize that there is a relationship between morality and health. Health depends on our life-styles, i.e. the way we think, the way we feel, and the way we live. Illness is the consequence of an unhealthy life-style such as one characterized by sensual indulgence, for example. This is the normativistic component of the Buddhist perspective on health which involves the practice of moral and religious values such as compassion, tolerance, and forgiveness. This is the underlying reason why Buddhism advises those who want to be healthy to practise morality (sila), mental discipline (samadhi), and wisdom (panna), in the Noble Eightfold Part.

Perhaps we will understand the role of kamma in health and illness as we look at the following cases. For example, in the time of an epidemic there are usually some people who succumb while others escape even though both groups are exposed to the same conditions. According to the Buddhist view the difference between the former and latter is due to the nature of kamma of each in the past. Other examples are the cases where though the treatment given was successful the patient died, and where in spite of ineffective treatment the patient lived. There have also been cases of remarkable and unexpected recoveries when modern medicine has given up all hope for remission. Such cases strengthen the Buddhist belief that besides the physical cause of disease, illness can be the effect of bad kamma in past lives. A disease with a kammic cause cannot be cured until that kammic result is exhausted. But the kamma of every person is a mystery both to himself and others. Hence no ordinary person can definitely know which disease is caused by kamma. Therefore one has to be careful in imputing kamma especially for disease because it may lead to a fatalistic attitude of not seeking any cure at all or giving up treatment out of despair. Buddhism advises us that for practical purposes we have to look upon all diseases as though they are produced by mere physical causes. And even if the disease has a kamma cause it should be treated. As no condition is permanent and as the causal relation between deed and its correlated consequence is more conditional than deterministic there is the possibility for the disease to be cured so long as life continues. On the other hand we cannot tell at what point the effect of bad kamma will be exhausted. Therefore we need to take advantage of whatever means of curing and treatment are available. Such treatment, even if it cannot produce a cure, is still useful because appropriate physical and psychological conditions are needed for the kammic effect to take place. The presence of a predisposition to certain diseases through past kamma and the physical condition to produce the disease will provide the opportunity for the disease to arise. But having a certain treatment will prevent a bad kammic result manifesting fully. This kind of treatment does not interfere with the working of the individual kamma but reduces its severity. The advice of Buddhism to a person with and incurable disease is to be patient and to perform good deeds to mitigate the effects of the past bad kamma. At least the individual effort to maintain or recover is itself good kamma.

The belief in kamma in relation to health and disease does not lead to fatalism, nor to pessimism. As mentioned before, the law of kamma does not rule with an iron hand or bring a curse. This law only stresses the causal relation between cause and effect. It does not entail complete determinism. Te believe in kamma is to take personal responsibility for health. Health is not given. It has to be gained by one's own efforts, and one should not blame others for the suffering one is going through because of the disease. Besides, it may be a comfort to think that our illness is no fault of our present lives but the legacy of a far distant past, and that by our own attitudes and efforts towards illness good kammic effects can arise. The belief in kamma also enables us to cope with the painful aspects of life, for example suffering from terminal illness such as leukemia or a more malignant form of cancer with tranquility and without fruitless struggle, nor negative and depressing mental states. Such acceptance will also enable us to overcome despair, endure the condition to the last days, and thus die a peaceful death.

The emphasis on the kammic cause of health and disease implies individual responsibility for health and illness. Kamma is created by choices we made in past lives. Health is to be gained by continuing personal efforts in this life. Good deeds (e.g.regular exercise, proper nutrition, etc.) lead to good health whereas bad deeds (e.g. poor living habits, abusing the body and the mind) in this and previous lives bring illness. The sense of responsibility is much needed in health care. At present, with the invention of "miracle drugs" and the development of new technologies, many people tend to have the illusion that all pain and suffering in life can be eliminated and that all suffering is bad, whether physical, mental, emotional, moral, or spiritual. And by blaming it on external forces people seek external means (e.g. pills, injection, therapies, etc.) of alleviating suffering rather than examining themselves and their own lives and seeking to change what it is within themselves that has resulted in illness. The Buddhist kamma view of health and disease, on the contrary, recognizes the reality of self-inflicted disease that can be traced to an individual's own life-style and habits, and encourages one to seek also for the cause of our disease, pain, and suffering within oneself, e.g. in relation to one's own life-styles, decisions, attitudes, and relationships that must be changed. It also recognizes the positive role of disease and suffering in refining our spirit and in strengthening our moral character, e.g. courage, self-understanding, and sympathy towards others.

