An introduction to Buddhism for heal professionals
By Graeme Lyall

In the year 563B.C. on the border of modern day Nepal and India, a son was born to a chieftain of the Sakya clan. His name was Siddhartha Gotama and at the age of thirty-five, he attained, after six years of struggle and through his own insight, full enlightenment or Buddhahood. The term 'Buddha' is not a name of a god or an incarnation of a god, despite later Hindu claims to the contrary, but is a title for one who has realised through good conduct, mental cultivation, and wisdom the cause of life's vicissitudes and the way to overcome them. Buddhism is perhaps. unique amongst the world's religions in that it does not place reliance for salvation on some external power, such as a god or even a Buddha, but places the responsibility for life's frustrations squarely on the individual.

The Buddha said:
By oneself, indeed, is evil done; By oneself is one defiled.
By oneself is evil left undone; By oneself indeed is one purified.
Purity and impurity depend on oneself. No one purifies another.
His teaching can be summarised as:
Not to do any evil,
To cultivate good,
To purify one's mind,
This is the Teaching of the Buddhas. To many people of other faiths the term 'Buddha' conjures up ideas of idol worship and concepts, such as, that Buddhists are atheists, such concepts being an anathema to the followers 'of the, so called 'religions of the book'. Buddhism, certainly, is very different from the Semitic religions, but it may surprise many of its critics to know that the Buddha condemned idolatry. When, just prior to his passing away, he was asked how he could be remembered he replied that those who practised his teachings would remember him best. Prior to the arrival on the Indian sub-continent of the Bactrian-Greeks, Buddha images were unknown. The Buddha foresaw that worship of him in any form would result in his deification with its consequent emphasis on seeking salvation from an external power rather than identifying Nirvana, the eradication of greed anger and delusion, as being solely within one's own power. Indeed, he was right. For many ethnic Buddhists, he is a God from whom they ask favours. However, Buddhists feel uncomfortable in acknowledging a Creator of the world. Buddhists do accept that there is a transcendental state possible of realisation by each and every one of us. We certainly do not accept the concept of an anthropomorphic god but many Christians, Jews and Muslims would join us in such a rejection. Buddhists, generally, are uncomfortable in using the term "God", because there is no clear definition of to what such a term refers. Indeed, an anthropomorphic view of God would be considered by Jews and Muslims to be idolatrous. If, as is the case with many modern theologians, one holds the Tillichian view that God is the "Ground of Being" - the very fact of existence - then no Buddhist could argue with this. However, a Buddhist would be hesitant in using the term 'God'. To a Christian, a Jew and a Muslim, this may be termed 'God', whereas a Buddhist would use the term 'Nirvana'. I feel that we are talking about a similar concept. Like most major religions, as time passed since the death of its founder, different sects or schools of thought arose however the essential teachings of the Buddha are accepted as pivotal to all schools of Buddhism. They differ mainly on the emphasis that they place on certain aspects of the teaching and in their interpretation of the monastic rules governing the conduct of the clergy known as the Sangha. The Theravada school, that followed by Buddhists from such countries as Sri Lanka, Burma, Thailand, Laos and Cambodia, claims to adhere strictly to the original teachings of the Buddha as contained in the Pali scriptures and it emphasises the goal of personal salvation for the individual follower. The Sangha of the Theravada is expected to observe to the letter the 227 rules laid down in a collection of books called the Vinaya, which includes such rules as eating only prior to midday and refraining from handling money. Four of these 227 rules, if broken, entail expulsion of the transgressor from the monastic order. They are: killing a human being, sexual intercourse, stealing and falsely claiming supernormal powers. Should a Buddhist monk of the Theravadin tradition come under your care, it could create a problem. Theravadin monks are not supposed to make any physical contact with a member of the opposite sex. This means that, preferably, male nurses should be used where possible when caring for these monks. The Mahayana school, followed mainly in China, Korea, Japan and Vietnam, is less rigid in its interpretation of the Teachings and emphasises the importance of the follower's becoming a Buddha for the salvation of all living beings. The Mahayana Sangha observes strict vegetarianism, unlike the Theravada where vegetarianism is optional, but Mahayana monks will eat in the evening. The post-midday meals are regarded as medicine. Some Mahayana sects, notably in Korea and Japan, admit married priests. The Vajrayana school, followed in Tibet and Mongolia and attracting many Western followers, is essentially the same in its interpretation of the Teachings as the Mahayana but it stresses the importance of the acceptance of a personal teacher who initiates his followers into, so-called, secret teachings known as Tantra. Neither the Theravada nor the mainstream Mahayana schools accept that there are such things as 'secret teachings' in Buddhism. The central teaching of all schools of Buddhism is grounded in the "Four Noble Truths". The first truth is that life is subject to Dukkha. Dukkha is often translated as 'suffering' but it is much more than that. It certainly means physical