Psychosomatic Medicine

**3**

**Chapter 1**

Medicine

and network medicine.

network medicine, institutionalization

*individual characteristics* (László Németh [1])*.*

*Imre Lázár*

**Abstract**

The Network Paradigm: New

Psychosomatic medicine, as a philosophical frame and practical approach of the diagnostic and therapeutical agency, had been undergone several renewals and reframing in the past. We overview the history of psychosomatics and map its branches. Psychoanalytic and psychodynamic frameworks, the Engelian biopsychosocial concept, the paradigm of behavioral medicine, the clinical psychophysiological research background, the clinical fields of PNI, psychocardiology, biobehavioral oncology, the so-called mind-body medicine, and stress medicine frameworks reflect a converging pluralism. Psychoneuroimmunology offers a comprehensive framework to analyze key issues of psychosomatics in a social neuroscience framework and to demonstrate the significance of the network approach in bridging the gap between psychosomatics and biomedicine. Network medicine creates a shared denominator for analyzing socioeconomic, interpersonal, life event-based narrative factors together with psychophysiological features of the clinical and health psychological problems and promotes convergence of psychosomatics, biomedicine, and lifestyle medicine, too. On the other side, psychosomatic medicine as a particular professional medical specialization is not universal at all. In Europe, one can find such specialization only in Germany, while psychotherapy applied by somatic experts is practiced in wider circles. Finally, we explore the new niches for psychosomatic orientation offered by integrative frameworks like lifestyle medicine

**Keywords:** names and frames of psychosomatics, psychoneuroimmunology,

**1. The network paradigm: new niches for psychosomatic medicine**

*Man is not an indifferent hanger for carrying the disease. Man is the larger part of the disease. Temperament affects even skull fractures. It affects the coloration of acute diseases and especially certain chronic and maybe non-exogenous disease types, which cannot be properly understood or judged unless we follow the internal and typically more significant threads of their etiology into the unique tangle of* 

Niches for Psychosomatic

#### **Chapter 1**

## The Network Paradigm: New Niches for Psychosomatic Medicine

*Imre Lázár*

#### **Abstract**

Psychosomatic medicine, as a philosophical frame and practical approach of the diagnostic and therapeutical agency, had been undergone several renewals and reframing in the past. We overview the history of psychosomatics and map its branches. Psychoanalytic and psychodynamic frameworks, the Engelian biopsychosocial concept, the paradigm of behavioral medicine, the clinical psychophysiological research background, the clinical fields of PNI, psychocardiology, biobehavioral oncology, the so-called mind-body medicine, and stress medicine frameworks reflect a converging pluralism. Psychoneuroimmunology offers a comprehensive framework to analyze key issues of psychosomatics in a social neuroscience framework and to demonstrate the significance of the network approach in bridging the gap between psychosomatics and biomedicine. Network medicine creates a shared denominator for analyzing socioeconomic, interpersonal, life event-based narrative factors together with psychophysiological features of the clinical and health psychological problems and promotes convergence of psychosomatics, biomedicine, and lifestyle medicine, too. On the other side, psychosomatic medicine as a particular professional medical specialization is not universal at all. In Europe, one can find such specialization only in Germany, while psychotherapy applied by somatic experts is practiced in wider circles. Finally, we explore the new niches for psychosomatic orientation offered by integrative frameworks like lifestyle medicine and network medicine.

**Keywords:** names and frames of psychosomatics, psychoneuroimmunology, network medicine, institutionalization

#### **1. The network paradigm: new niches for psychosomatic medicine**

*Man is not an indifferent hanger for carrying the disease. Man is the larger part of the disease. Temperament affects even skull fractures. It affects the coloration of acute diseases and especially certain chronic and maybe non-exogenous disease types, which cannot be properly understood or judged unless we follow the internal and typically more significant threads of their etiology into the unique tangle of individual characteristics* (László Németh [1])*.*

#### **1.1 Roots and branches, names and frames of psychosomatics: a historical analysis**

Psychosomatic medicine, as a philosophical frame and practical approach of the diagnostic and therapeutical agency, had been undergone several renewals and reframing in the past. If we try to explore the archeology of psychosomatics, we can trace its orientation back to Galenus, Hippocrates, or the Chinese *The Yellow Emperor's Classic of Medicine*.