However, the Buddhist emphasis on individual kamma or personal responsibility for health does not mean that Buddhism assigns personal responsibility for all illness. In the Buddhist view kamma has both individual and social dimensions. This latter component is what may be termed as social kamma which, in health care, refers to the environmental factors that could aggravate or mitigate and individual kamma. These factors such as socio-economic factors, e.g. unhealthy and dangerous working conditions, can act as the hazardous/supporting environment for health/illness of and individual. And society could hold employers and businesses responsible if they did not maintain a healthy environment for their workers or provide safety measures. This concept of social kamma also implies responsibility on the part of government to provide adequate health care services to all its citizens in proportion to their health needs and medical conditions.

The body and physical health

In the Buddhist perspective the unique body of each of us, both in appearance and structure, is a result of our past kamma. The human body is at the same time the means by which we contact the world and the physical manifestation of our mind. Being such an important instrument, the body must be duly attended to, i.e. one must not abuse it through food, alcohol, drugs, or by taxing it with over-indulgence and deprivation. Even enlightenment, the highest goal of Buddhism, cannot be attained by the mortification of the body, as witnessed in the personal experience of the Buddha. This is due to the interdependency of the mind and the body. Intellectual illumination can be attained only when the body is not deprived of anything necessary for the healthy and efficient functioning of all bodily organs.

According to Buddhism, any life lived solely for self-seeking or self-indulgence is a life not worth living. Buddhism therefore encourages us to make use of the body for higher purposes, particularly for attaining the highest goal, nibbana, liberation from the endless cycle of birth and rebirth (samsara) as subjects of contemplation. Constant practice of morality and meditation will enable us to have self-control over the appetites, sensations, and egoistic drives.

Physical health is viewed by Buddhism as constituted by the normal functioning of the body and its organically interrelated organs. When one of them fails to function, debility and disease set in. The normal function of the body organs is the result of the harmony and equilibrium of the four primary elements in the body, i.e. earth (pathavi), water (apo), wind (vayo), and fire (tejo). If the balance is disturbed, the normal function is disrupted and a state of disease appears. Curing is the restoration of this balance, i.e. putting the entire physical being, and not just the pathologically afflicted part, into good condition. Since each part of the human body is organically related to all other parts, for good health the entire body must be in good condition. In view of the fact that the body, like all phenomena, is always in a state of change, decline, and decay, physical health cannot last long. It is impossible for the body to be perfectly healthy and free from all diseases at all times. Human life is vulnerable to disease at very stage. Disease is a reminder of human fragility. This implies that (complete) health is not a totally attainable state. Human wholeness or well-being, therefore, does not mean the absence of all pain and suffering in life, but learning to deal with pain and suffering, how to use it and transcend it for the sake of personal growth and sympathetic understanding of others.

The Buddhist understanding of physical disease in terms of the disturbance of the harmony and equilibrium in the body is different from the militaristic view of disease focused on the hostile germs. According to this view disease is caused by the attack of the hostile germs in the environment to a particular part of the body. These different views lead to different ways of curing. The Buddhist way is to bring harmony to the body where disharmony has taken place either by medicine or by the change in thought and way of living. Medicine is used to boost the body's self-healing power i.e. to be able to deal with the disease, to restore the balance in its own way. Healing is more an expression of the combined efforts of the mind and the body to overcome disease than a fighting between medicine and disease. On the contrary the other way is to fight back the germs with drugs which usually are chemical. The effectiveness of these drugs depends on their attacking power on the inflicted part and not on the restorative power as in the case of Buddhism.