and mental suffering but it also means that life is full of frustrations - we would always prefer things to be other than the way they are. As we grow old, we wish we could remain young. If we are poor, we wish we could be rich. When we are separated from our friends and loved ones, we are saddened. Dukkha is birth sickness, old age, pain and despair, separation from those whom we like and association with those whom we dislike. All of these are examples of Dukkha and that is the First Noble Truth. The Second Noble Truth states that the Cause of Dukkha can be attributed to three things - greed, anger and a deluded mind. We tend to be attached to people and material things and when we are separated from them, we suffer regret. We cling to these things as if they will last forever and we find it hard to accept the fact that they don't. We get angry or have aversions to those things that we do not like. Buddhism teaches that anger harms the one who is angry more than the object to which this anger is directed. Anger causes heating of the blood and an unpleasant appearance. The more we get angry with someone and they react to our anger the more this anger increases. Anger is unproductive - it doesn't solve the problem. Our minds are deluded because we do not see things as they really are - that is, subject to impermanence, frustrating and devoid of a permanent self or substance. Everything, material or immaterial, is subject to change or impermanence. Perhaps you are sitting comfortably in your chair listening to me. If you remain in that chair for the next three hours, without moving, do you still think you could regard the chair as comfortable? Believe me, I do not intend to keep you here for the next three hours. If you remained fixed in that chair for a month, you would probably find that you are crippled and unable to move. Instead of being a health carer, you will probably become a patient. If you remain in that chair for a hundred years, you will probably be a skeleton and the chair will be fairly seedy too. Professor Lewis Lancaster, from UCLA, relates that, when visiting Australia, and getting on the aircraft in Los Angeles he was sitting in a very comfortable seat. After sixteen hours non-stop flight he realised the truth of impermanence. He could not wait to get away from that seat. What starts as being regarded as 'comfortable' can soon change to being uncomfortable. Everything is relative. The way we see things depends on the time, place and current situation. We, ourselves, are subject to this change. Every cell in our body is constantly ageing and dying and being replaced. Our thoughts and ideas are constantly changing or being modified. Your thoughts and ideas, since you came to this chapel, are different. They have changed considerably. Is there anything in you which is not subject to change? This is why Buddhists say, in the ultimate sense, there is no 'you' or unchanging self entity. This change and this "no self' is difficult to accept and is, therefore, Dukkha. The third Noble Truth concerns the overcoming of Dukkha, that is, overcoming the greed anger and delusion that are the source of Dukkha. Accepting change as a characteristic of life and not becoming angry or frustrated about it is part of the way to overcoming Dukkha. The overcoming of Dukkha is termed "Nirvana". Nirvana is not a place but a state of mind - a mind that sees things as they really are and not clouded by delusion. The Fourth Noble Truth is the method taught by the Buddha for attaining the state of Nirvana. It is known as the Noble Eightfold Path. You may be wondering why the term 'Noble' is used for the Path. One who walks the Path is considered to be a noble person. The eight steps of the Path are: Right Understanding, that is knowledge that the Four Noble Truths lead to the overcoming of Dukkha. It does not imply a total understanding of these Truths but a confidence that, by following the Path, the result will be attained. Right Thought is to be constantly aware of one's thoughts and actions and thereby avoid harm to any living creature. Right Speech is awareness of one's speech so that, what one says, is beneficial to the hearer. Right Action is to be aware of one's actions and observe the five precepts so that one does not cause harm to oneself or any other living creature. The five precepts are: To undertake the training to avoid taking the life of beings. This precept applies to all living beings not just to humans. All beings have a right to their lives and that right should be respected. This would include the unborn, so abortion is not an acceptable alternative for controlling the population, however, contraception is not an issue as far as Buddhists are concerned. Its corollary is to protect and respect the life of all beings. To undertake the training to avoid taking things not given. This precept goes further than mere stealing. One should avoid taking anything unless one can be sure that is intended for you. Its corollary is to cultivate generosity. This has the added bonus of eradicating attachment. To undertake the training to avoid sensual misconduct. This precept is often mistranslated or misinterpreted as relating only to sexual misconduct but it covers any overindulgence in any sensual pleasure such as gluttony as well as misconduct of a sexual nature. A Buddhist should be mindful of the possible effects on themselves and on others of improper sexual activity. This precept would include adultery because this also breaches the precept of not taking what is not freely given. A relationship with someone who is committed to another is stealing. Similarly in cases of rape and child abuse, one is stealing the dignity and self respect of another. One is also the cause of mental