Vipassana and Mental Health in Tihar Jail

-Dr. Kishore Chandiramani
-S.K. Verma **
-Amulya Khurana ***
-Udai Pareek ****

* Associate Professor of Psychiatry, A.I.I.M.S., New Delhi.
** Additional Professor of Clinical Psychology, P.G.I.M.E.R., Chandigarh.
*** Assistant Professor, Department of Humanities, I.I.T., New Delhi.
*** Indian Institute of Health Management Research, Jaipur, Rajasthan.

Introduction

Antisocial behavior is common to most adults, and in many situations is an ordinary non-pathological phenomenon. Individuals within a society show varying degrees of traits such as hostility, mistrust, helplessness, hope, honesty, altruism etc. and may at times find themselves placed at the antisocial end of the spectrum. It is only when such offenses are repeated frequently that a person gets the label of "antisocial personality".

The criminal offenders have always exposed society's ambivalence about them, which is represented by such issues as punishment versus rehabilitation in the prison setting. The management of behavioral problems in prison involves complex clinical and legal issues and evokes strong public emotions.

The concept of detaining an individual in prison for rehabilitation and treatment, rather than punishment, was a philosophy pioneered at Herstedvester prison in Denmark. The goal in such treatment is growth in the inmates' adaptive functioning1.

Criminal Behavior

Any attempt at correction of criminal behavior should take into consideration the antecedent and maintaining factors. Disregard for truth and social norms; deficient impulse control, empathy and guilt; inability to learn from experience; lack of skills and educational failures are the hallmarks of antisocial personalities. Environmental failures in the future inmate's early years are related to parental absence, unavailability or unreliability. The notion that disturbed families are at the root of development of anti-social behavior must be seen in the context of many such families that do not give rise to such persons.

It is important to consider the psychological factors operating in the form of primitive defenses against loss, problems of basic trust expressed through hostility of grievance2 and protecting oneself from abuse and leaving by others3. The weaknesses of the antisocial personalities are manifest in the form of externalization and avoidance of consciousness of one's own inner life, resulting in narcissism riddled with rage and sadism4. There is a particular emptiness, even a sadness, at the core of the psychopathic personality5. Such individuals do not suffer merely behavioral problems, but a deep emotional, perhaps physical deficit.

With Vipassana the individual learns to re-establish contact with his unconscious. The enhanced awareness thus achieved results in enhanced empathy, trust, tolerance, social conformity and the courage to accept and handle losses and destructive impulses.

Crime and Mental Illness

A sizeable number of criminals at some point demonstrate signs of mental disorders that affect the manner in which they are dealt with by the criminal justice system.

The nature and the quality of the relationship between mental illness and criminal behavior is a particularly controversial issue when considering treatment for mentally disordered offenders. The estimates of mental illness within prison inmates are reported to vary between ten and seventy-five percent6 . Roth estimated that fifteen to twenty percent of all prison inmates manifest sufficient psychopathology to warrant medical and psychiatric treatment7. Many inmates manifest mental disorders in jail as a result of the stresses of incarceration. These include overcrowding, social and sensory isolation, exposure to a high density of hard-core offenders, and a variety of uncertainties, fears and frustration.

There is little literature describing the successful application of the traditional psychiatric treatment methods to the patients with antisocial personality disorder. Factual understanding of the relationship between criminality and mental illness, prediction of dangerousness, and effectiveness of various management approaches is clearly inadequate. Rigorous research efforts are an absolute necessity if the rational development of safe and effective management programmes is to occur for prison inmates.

Vipassana and Positive Mental Health

While on one hand, the emotional climate of prison can prove destructive to most goals of rehabilitation, it can provide a safe structure that inhibits self-destructive feelings and impulses, and can offer opportunities for growth and development. Certain aspects of the prison milieu can be utilised creatively by the correctional system. In this context Vipassana offers an experience very different from the life histories of most inmates, who have suffered from actual or relative neglect and abandonment, and from a lack of consistent, caring and responsive people in their environment. The emphasis, in Vipassana, is on empathetic understanding, a caring, non-retaliatory but firm approach and unconditioned positive regard for each individual. This can reduce anxieties and foster psychological growth and self reliance.