The mind and mental health

Physical health is important because Buddhism regards is to be the means to intellectual enlightenment. Buddhism does not want people to spend a large part of their lives in poor health or else they will not be able to devote themselves to the highest purposes. Although Buddhism views the mind and the body in interdependence, its teaching gives special attention to the mind and its power. It is stated in the very first verse of the Dhammapada that what we are is the result of our thoughts. The source of our lives and hence of our happiness or unhappiness lies within our power. No one can harm us but ourselves. It is the kind of thought we entertain that improves our physical well-being or weakens it, and also ennobles us or degrades us. This it the reason why Buddhism designates thought as the cause of both physical are verbal actions with their kammic results and considers mental health of the utmost importance and the training of the mind to attain the highest stage of health as its sole concern. This preoccupation with mental health is also regarded as the true vocation of Buddhist monks. The training is based on the belief that both the body and the mind are prone to sickness. But since the mind is able to detach itself from the body it is possible to have a healthy mind within a sick body.

According to Buddhism for the mind to be healthy, first it is necessary to develop a correct view of the world and ourselves, i.e. a realistic acceptance of the three traits of existence: impermanence, insubstantiality, and suffering of unsatisfactoriness. The adoption of the wrong views makes us see the transitory as permanent, the painful as happy, the impure as pure, and what is not-self as self. Consequently we crave and struggle for what is not something that does not seem to change, e.g. the illusory permanent and identical self and the permanent object od desire -and we always suffer disappointment. By accepting thing as they reality nothing more than a name for the complex of psycho-physical elements (nama-rupa) - the mind no longer strives for the satisfaction of self-seeking impulses nor clings to objects. As a result the mind is at rest and thereby psychological suffering is eliminated leading to improved mental health.

Apart from changing our thought by the adoption of this correct view and by developing an attitude of detachment towards the world and ourselves, our mental health is dependent on our power to rein in our appetites and to restrain and/or eradicate negative motions much as greed (lobha), hatred (dosa), anger (moha), and our possessive and aggressive tendencies. All these unwholesome states can act as the cause of mental and physical illness. Such control can be achieved through the practice of morality and meditation. Every set of Buddhist precepts and every type of meditation are aimed at controlling the senses, impulses, and instincts and easing the tension and eliminating the unwholesomeness of thoughts that tend to make the mind sick.

Buddhist meditation is not only a means to cure the mind from its ailments caused by incorrect views, self-indulgence, hatred, and anger of all forms, but is also devised as a means to induce positive wholesome mental states, particularly the four sublime states: loving kindness (metta), compassion (karuna), sympathetic joy (mudita), and equanimity (upekha). Loving kindness enables us to love and be kind to one another while compassion wants us to help those in distress. Sympathetic joy is an ability to rejoice in the joy of others and equanimity is the equanimous temperament without being either elated or dejected in the face of the vicissitudes of life - gain and loss, fame and lack of fame, praise and blame, happiness and sorrow. The continual cultivation of these wholesome mental states is an important Buddhist way of making the mind healthy. Actions spring from this healthy mind are always good and wholesome and thus conductive to our holistic health. This over-all health is reflected in all aspects of life including thinking, speaking, living and doing.

Concluding Remarks

The Buddhist concept of health and disease is formulated within the context of the principle of Dependent Origination and its related law of kamma. Accordingly health and disease are to be understood holistically in their over-all state in relation to the whole system and environmental conditions-social, economic, and cultural.

This view is diametrically opposite to the analytic view which tends to dissect human beings into different segments both in the physical and mental realms. As a result health is defined too narrowly as the mere absence of measurable symptoms of disease. Doctors and other medical personnel who hold such view direct their attention to particular parts of a person when considering whether or not a person is healthy and have not been concerned enough with their patients as whole human beings, reducing their care of them to the quantifiable control of physical symptoms. The Buddhist holistic perspective, on the contrary, focuses on the whole person and argues that since human beings are not merely physical creatures but mental, emotional, social and spiritual beings as well and that, as a psychosomatic unity, bodily illness affects the mind and emotions and emotional, mental and social maladjustments can affect the body, then to be concerned about a person's health one must be concerned about his entire person, body, mind and emotions, as well as his social environment. This may seem an utopian goal that medicine or health care services alone cannot accomplish. But it should be thought of and striven for Perhaps this overall health could be made possible only through the concerted efforts of medicine, the individual and social agencies concerned.

Notes
1. The most detailed and coherent systematic exposition of the principle of Dependent Origination is given in Visuddhi Magga: The Path of Purification.
2. This law is also referred to as the law of causality according to which a deed is likened to a seed which will sooner or later result in certain fruits.