Galenus wrote about the connection between melancholy and mammary carcinoma following theories by Hippocrates, attributing the cause of breast cancer to an "excess of black bile," implying more than a disbalance of humor, and pointing to the habitus, the emotional and behavioral character. Emotional disorders and mental illnesses also had been considered to constitute a significant part of diseases in Chinese medicine, where such illnesses were classified as Qing Zhi disorders. The so-called emotion-wills implied the Qi Qing:-seven emotion, namely happiness, anger, anxiety, pensiveness, sorrow, fear, and fright and the Wu Zhi five wills: happiness, anger, thinking, sorrow, and fear. According to the ancient Chinese approach, they play a primary role in the onset, progress, and prognosis of most of the diseases.

As emotions are deep *human ecological representations* of the environment depending on perceptions, evaluation, and interpretation of the outer and internal environment, we can realize that psychosomatics is also a human ecological approach immersed into external and internal networks of social, psychological, neuroendocrine-immune and molecular layers.

The emotional response to environmental challenges depends on personality (A, C, D type) as a result of personal history (early mother–child attachment, adverse childhood experiences); personal development; Pavlov's, Skinner's, and Bandura's learning processes and system-like social influences (family relationships in frame of Milano School, worksite mental health issues); competition and frustration; domination and submission; social rank; and self-evaluation (shame, feeling guilty).

In an overview of the history of psychosomatic concepts regarding human suffering, we find changing frames for the connection between mind and body in a multilayered human ecological setting. The psychoanalytic and psychodynamic frameworks, the hypnotic phenomena, stress medicine based on Cannon's fight-orflight reaction, Selye's stress, Lipowski's consultation-liaison medicine, the Engelian biopsychosocial concept, and the paradigm of behavioral medicine have network features in common.

In the background, the clinical psychophysiological research emerges with the clinical fields of psychoneuroimmunology, psychocardiology, and biobehavioral oncology. This way, the so-called mind-body medicine and stress medicine frameworks reflect a converging pluralism. The frames are diverse, and the foci are common. Information flow through the social, cognitive-emotional, psychological, neural, endocrine, and immune interfaces and the molecular transcriptomic interfaces and *backward*. These paths and regulative networks have shared evolutionary origins. These are the structural-functional, patterned heritage of ours, organizing biopsychosocial adaptation and the structural wisdom of the human body. Their adaptive/maladaptive potential depends on the changing environmental context.

Drawing a Venn diagram of different historical or competing schools of psychosomatic medical philosophy, we find many overlapping themes, which might also be considered as hubs of multilayered network organization of psychosomatic phenomena, working as a network of networks (**Figure 1**). The letters sign some of the evolutionary steps of psychosomatics without a claim for the whole picture (**Table 1**).

**5**

**Figure 1.**

*Venn diagram of different psychosomatic discourses.*

*The Network Paradigm: New Niches for Psychosomatic Medicine*

Contemporary psychosomatic medicine broke away from the psychoanalytic foundations, and its research directions reflected a turn toward networking with other disciplines, as an interdisciplinary approach named behavioral medicine. The behavioral medicine and the concept of consultation-liaison psychosomatics bound to Lipowski [2] brought psychosomatics closer to mainstream biomedicine, enhancing their collaboration. The Engelian turn of the biopsychosocial paradigm explicitly expressed the importance of information flow through the network of networks that built up dynamically connected social, psychological, somatic, and molecular-genetic layers. In 1977, the Yale Conference on Behavioral Medicine had a strong impact to the history of psychosomatic medicine. The participants, like Joseph Matarazzo, Redford Williams, David Shapiro, and Gary Schwartz, defined a new framework for the former psychosomatic medicine, as the study and treatment of diseases, disorders, or abnormal states in which psychological processes and reactions are believed to play a prominent role. There were several opinions regarding the identification of psychosomatics with behavioral medicine. Some considered it identical; others expressed the opinion that behavioral medicine was only a fraction of psychosomatics, while others viewed behavioral medicine implying psychosomatic medicine and additional areas of medical and psychological concern. The wider definition of behavioral medicine extended the former borders of psychosomatics, proposing *behavioral medicine as "*the field concerned with the development of behavioral-science knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment, and rehabilitation. Psychosis, neurosis, and substance use are included only insofar as they contribute to physical disorders as an endpoint" [3]. Further extension of former