Vipassana can help in shifting the focus of inmates from desire for discharge, transfer or parole to increasing self-awareness and improved functioning within the prison walls. Vipassana allows us to realize the inevitability of loss and how to come to terms with it, and to view others as suffering individuals struggling to reach their own goals. This helps inculcate feelings of compassion, sympathetic joy and friendliness etc.

Review of Literature

Considerable data is available documenting the various bio-psycho-social benefits that accrue from the practice of Vipassana meditation. At the Central Jail, Jaipur, Shah K., (1976)8, Unnithan T.K.N. & Ahuja R. (1977)9, and Vyas G.N. (1977) found a marked change in the attitude and behavior of the participants who were hardened criminals convicted of heinous crimes. They regretted their offenses and became more calm and equanimous.

In 1991 and 1992, four prison courses held in Gujarat revealed many positive changes in prisoners and jail staff in the form of decreased quarrels; better conduct towards visitors by both prisoners and staff; reduction in feelings of revenge; self-imposed discipline and improvement in mental and physical health. The Department of Sociology, Gujarat Vidyapeth, conducted research at Ahmedabad studying behavior patterns before and after a Vipassana course. These reports prompted the Union Home Ministry to give it a try in Tihar Jail. The recent studies assessing the psychological effects of Vipassana meditation carried out in Tihar Jail in November 1993 and January 1994 have revealed statistically significant reductions in anxiety, depression, hostility and feelings of hopelessness, and enhanced well-being and hope for the future10.

At the Rajasthan Police Academy, Jaipur, Sinha et al (1976)11 found improved attention span, alertness and emotional stability in police officials after practicing Vipassana. In some other areas of Government too, Vipassana is found to have made a major impact. In Burma, Sayagyi U Ba Khin used Vipassana as an instrument of change and reform. He succeeded in eradicating most of the corruption from the departments headed by him.

There is a need to study the psychological effects of Vipassana meditation on prisoners in a systematic manner over a long period, using reliable and valid scientific instruments. The present study will examine the impact of Vipassana on the inmates' psychopathology, their attitude to law and certain positive mental health dimensions such as trust, well-being, achievement orientation and quality of life.

The Technique of Vipassana

Vipassana means "insight", seeing things as they really are. To learn this technique it is required to take a ten-day residential course under a qualified teacher. To begin with, the student has to take a vow of observing certain rules of moral conduct (sila). These are abstention from: killing any sentient being, stealing, sexual misconduct, telling lies, and taking any intoxicants. This first step itself is likely to bring about positive changes in a prisoner's lifestyle.

The second component of this training is called Anapana ie. awareness of respiration. The student observes the natural flow of incoming and outgoing breath, just breath. Thus the mind becomes concentrated on this neutral activity and the person assumes greater control over his mind. It promotes neutral observation here and now (present orientation), since the act of breathing is free from any craving or aversion.

The third step is described as Vipassana ie. purification of mind through enhanced awareness. The individual engages himself in choiceless and effortless observation of internal body sensations and tries to hold an attitude of non-judgement and non-reaction. This observation is supposed to have a corrective influence on psychic disturbances. Vipassana, therefore, is a science of mind and matter. Whatever arises in the mind, be it anger, fear, insecurity, passion, or sadness, it is associated with certain body sensations. Observing these sensations in a detached impersonal manner helps the individual overcome these emotions.

Aims and Objectives

1. To study the impact of Vipassana on psychological symptoms or disorders such as anxiety, depression, insomnia, adjustment problems etc. in prisoners.
2. To study the impact of Vipassana on certain positive mental health dimensions such as interpersonal trust, achievement value, subjective well-being and perception od quality of life by the prisoners.
3. To find out if Vipassana brings about any change in the attitude of prisoners towards law and in their feelings of being alienated from mainstream life.
4. To study the possible "change (corrective) factors" in the theory and the practice of Vipassana, and the "change process" a prisoner goes through during a Vipassana course and subsequently.