3. Buddhism and Healing - by Alfred Bloom, Professor Emeritus, University of Hawaii

http://www.shindharmanet.com/writings/healing.htm

Buddhism began in India about 5th century BCE and began its spread through Asia from about the 3rd century BCE when King Asoka sent out missionaries to South Asia and to the West. In the course of time, it evolved into two major traditions known in ancient times as Hinayana and Mahayana, the Smaller and the Larger Vehicles. Today, we do not us the term Hinayana or the Small vehicle, because it is pejorative. The style of teaching of that early tradition is now called by the name Theravada, which means "Way of the Elders." There are significant differences between the two traditions which we will not take up in detail, except to indicate that Mahayana Buddhism spread largely to the Northwest and then North and East Asia, including the countries of China, Mongolia, Tibet, Korea and Japan.

Buddhism is sometimes described as a philosophy seeking a religion, in contrast to Christianity which was a religion seeking a philosophy. The consequence of this difference has been that Buddhism focuses on certain philosophic principles rather than beliefs. There are beliefs but they are not the primary consideration. There is, therefore, a considerable variety of teachings in Buddhist tradition, sometimes contradictory and confusing if one does not know the history.

However, Buddhism is a religion of practice and in its monastic forms strives to realize the principles as experiences in one’s own life.

Ultimately, they hope to achieve enlightenment as Gautama experienced. Speculation and doctrine are secondary to experience guided by a teacher and the major principles. Hence, meditation is a central feature of Buddhism.

Gautama’s enlightenment experience reached after six years of intensive spiritual search includes basic principles that permeate all Buddhist traditions. These are the Middle Path between extremes of hedonism and asceticism; the four noble truths and eightfold path, and the principle of interdependence, no-soul, and impermanence.

These teachings are first expressed in what we call now the Theravada teaching and practice. As indicated by its name, it is more conservative. The Mahayana tradition is more flexible and adaptable so that each country and culture where it spread developed its own distinctive styles of Buddhism which have been maintained to the present time.

Mahayana Buddhism elaborated on the initial principles and developed a cosmic, universal perspective indicating that all beings have Buddha nature and all beings will attain Buddhahood. Mahayana has been very positive in affirming life in this world, though it also has beliefs about the afterlife. It has a philosophy of education that takes into account individual differences whereby the teaching is to be given in harmony with the level of understanding and spiritual development of the student. This has been the basis of its adaptability and integration with native cultures. It is replete with Buddhas and Bodhisattvas who meet the spiritual need of each individual. While merging with folk traditions, Mahayana also developed subtle systems of philosophy focused on the concept of emptiness and exploring the nature of reality and our perception of it. There is a a wide variety of literature.

Buddhism in Hawaii is mainly the Mahayana tradition in its various forms which we see in the differing denominations. There are South Asian Buddhists from Vietnam and Laos; East Asian from China, Korea and Japan; and Tibetan Buddhists. There are Theravada Buddhists mainly from Thailand and some from Cambodia.

Mahayana Buddhism never denied the Theravada but built its teaching with that as its foundation and precedent. They considered the Theravada as elementary teaching and background for the more advanced Mahayana teachings.

Buddhism has had a concern for health, spiritual health, from its very beginning. Gautama, who became Buddha or Enlightened One, initially tried to solve the problem of human existence through extreme ascetic practice. He found this harmful and ineffective. He discovered that enlightenment could come only when there was a healthy mind in a healthy body. He enunciated the principle of Middle Path between extremes. Spiritual development can only come when one avoids hedonism, devotion to pleasure or asceticism, mortification of the body.

The Buddha is sometimes described as a physician because his analysis for the human condition proceeds as a doctor might in observing the condition, seeking the cause, prescribing the cure and applying it. In Buddhism these are called the Four Noble Truths.

The first truth is that all life is suffering. Westerners often see this declaration as a negative, pessimistic assessment of life. Rather, it is realistic, looking at the actual conditions of human life. The term for suffering -- Dukkha -- refers to a broad spectrum of conditions, namely dis-ease, not merely disease as a physical experience, anxiety, frustration, dissatisfaction. It takes into account that there is suffering in parting from things we love and meeting things that are unpleasant. There is suffering in what we call surfeit or too much of a good thing. Suffering in Buddhism comprises both physical and mental features.