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

*The Network Paradigm: New Niches for Psychosomatic Medicine DOI: http://dx.doi.org/10.5772/intechopen.91885*

Contemporary psychosomatic medicine broke away from the psychoanalytic foundations, and its research directions reflected a turn toward networking with other disciplines, as an interdisciplinary approach named behavioral medicine. The behavioral medicine and the concept of consultation-liaison psychosomatics bound to Lipowski [2] brought psychosomatics closer to mainstream biomedicine, enhancing their collaboration. The Engelian turn of the biopsychosocial paradigm explicitly expressed the importance of information flow through the network of networks that built up dynamically connected social, psychological, somatic, and molecular-genetic layers.

In 1977, the Yale Conference on Behavioral Medicine had a strong impact to the history of psychosomatic medicine. The participants, like Joseph Matarazzo, Redford Williams, David Shapiro, and Gary Schwartz, defined a new framework for the former psychosomatic medicine, as the study and treatment of diseases, disorders, or abnormal states in which psychological processes and reactions are believed to play a prominent role. There were several opinions regarding the identification of psychosomatics with behavioral medicine. Some considered it identical; others expressed the opinion that behavioral medicine was only a fraction of psychosomatics, while others viewed behavioral medicine implying psychosomatic medicine and additional areas of medical and psychological concern. The wider definition of behavioral medicine extended the former borders of psychosomatics, proposing *behavioral medicine as "*the field concerned with the development of behavioral-science knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and these techniques to prevention, diagnosis, treatment, and rehabilitation. Psychosis, neurosis, and substance use are included only insofar as they contribute to physical disorders as an endpoint" [3]. Further extension of former


**7**

**Table 1.**

*The Network Paradigm: New Niches for Psychosomatic Medicine*

P 1936 Bergmann Pathology of functional internal

Q 1937 Hetényi Autonomous nervous system-based

R 1937 Papez Mental experience is transformed

S 1940 Scharrer The central nervous system

TY 1943 Dunbar Relationship between personality

Y 1955 Charva The system model of

U 1955 LeShan Specific pattern of cancer risk

Ü 1957 Bálint Doctor-patient relationship and

V 1972 Weiner Psychosomatic problems

Matarazzo Schwartz/Weiss

Z 1984 Caccioppo Development of social

medicine

diseases of internal medicine

into the psychophysiological pattern of emotions by the limbichypothalamic system

controls the hormone production of the endocrine system through the hypothalamus

and psychosomatic disease

neurohumoral integration

based on a biographical history and personality survey of cancer patients

communication as a factor in healing. Bálint groups

as disorders of information transmission between the limbichypothalamic–pituitary system

neuroscience

Behavioral medicine Mind-body

T 1942 Bykow Corticovisceral pathology Neurovisceral

X 1950 Alexander Psychosomatic medicine Neuroimmune

W 1974 Ader Psychoneuroimmunology Neuroimmune

ZS 1995 Meaney Social epigenomics Mind-body

Neurovisceral network

Neurovisceral network

Neurovisceral network

Neuroendocrine network

network

Mind-body network

network

Neurovisceral network Neuroendocrine network

Neuroimmune network

> Mind-body network

Neuroendocrine network

network

network

Mind-body network

network

psychosomatics included social and institutional spheres and deep biological

The disciplines contributing to the study of behavioral phenomena include psychology, sociology, anthropology, education, epidemiology, biostatistics, and psychiatry. These disciplines must be coupled with the biological and medical sciences relevant to understanding the disease processes under study. The networking position of behavioral medicine is apparent from epistemological perspective, too. The following matrix clarifies the deep connection with network medicine (**Figure 2**).

system and network insights as well.