Materials and Methods

This study aims to assess the overall impact of Vipassana on the mental health of prisoners and to find out the scientific rationale for its use as a reform measure in prisons.

In view of the comprehensive nature of the research to be undertaken, it is proposed to conduct the study in terms of four different components. These will be pursued by four teams of investigators functioning independently, but in collaboration with each other. These four components are in keeping with the four aims and objectives listed above. The methodology has been described separately for each component except for the inclusion and exclusion criteria. To avoid the element of fatigue influencing study results, different samples of prisoners will be used for the four different components, as far as possible. They will be drawn from the total population of about one thousand prisoners undergoing Vipassana.

• Inclusion Criteria: Male
• Age 16 to 60 years
• Preferably literate
• Exclusion Criteria: Low motivation for participation in the course, unwillingness to participate in research, very much disturbed or agitated prisoners who cannot follow instructions, or unable to do Vipassana well in the opinion of the teachers, will be dropped from the study.

COMPONENT I:

To study the impact of Vipassana on the personality profile of prisoners and the psychological disorders present.

• Sample Size: Study Group - About 100 subjects are to be selected randomly from the list of prisoners volunteering to do Vipassana.
• Control Group - About 50 subjects not undergoing Vipassana.

Instruments to be used:

1. Personality Trait Inventory (N.N. Sen, 1966)12 - This is a ninety item questionnaire in Hindi measuring eight personality traits viz. activity, dominance, paranoid tendency, depressive tendency, emotional instability, introversion, superego, cyclothymia and social desirability. It is based on the Minnesota Multiphasic Personality Inventory (MMPI) of Hathaway and Mackinley (1951), a well known personality questionnaire with well established clinical utility.
2. P.G.I. Health Questionnaire N-1 (N.N. Wig and S.K. Verma)13 - This consists of 38 questions divided into a) physical and b) mental sections. It is a short and simple screening instrument for assessing neuroticism, and can be used with an illiterate, unsophisticated population. It has a discriminatory power to separate psychiatric from normal individuals and can be used for assessing the progress of any treatment.
3. Clinical Interview, followed by the administration of Hamilton Anxiety and Beck's Depression Inventories. All the subjects receiving scores above the cut-off point in the P.G.I. Health Questionnaire N-1 will be subjected to a detailed interview to identify any psychiatric disorder. All subjects receiving a psychiatric diagnosis according to the ICD-10 will then be administered Hamilton Anxiety and Beck Depression Inventories to quantify psychopathology.
4. Draw a Person Test14. - This will be administered to all the subjects in the control and study groups. It is a graphometer test that is frequently used as a projective technique. A general assumption is that the drawing of a person represents the expression of self or body in the environment, thus representing self-image or body-image of the drawer. It is possible to use figure drawings for comprehensive evaluations of the personality.

The test is easily administered, usually with the instruction: "I would like you to draw a picture of a person", followed by an interrogation procedure in which the subject is questioned about his drawing, "What are his desires and fears?"

Assessments

The following assessments will be carried out inside Tihar Jail:

1. Pre-course -

• Within a week prior to the start of the course, from 28/3/94 to A/94

2. Post-course -

• Within a week after the course, from 16/4/94 to 2A/94
• After three months of the course, around 15/7/94

The expected time required for the assessment of each subject or group of subjects is about two hours.

COMPONENT II

This is a study of the impact of Vipassana on positive mental health dimensions. The four dimensions to be assessed in this area interpersonal trust, achievement value, quality of life and well-being.

Although roots of adult achievement needs are to be found in the ways parents treat their children, it has been noted that achievement needs are closely related to independence needs, and that psychological interventions such as Vipassana can bring positive changes in the achievement value measures.