Based on the principle of cause and effect, Buddhism sees the core problem in suffering caused by ignorance, not knowing the true nature of our life and world. We avoid facing the impermanence of life in all its dimensions. We are deluded by focusing on permanence and not realizing the non-soul character of all things. Non-soul is one of the difficult concepts of Buddhism and it means that nothing has its own essence or is totally self explainable or contained. Everything is interdependent with every other thing and the failure to see this leads to our egoism and our problems and conflicts with others who also pursue their own ego interests. We see everything only in reference to ourselves and as self-centered beings, we encounter resistance in the world, which increases our unhappiness and dissatisfaction.

Going deeper, the cause of the many forms of suffering is desire, perhaps better craving, lust, thirst or in general passions of hatred, greed and anger. These passions arise from our ego attachments to things, our ideas, our bodies etc.

However, Buddhism is an optimistic system and proposes a cure or healing. Whatever has a cause can be remedied by removing the cause.

The way to remove the cause is known as the Noble Eightfold Path It includes: Right View, Right Intentions, Right Speech, Right Action, Right Livelihood, Right Effort, Right Mindfulness, and Right Concentration.

The system is a total spiritual discipline involving the body and mind. It aims not only at improving life, but also to liberate one from the bondage to finite existence and repeated reincarnations in the stream of births and deaths. The goal is ultimately Nirvana.

Though Buddhism aims at a final solution to the problems of existence, it also provides a pattern for living holistically in this world. Initially, it was for monks but its principles have relevance for ordinary life. The system of eight aspects of Buddhist spirituality begins with Right Views, which contributes to mental health. By having a proper and realistic understanding of the self as a dynamic, evolving process, we may become more adaptable and flexible confronting life situations. Accepting the impermanence of life and things, we may become more tranquil. There is a famous story about a mother, Kisa Gotami. Her baby had died and she was distraught. She pleaded with the Buddha to restore her child. The Buddha agreed, on the condition that she bring a mustard seed from a home where there had never been a death. She searched but could not find such a home. She gained insight and returned to the Buddha, now understanding that her child suffered death as all others do. She then accepted the death of her child.

The five aspects of Right Intentions, Right Speech, Right Action, Right Livelihood, Right Effort take up the inner and outer dimensions of our life activities. Buddhism focuses on the activities of the mind, body and speech, which are involved in all our activities. These should be integrated and in harmony with our understanding of reality. It involves ethical, spiritual and physical dimensions of living.

Right Mindfulness, and Right Concentration are perhaps the best known features because we hear so much about meditation in Buddhism and other traditions. Mindfulness is maintaining a focus of attention, an awareness of what is going on without focusing on a particular objects. It is a detached observation of what is happening within us and around us in the present moment

Right Concentration describes the unification of all mental functions on an object of meditation. It involves deep attentiveness and tranquility. Essentially meditation enables a detachment from the distracting flow of stimuli that assault the mind and permits an inner unification of the psyche to develop. As Jon Kabat-Zinn has written on mindfulness and meditation, it is like climbing out of a raging current in a stream and watching the stream from the bank. This unification can become the basis for more creative activity or involvement. We call it centering or working from the inner quietude of our minds. In meditation our egoism and its stake in things is set aside, allowing other perceptions and alternatives to emerge. When people get angry and wish to retaliate for a hurt, we say count to 10. That is, give space for the mind to truly assess the situation and find a more proper response. Meditation is a more developed spiritual approach to our problems.

Buddhism contributes to mental and physical health through encouraging the development of a unified and centered personal approach to our life affairs. It assists the well-being of the body through the body-mind synthesis in which the physical elements and the psychological and spiritual dimensions are all part of a continuum and a dynamic interrelation. In the west, we are prone to distinguish flesh and body, matter and spirit, body and soul, etc. However, Buddhism sees things as process in which all features of existence are interdependent and ultimately one. According to Jon Kabat-Zinn:

"Since the mind plays such an important part in people's experience of their bodies and what's possible in their lives, it seemed that a hospital would be a perfect place to train people in meditative awareness. They could optimize their inner resources for healing and take responsibility for their health." ("Mindful Medicine")

According to Kabat-Zinn, meditation-mindfulness can help in reducing stress, pain and depression. By letting go of stress, one may even enhance the body's self-healing powers. Studies have shown that anger and hostility affect our health. According to one study, they influence heart disease (Dalai Lama, Dr. Howard Cutler, "The Art of Happiness," New York: Riverhead Books, 1998, p.247.)