*Network features of psychosomatic models [4, 5].*

Sz 1977

1978

*DOI: http://dx.doi.org/10.5772/intechopen.91885*


*The Network Paradigm: New Niches for Psychosomatic Medicine DOI: http://dx.doi.org/10.5772/intechopen.91885*

#### **Table 1.**

*Network features of psychosomatic models [4, 5].*

psychosomatics included social and institutional spheres and deep biological system and network insights as well.

The disciplines contributing to the study of behavioral phenomena include psychology, sociology, anthropology, education, epidemiology, biostatistics, and psychiatry. These disciplines must be coupled with the biological and medical sciences relevant to understanding the disease processes under study. The networking position of behavioral medicine is apparent from epistemological perspective, too. The following matrix clarifies the deep connection with network medicine (**Figure 2**).


#### **Figure 2.**

*Matrix of problems with which behavioral medicine is concerned [3].*

In this matrix, a disease is indexed at the sociological, epidemiological, anthropological, psychological, biomedical, and physiological levels of networks, and this is a multidimensional analysis with reference to different times (risks, pathophysiology, prognosis, treatment, and rehabilitation) and agency.

While behavioral medicine extended the core psychosomatic view to the broadest hermeneutical frame, the consultation-liaison psychosomatic medicine was connected to the mainstream psychiatry, with the following scope of interest:


Research into neuroimmunomodulation in immune laboratories had an explosion in the 1970s, in addition to research into the physiology of stress, creating the basis for a new "network" field of psychosomatics, the psychoneuroimmunology.

#### **1.2 Psychoneuroimmunology: a "network discipline"**

The rise of psychoneuroimmunology is a typic example of behavioral and medical interpretation of human disease. Its core explanatory model is based on insights of neuroimmune modulation, the bidirectional communication between neuroendocrine and immune system enabled by shared receptors and cross talk of messengers, and their integrated neuroendocrine-immune information pathways consisting of neurotransmitters, interleukins, neuropeptides, and hormone, including even myokines and adipokines [6]. These evolutionary patterned

**9**

*The Network Paradigm: New Niches for Psychosomatic Medicine*

heuristic features are close to what network medicine offers [6].

communication networks create a *network of networks* throughout the whole body, including the brain and all the organs. In the social-psychological, cognitiveevaluative, emotional, neurovisceral associations, connections, and circles, regulative positive and negative feedback loops create unity of rational, emotive, visceral, molecular, receptoral, and transcriptomic-genetic levels. The prehistory of psychoimmunology is mostly shared with psychosomatics, and its hermeneutic and

As early as at the end of the nineteenth century, we see data about the effect of damaging the nervous system on the loss of protection against anthrax. At the beginning of the twentieth century, Salomondsen and Mandsen already connected vagotomy and the atopic and anaphylactic reactions, and Hatiegan first described the effect of adrenaline on increasing the amount of lymphocytes in 1925, which

In Metalnikov and Chorine's 1926 work, they already discussed the conditionability of immune phenomena. The general immunological influence of emotions was described by Erich Wittkower, when he detected an increase in the number of white blood cells in the states of anxiety, anger, grief, and heightened mood. He coined the term "Affektleukocytose" to describe this phenomenon, which he explained with the stimulation of the sympathetic nervous system. A group of physiologists from Cluj-Napoca, Csaba Hadnagy and the Romanian Baciu, also joined this trend when they examined the effects of emotions and the autonomous nervous system on the number of white blood cells at the beginning of

Locke had already prepared a bibliography of more than 1500 articles in 1983 under the title *Behavioral Immunology.* If we take into account the names given to the scientific field discussed in these articles, the first "christening" took place in 1974 and is connected to Robert Ader, who used the term psychoimmunology and in 1981 extended it as psychoneuroimmunology. The term of *neuroimmunomodulation* is connected to Herbert Spector, while Berczi and Szentiványi used the term *neuroimmune biology*. They all include the overlap of different networks thought to