pain, not to mention physical pain so one is causing harm to another living being. Therefore, such behavior is breaking several precepts. Its corollary is to respect the dignity and rights of all beings - to treat each female as your own sister or mother and each male as your brother or father. To undertake the training to refrain from false speech. As well as avoiding lying and deceiving, this precept covers slander as well as speech which is not beneficial to the welfare of others. Its corollary is to become trustworthy and considerate. To undertake the training to abstain from substances which cause intoxication and heedlessness. This precept is in a special category as it does not infer any intrinsic evil in, say, alcohol itself, but indulgence in such a substance could be the cause of breaking the other four precepts. Its corollary is to develop clear thinking and an alert mind. These are the basic precepts expected as a day to day training of any lay Buddhist. Right Livelihood is to earn one's living in a way that does not cause harm or suffering. Such occupations as the selling of intoxicants, firearms or animals for slaughter would be considered inappropriate for Buddhists. Right Effort is the avoiding of evil which has not already arisen, rejecting evil which has already arisen, the acquiring of wholesome things which have not yet been acquired and the stabilising of those wholesome characteristics that have already been acquired. Right Mindfulness is training in constant awareness of the effects of one's actions, whether of body, speech or mind, and thus avoiding harmful actions. Right Concentration is cultivating the mind through concentration and meditation so that one attains intuitive insight or highest wisdom. Most Buddhists believe that, upon the dissolution of the body, rebirth may take place in a state consistent with the qualities of the consciousness energy, or resultant of past actions, known as karma, at the time of death. This rebirth may occur in human form, animal form, as a ghost, in a blissful state or in a woeful state. Each of these states is impermanent and lasts as long as the karmic energy, which was the cause of that rebirth, sustains it. In other words, we are subject to a constant round of rebirths until Nirvana, or the release from rebirth is attained. The Theravada tradition believes that rebirth is instantaneous upon the death of the individual, whereas the Mahayana and Vajrayana traditions believe in an intermediate state, known as antarabhava, which can last until the right conditions for rebirth prevail. What is more important for the dying patient than ceremonies after death, is the care received in the days leading up to their passing. Every effort should be made to direct their thoughts to the positive aspects of their lives. This is where a visit from a member of the Buddhist clergy can be beneficial., however chaplains and nursing staff, being aware of the importance of positive thoughts, can also be helpful in this regard. Buddhists believe that the final thoughts of a being are crucial in determining their state of rebirth. With patients from a Chinese background, it is common for a group of lay Buddhists to visit and chant the name of the Buddha of Infinite Light, Amitabha. The Amitabha Buddhist Association in New South Wales provides such a service. Another useful device is the chanting machine which can be placed close to the patient so that they are constantly aware of the name of Buddha Amitabha. I have used this with a patient in a coma by placing the machine under their pillow so that, should they regain consciousness, this will be the first thing that they hear. Hearing this chant can contribute to relieving the patient's anxiety and also direct their thoughts positively. It is very important to be aware of the ethnic background of the patient. This chanting has relevance only to patients of Chinese background. For patients from other ethnic groups, it is advisable to contact the appropriate Buddhist clergy. Following the death of a patient, from the Theravadin or Southern School, rebirth occurs at the instant of death. The clergy can comfort the family and arrange to attend the funeral for blessing chanting. Many Theravadins will willingly offer the body of the deceased for organ transplants. This is due to the belief that the energy of the deceased has completely passed on and the body serves no further purpose for the deceased. However, the position concerning the Mahayana and Vajrayana traditions is quite different. As I have alredy mentioned, they accept an intermediate or limbo state before rebirth takes place. Preferably, they prefer that the body not be touched for forty eight hours following the death. It is held that the consciousness energy may not leave the body until this time period has passed. This may seem impractical in a hospital situation but touching or moving the body during this critical period is a cause of much concern, especially to the immediate family. The majority of Mahayana Buddhists would, therefore, prefer that their relatives pass away at home. Three conditions are necessary for conception in the womb of either a human or animal to occur, that is, male sperm, female ovum and the karmic energy that has passed over from the previous incarnation. Karma is not a reward or punishment for past actions but rather a natural result or outcome of them. Buddhists do not accept the concept of a creator god who sits in judgement on his creation. We are our own creator by our past actions. The Law of Karma states "We are what we have done and we will be what we are now doing". On a popular level as taught in institutionalised Buddhism, whenever misfortune or happiness befalls us, it is due to our past