Another measure of positive mental health, that is Quality of Life, has been variously defined as "the subjective satisfaction expressed or experienced by an individual in his physical, mental and social situation" (Jonsen 1982)15, or "the capacity of an individual to realize his life plans (Cohen 1982)16. The extent to which the goals of prison reform are met can be measured in terms of positive changes in the subject's perception of his quality of life.

The sample will consist of a separate cohort of 150 subjects divided as follows:

• Sample Size: Study Group - About 100 subjects are to be selected randomly from
• the list of prisoners volunteering to do Vipassana.
• Control Group - About 50 subjects not undergoing Vipassana

Instruments to be used:

1. Interpersonal Trust Scale (Gupta S.C.) - This is a twenty item scale in Hindi measuring the various aspects of trust exhibited by an individual in his interpersonal relations. The items are rated on a four point rating scale.
2. P.G.I. Quality of Life Scale (Moudgil A.C., Verma S.K. and Kaur K. 1986)17 - This is a seventeen item scale to measure a subject's perception of his quality of life, that is, excellence of one's life that contributes to satisfaction, happiness, and benefits mental health. It has been found to be independent of personality variables like neuroticism, socio-economic status, locus of control, education and age, but related to well-being and to the achievement value index.
3. P.G.I. Achievement Value Index (Menon D.K., Wig N.N. and Verma S.K., 1988)18 - This is a short, simple, eight item scale in easily understandable Hindi. The format of this scale follows the pattern of a semi-structured interview schedule, administered individually. The score range is 0 to 16, and the higher the score, the greater is the achievement value orientation of the person. It measures this orientation as conceived and hypothesised by Kluckhohn. It is related to internal locus of control and contributes to the quality of life. Higher scores are related to such factors as doing away with tradition, acceptance of innovative methods, planning ahead of time, making independent decisions and sticking to them, and individualistic and activistic attitudes.
4. P.G.I. Well-Being Scale (Verma S.K., et al)19 - This is a twenty item simplified test in Hindi to measure positive mental health. It measures aspects such as cheerfulness, relaxation, emotional control, satisfaction and freedom from illness, worry and distress. It has been used remarkably well for outcome evaluation of psychotherapeutic interventions.

Assessments

The assessment schedule will be the same as that of Component I. The expected time required for the assessment is about one hour.

COMPONENT III

To study the changes in attitude of prisoners to law and their 'feelings of alienation', after they undergo a Vipassana course.

The management of prison inmates should be directed towards changing their attitude and behavior, so that future criminal activity does not occur. Success, therefore, is frequently defined in terms of prevention of future antisocial acts. A prisoner's attitude to law and his feelings of alienation from mainstream life can, to some extent, determine future criminal activities. Any positive change in these two aspects following the Vipassana course will establish its credentials as a prison reform measure.

Sample

The sample selected for Component I will be administered scales for assessment of attitude to law and anomie. The assessment procedure will also be similar to that of Component I.

Instruments to be used:

1. Law Scale (Khan I.A., 1989)20 - This is a brief and simple seventeen item scale to measure objectively the opinion of Indian people towards law. It can therefore be used to measure attitudinal changes and to know the implications of such changes on the psychological health of the people. The responses of the subjects are quantified by assigning arbitrary weights to the five response categories. For favorable statements the values 5,4,3,2, and 1 are assigned to strongly agree, agree, undecided, disagree and strongly disagree responses respectively. The scoring system is reversed for statements expressing unfavorable attitude. A high score shows favorable attitude towards law.
2. Leo Sroles Scale of Anomie (1956)21 - This is a five item scale used to measure the perception of anomie of the respondents. It measures a state of hopelessness caused by a breakdown of rules of conduct, and loss of belief and sense of purpose. Each item is scored as follows: 1- disagree, 2- undecided, 3-agree. The degree of anomie can be graded as mild, moderate or severe based on the total score from five to fifteen.

COMPONENT IV

This is a study of change factors and the change process in the theory and practice of Vipassana relevant to prison reforms. Scientific understanding of these change factors is required to justify the use of Vipassana in reform.