The Dalai Lama states:

"The destructive effects of hatred are very visible, very obvious and immediate. For example, when a very strong or forceful thought of hatred arises within you, at that very instant, it totally overwhelms you and destroys your peace of mind, your presence of mind disappears completely. When such intense anger and hatred arises, it obliterates the best art of your brain, which is the ability to judge between right and wrong, and the long term and short term consequences of your actions." (Ibid., p. 250.)…

However, the role of Buddhism in creating healthy life-conditions does not involve miracle cures, but employs methods for dealing with the emotional elements that accompany pain and even intensify it. The Dalai Lama indicates that happiness is not merely a feeling, but is the result of right thinking. Our problems begin with negative thinking. However, negative thought is not intrinsic to our minds and the mind can be trained to develop positive attitudes of love, compassion, patience and generosity. This approach has taken form in what is known as cognitive therapy, which seeks the source of negative and self-defeating ideas. Right thinking is not just a matter of correct information and belief. Right thinking in Buddhism means a transformation in one’s understanding of the nature of existence. Enlightenment is transformation of one’s total being.

I should point out that there are forms of therapy based in Buddhism. From the Pure Land tradition, there is the method of Naikan therapy which is a system of introspection to make one aware of our interdependence with others and to arouse the sense of gratitude for their contribution to our lives. This positive force can offset personal problems that induce negativity.

There is also Morita therapy based in Zen Buddhism and is reality therapy, that is living in harmony with reality as it is. According to Morita therapy, "the gap between the world as it is and the world as we think it ought to be can fill with pain. When we do not look the way we think we ought to look and when we cannot accomplish our goals as rapidly and effortlessly as we think we ought to be able to accomplish them, we worry that either there is something wrong with us or we are victims of injustice. Rather than futilely railing against nature or trying to force it into complying with our ideals, we can learn to live in harmony with it. To live in harmony with nature, we accept as parts of ourselves our talents, imperfections, painful feelings and real desires."

I should conclude by indicating that Buddhism has all the elements of folk religions common around the world. There are Buddhas and bodhisattvas who offer healing and prayers requesting their blessing. There are shrines and services where people seek alleviation and healing from their illnesses. Among the most common figures are: Yakushi Buddha, the Buddha of healing; Kuan-yin, the Bodhisattva of compassion (a central figure in healing); and Jizo Bodhisattva who cares for children and the dead and also heals. Chapter 25 of the Lotus Sutra devoted to Kuan-yin presents the blessings she gives to her devotees. The text called the Heart Sutra, a profound philosophical text which is one page, is often recited in times of disaster and personal problems. There are practitioners who are considered to have special powers for healing and are consulted for many problems. There are practitioners in this community, some well known and others not.

In addition, there is the Daishi-sama cult based in Shingon Buddhism. The central figure is Kobo Daishi, a great teacher in ninth-century Japan who founded the Shingon sect. He became known in popular tradition as a healer, as well as culture hero. Many people in Hawaii also pray to Kobo Daishi.

Much of Japanese religion focuses on healing using different methods. The popular religion is focused on benefits in this life of health, wealth and success -- though still holding traditional beliefs about the afterlife. The modern new religions also maintain this emphasis.

Buddhism is a complex of spiritual principles, practices and practitioners all designed to enhance the life of people corresponding to the level of their understanding and devotion. The heart of Buddhism is the Buddha’s compassion, which takes many forms and applications.