karma. This tends to imply a punisher or rewarder, in other words a judging god, an idea which Buddhists reject. That is why many modern Buddhist scholars interpret Karma as a psychological phenomenon. Bad actions cause remorse, regrets and feelings of guilt which disturb our peace of mind, whereas good actions bring joy and happiness and peace of mind. Buddhists of all schools regularly perform the action of 'Taking Refuge'. A refuge is a shelter or safe haven and similarly, in Buddhism, taking refuge is considered to be a protection. The refuges are:- The Buddha - the teacher, is referred to in the scriptures as "Teacher of gods and men". The Dharma - his teaching. Before the Buddha passed away, he told Ananda, his chief disciple, that after his passing, the Dharma would be the teacher. The Sangha - is the community of followers. More specifically, it refers to those who have left home to follow the spiritual life, the Bhikkhus and Bhikkhunis or Buddhist clergy. In the broader sense, it includes those who are following his teachings whether they be monastic or lay. The initial recitation of the "Three Refuges", before a member of the monastic Sangha, constitutes formally becoming a Buddhist. In the Tibetan tradition, an additional refuge is added, that of taking refuge in the teacher, who initiates the student. Another important devotional practice is the recitation of the five precepts, known as the 'Panca Sila'. These are training rules and, unlike, say, the Ten Commandments in Christianity, they are not based on fear and feelings of guilt. A Buddhist should undertake training to try to observe these precepts but, if a precept should be broken, one should analyse one's action and try to avoid breaking it in the future. This is not to suggest that the consequences of this unwholesome action or Karma will be avoided - the admonition in the Christian Bible, "as ye sow, so shall ye also reap" applies to Buddhists as well as to Christians. The emphasis in Buddhism is to train one's self-awareness of one's actions and their effects on both one's self and others and to avoid unwholesome actions and cultivate beneficial ones. Other important devotional practices are the chanting of sutras or sermons of the Buddha or other great Buddhist teachers, prostrations before a Buddha image, and, most importantly, practising meditation. The chanting of sutras is often, mistakenly, referred to as Buddhist prayers. Buddhists do not pray to a god, however, Buddhists from the Mahayana tradition will sometimes pray to Bodhisattvas for assistance and blessings. Prostrations are considered a means of paying respect to the teacher in a similar way to people respecting those who have passed away by placing flowers on a grave. Prostrations also are a means of cultivating humility. The Buddha condemned 'rites and rituals' as being useless and not conducive to salvation. The practice of prostrating before images is more a part of institutionalised Buddhism rather than being a part of the Teaching itself. Meditation is a central part of Buddhist practice. In the Theravadin tradition, two forms of meditation, calm or Samatha and insight or Vipassana are recognised as essential practice in achieving spiritual progress. Calming the mind is achieved by concentration on a specific object and excluding all extraneous thoughts. Often, the breath or the movement of the diaphragm is used as a suitable object for concentration. At other times meditation beads or even counting the breaths are used to fix the mind during this preliminary practice. Once the mind has been trained in concentration, the meditator can then reflect on the feelings and sensations of the body, noting them as they arise and pass away. This latter practice is known as Vipassana and is the means of cultivating insight or mindfulness.
In the Cha'n or Zen tradition, two techniques are employed. One method is to concentrate on the breath and then try to clear the mind of all thoughts whatsoever. This method eliminates the constant chatter of the mind and results in an awakening. Another Cha'an technique is to ponder a question which has no rational answer. Typical koans are, "what was your face before you were born?" "what is the sound of one hand clapping?" or the word "Mu". These techniques are aimed at pushing the mind beyond rational thought in order to experience the ultimate awakening. A technique used by the Pure Land Sect of the Mahayana is to constantly recite the name of the Buddha of infinite light, Amitabha Buddha called Omi t'o-Fo in Chinese. This, again, is a means of fixing the mind on one object and not dissimilar to repetitions of prayers used by many Christians or mantras used by Tibetan Buddhists. The result is a calmed mind, and, according to Pure Land Buddhism, rebirth in the Pure Land where enlightenment may be attained by listening to the teaching of Buddha Amitabha. It should be noted that the Pure Land is not some form of heaven. When the mind is pure, one is already in the Pure Land. Likewise with Amitabha Buddha. All Buddhas and Bodhisattvas, being the essence of an awakened mind, are a constituent of mind. Before I conclude, I should mention diet. Most Buddhists do not observe any dietary restrictions apart from those strictly following the Mahayana tradition. The eating of meat or fish is not acceptable to strict Mahayana followers. Usually, they also avoid eating food prepared with onions or garlic which, it is believed, arouse the senses.
The foregoing is by no means a comprehensive introduction to the teachings of the Buddha and such a short introduction can hardly do the teaching justice, however I hope that it gives you a better understanding of those patients in your care who claim Buddhism as their religious faith.