It is proposed to be a long-term, in-depth, experiential, individual based study of a select group of individuals. They would be those who, in the opinion of Vipassana teachers, have undergone significant changes. Such individuals may be considered to be well established in the technique and a source of inspiration for others. Close observations of their life histories and their journey from crime to wisdom and equanimity will provide valuable information for subsequent planning of prison reforms.

The sample will consist of about twenty subjects identified by the Vipassana teachers at the end of the course. The assessments will be carried out by psychologists at regular intervals.

The subjects' opinions of "What they found beneficial", and the content analysis of the discourses and instructions will be helpful in this regard.

References

• Sturup G.K. (1968) Treating the "untreatable", chronic criminals at Herstedvester, John Hopkins University Press, Baltimore.
• Glover E. (1960) The Roots of Crime, New York, International University Press.
• Greenwald H. (1967) Treatment of the Psychopath, Voices, Spring.
• Person E. (1986) Psychoanalytic Treatment of Antisocial Personality, In Unmasking the Psychopath, Eds. Reid W.H., Dorr D., Walker J. et al, New York, W.W. Norton.
• Reid W.H. (1978) The Sadness of the Psychopath, Am. J. Psychotherapy, 32:496-509.
• Adler G. (1985) Correctional Psychiatry In Comprehensive Textbook of Psychiatry (Eds.) Kaplan H.I. & Sadock, B.J., 1990-97. Williams & Wilkins, Baltimore/London.
• Roth L.H. (1980) Correctional Psychiatry, In Curran W., McGarry A., Petty C. (Eds), Modern Legal Medicine, Psychiatry and Forensic Science, pp 677-719. Philadelphia, F.A. Davis.
• Shah (1976) Impact of Vipassana Meditation on Prisoners, College of Social Work, Bombay, (A Report).
• Unnithan T.K.N. and Ahuja R. (1977) Prisoners Meditation Camp: A Sociological Analysis, The Maha Bodhi Journal, 85: 303-309.
• Kishore Chandiramani, Verma S.K., Dhar P.L. & Ahuja N. (1994) Psychological Effects of Vipassana on Tihar Jail Inmates. An Unpublished Report.
• Sinha S.N., Prasad S.C., and Sharma K.N. (1976) Evaluation of Psychological Effects of Vipassana Meditation, In Project Report - Meditation and Training of Police Personnel, Home Dept., Govt. of Rajasthan, Jaipur 118-128.
• Sen N.N. (1966) Personality Trait Inventory, Delhi, NCERT Publ.
• Wig N.N. and Verma S.K. (1971) P.G.I. Health Questionnaire N-1, A Simple Neuroticism Scale in Hindi, Bull, P.G.I., 5,4, pp 152-156.
• Carr A.C. (1985) Psychological Testing of Personality, In Comprehensive Text book of Psychiatry Eds. Kaplan H.I. & Sadock, B.J., 1990-97. Williams & Wilkins, Baltimore/London.
• Jonsen A.R., Siegler M., and Winslade W.J. (1982) Clinical Ethics, A Practical Approach to Ethical Decision in Clinical Medicine, Bailliere Tindall, London.
• Cohen C., (1982) On Quality of Life: Some Philosophical Reflections, Circulation 66, (Supp 3) 29-35.
• Moudgil A.C., Verma S.K. and Kaur K., (1986) P.G.I. Quality of Life Scale, Indian Journal of Clinical Psychology, 10: 299-304.
• Menon D.K., Wig N.N. and Verma S.K. (1988), Manual for P.G.I. Achievement Value Index, Rupa Psychological Centre, Varanasi.
• Verma S.K., Dubey B.L. and Gupta D. (1983) P.G.I General Well-being Scale, Indian Journal of Clinical Psychology, 10: 299-304.
• Khan, I.A. (1989) A Law Scale, Journal of Personality and Clinical Studies, 5(1), 101-104.
• Srole L. (1956) Social Integration and Certain Corrolaries: An Exploratory Study, American Sociological Review 21 (December) 709-716.