4. Understanding & Managing Stress - by Professor Lily de Silva

http://www.beyondthenet.net/thedway/stress.htm

Stress is a term adopted from engineering science by psychology and medicine. Simply defined, stress in engineering means force upon an area. As so many forces are working upon us in the modern age, and we find it extremely difficult to cope under so much pressure, stress is called the "disease of civilization." Phillip Zimbardo in his Psychology and Life traces four interrelated levels at which we react to the pressures exerted upon us from our environment. The four are: the emotional level, the behavioral level, the physiological level, and the cognitive level. The emotional responses to stress are sadness, depression, anger, irritation, and frustration. The behavioral responses are poor concentration, forgetfulness, poor interpersonal relations, and lowered productivity. The physiological responses consist of bodily tensions, which may lead to headaches, backaches, stomach ulcers, high blood pressure and even killer diseases. At the cognitive level one may lose self-esteem and self-confidence, which leads to feelings of helplessness and hopefulness. At worst such a person may even end up committing suicide.

In order to understand stress let us consider the various environmental factors which exert pressure on modern man. In this atomic age the very survival of the species is threatened. Nuclear war threatens every single human being on earth, irrespective of whether one lives in a country with nuclear weapons or not. Population explosion threatens man with severe food shortages; at present even a large segment of human Population is undernourished while still others are dying of starvation and malnutrition. Environmental pollution causes severe health hazards and mental and physical retardation. Unemployment among the skilled is a growing global problem. The pace of life has become so hectic that man is simply rushing from one task to another without any relaxation. This is really paradoxical in an age when labour-saving devices are freely available and are in use to an unprecedented degree. Competition for educational and employment opportunities is so severe that it has contributed a fair share to increase the rate of suicide. Enjoyment of sense pleasures has grown to obsessive that it has become like drinking salt water to quench thirst. Constant stimulation of the senses is today considered a necessity, and thus pocket radios with earphones, chewing gum and cosmetics are marketed every where. Sense stimulation goes on unrestrained but satiation is far from achieved. It is no wonder that man caught up in all this, is terribly confused and frustrated, and his life is intolerably stressful. This is the situation Buddhism describes as "tangles within and tangles without, people are enmeshed in tangles."

While the above observations were made from the point of view of modern studies and contemporary conditions, Buddhism makes similar observations from a psychological perspective. Man experiences stress and suffering because of five psychological states which envelop his whole personality. They are called ‘nivarana’ in the Pali language, meaning hindrances. They hinder happiness and overcloud man’s vision of himself, his environment and the interaction between the two. The thicker and more opaque these hindrances, the greater the stress and suffering man experiences. The thinner and more sparse these hindrances, the less his suffering with a corresponding increase in happiness. These five hindrances are the desire for sensual pleasures, anger, indolence, worry and doubt. The Pali Canon illustrates the effect of these hindrances with the help of five eloquent similes. The mind overpowered by the desire for sense pleasures is compared to coloured water which prevents a true reflection of a thing on the water. Thus a man obsessed with the desire for sense pleasures is unable to get a true perspective of either himself or other people or his environment. The mind oppressed by anger is compared to boiling water which cannot give an accurate reflection. A man overpowered by anger is unable to discern an issue properly. When the mind is in the grip of indolence, it is like moss covered water: light cannot even reach the water and a reflection is impossible. The lazy man does not even make an effort at correct understanding. When worried, the mind is like wind-tossed turbulent water, which also fails to give a true reflection. The worried man forever restless is unable to make a proper assessment of an issue. When the mind is in doubt it is compared to muddy water placed in darkness which cannot reflect an image well. Thus all the five hindrances deprive the mind of understanding and happiness and cause much stress and suffering.

Buddhism puts forward a methodical plan of action for the gradual elimination of stress and the increase of happiness and understanding. The first step recommended in this plan is the observance of the Five Precepts comprising the abstention from killing, stealing, illicit sex, falsehood and intoxicants. Stress is greatly enhanced by guilt, and these precepts help man to free his conscience of the sense of guilt. The Dhammapada says the evil-doer suffers here and hereafter; on the other hand, the man who does good deeds rejoices here and hereafter.

Buddhism firmly believes that evil increases stress while good increases happiness. In addition to the observance of the Five Precepts throughout life, Buddhism advocates the periodical observance of the Eight Precepts by laymen. These additional precepts attempt to train man for leading a simple life catering to one’s needs rather than one’s greeds. A frugal mode of life where wants are few and are easily satisfied is highly extolled in Buddhism. It is the avaricious and the acquisitive mentality that is responsible for so much stress that we experience.

The next step in the process of training is the control of the sense faculties. When our sense faculties are uncontrolled we experience severe strain. We have to first understand what is meant by being uncontrolled in the sense faculties. When a person sees a beautiful form with his eyes, he gets attracted to it; when he sees an unpleasant object, he gets repelled by it. Similarly, with the other senses too. Thus the person who has no control over his senses is constantly attracted and repelled by sense data, as during waking life sense data keep on impinging on his sense faculties constantly. When pulled in different directions by sense stimuli, we become confused and distressed.

Our sense faculties have different spheres of activity and different objects, and as each sense faculty is a lord in its own sphere, and as they can severally and collectively dominate man, they are called in Pali indriyas, meaning "lords" or "masters". If we allow the sense faculties to dominate us, we get terribly confused. If we assert ourselves and control our sense faculties, we can have unalloyed pleasure (avyasekasukha), so called because this pleasure is uncontaminated by defilements. It is also called adhicittasukha, meaning spiritual pleasure. Whereas sense pleasures increases stress, this type of spiritual pleasure reduces stressfulness and increases peace of mind and contentment.

The third step in the management of stress is the cultivation of wholesome mental habits through meditation (bhavana). Just as we look after and nurture our body with proper food and cleanliness, the mind too needs proper nourishment and cleansing. The mind is most volatile in its untrained state, but when it is tamed and made more stable it brings great happiness. Buddhism prescribes two fundamental meditative methods of mind-training called samatha and vipassana, calm and insight. The former is the method of calming the volatile mind, while the latter is the method of comprehending the true nature of bodily and mental phenomena. Both methods are extremely helpful for overcoming stress. The Samannaphala Sutta explains with the help of five appropriate similes how meditation reduces the psychological stress caused by the five hindrances. The man who practices meditation gains a great sense of relief and it is this sense of unburdening oneself that the similes illustrate. They are as follows: A man who has raised capital for a business by taking a loan, prospers in business, pays off the loan and manages his day-to-day affairs with financial ease. Such a man experiences a great sense of relief. The second simile portrays a man who has suffered a great deal with a prolonged chronic illness. He gets well at long last, food becomes palatable to him and he gains physical strength. Great is the relief such a man experiences. The third simile speaks of the relief a prisoner enjoys after being released from a long term in jail. The fourth is the slave who gains freedom from slavery. The fifth simile speaks of a well-to-do man who gets lost in a fearful dessert without food. On coming to a place of safety he experiences great relief. When the stress caused by the five hindrances is eliminated from the mind, great joy and delight arise similar to the relief enjoyed by the men described in the similes. The best and most effective way of overcoming stress is the practice of meditation or mental culture. But as a prelude to that at least the Five Precepts must be observed.

The cultivation of positive emotions such as loving kindness (metta), compassion (karuna), sympathetic joy (mudita) and equanimity (upekka) is another means of conquering stress. Strained interpersonal relations is one of the common causes of stress in household life and in the work place. Loving-kindness is the positive wholesome attitude one can cultivate with benefit for oneself and other in all interpersonal relationships. Compassion is the emotion with which one should regard and help those in distress. Sympathetic joy is the ability to rejoice in the joy of another. It is difficult for a man of mean character to entertain this attitude as the joy of another brings jealousy to the mind of such a person. Where there is jealousy there is no unity, and where there is no unity there is no progress. The cultivation of these positive emotions stands for both material and spiritual progress. Equanimity is the attitude to be adopted in the face of the vicissitudes of life. There are eight natural ways of the world that we have to face in life. They are gain and loss, fame and lack of fame, praise and blame, happiness and sorrow. If one trains oneself to maintain an equanimous temperament without being either elated or dejected in the face of these vicissitudes, one can avoid much stress and lead a simple life with peace and contentment. We cannot change the world so that it will give us happiness. But we can change our attitude towards the world so as to remain unaffected by the stresses exerted by events around us. Buddhism teaches the way to bring about this wholesome change of attitude.

Extract from "One Foot in the World – Lily De Silva"
Buddhist Publication Society
Wheel Publication No. 337/338


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