Even in the comprehensive work of Franz Alexander, psychosomatic medicine

Reviewing contributions to the prehistory of psychoimmunology, we can find the researchers' sensitivity toward the neuro-immunobiological network response to environmental challenges, as a shared feature in oeuvre of Hungarian scientists, like Selye, Berczi and Nagy, Bertók, Bohus, or Jancsó Jr. Selye presented the first neuroendocrine-immunological insight to human adaptation in 1936 when he proved the somatic triad of general adaptation syndrome, including peptic ulcer, adrenal hypertrophy (endocrine), and thymic and lymphoid atrophy. Selye confirmed the effect of the adrenocortical extract on inducing thymic atrophy in rats in 1943, and he called attention to the role of corticosteroids in regulating the inflammatory response in 1949. This research resulted in the development of

includes also internal diseases which, some decades later, turned to be understood in psychoneuroimmune contexts, like IBD, bronchial asthma, rheumatoid arthritis, peptic ulcer, Graves disease, neurodermatitis, and, as recent data show, hypertension which is not an exception at all. Although Alexander did not realize the neuroimmune information pathways and the networked features behind these diseases, his "psychosomatic" internal medicine was strongly attached to psychosocial relationships and conflicts including clinical phenomena generated by neuro-

**1.3 Hungarians' contributions to psychoneuroimmunology**

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

was confirmed by Frey and Tonietty in 1927.

the 1940s.

be autonomous.

immunobiological networks.

#### *The Network Paradigm: New Niches for Psychosomatic Medicine DOI: http://dx.doi.org/10.5772/intechopen.91885*

communication networks create a *network of networks* throughout the whole body, including the brain and all the organs. In the social-psychological, cognitiveevaluative, emotional, neurovisceral associations, connections, and circles, regulative positive and negative feedback loops create unity of rational, emotive, visceral, molecular, receptoral, and transcriptomic-genetic levels. The prehistory of psychoimmunology is mostly shared with psychosomatics, and its hermeneutic and heuristic features are close to what network medicine offers [6].

As early as at the end of the nineteenth century, we see data about the effect of damaging the nervous system on the loss of protection against anthrax. At the beginning of the twentieth century, Salomondsen and Mandsen already connected vagotomy and the atopic and anaphylactic reactions, and Hatiegan first described the effect of adrenaline on increasing the amount of lymphocytes in 1925, which was confirmed by Frey and Tonietty in 1927.

In Metalnikov and Chorine's 1926 work, they already discussed the conditionability of immune phenomena. The general immunological influence of emotions was described by Erich Wittkower, when he detected an increase in the number of white blood cells in the states of anxiety, anger, grief, and heightened mood. He coined the term "Affektleukocytose" to describe this phenomenon, which he explained with the stimulation of the sympathetic nervous system. A group of physiologists from Cluj-Napoca, Csaba Hadnagy and the Romanian Baciu, also joined this trend when they examined the effects of emotions and the autonomous nervous system on the number of white blood cells at the beginning of the 1940s.

Locke had already prepared a bibliography of more than 1500 articles in 1983 under the title *Behavioral Immunology.* If we take into account the names given to the scientific field discussed in these articles, the first "christening" took place in 1974 and is connected to Robert Ader, who used the term psychoimmunology and in 1981 extended it as psychoneuroimmunology. The term of *neuroimmunomodulation* is connected to Herbert Spector, while Berczi and Szentiványi used the term *neuroimmune biology*. They all include the overlap of different networks thought to be autonomous.

Even in the comprehensive work of Franz Alexander, psychosomatic medicine includes also internal diseases which, some decades later, turned to be understood in psychoneuroimmune contexts, like IBD, bronchial asthma, rheumatoid arthritis, peptic ulcer, Graves disease, neurodermatitis, and, as recent data show, hypertension which is not an exception at all. Although Alexander did not realize the neuroimmune information pathways and the networked features behind these diseases, his "psychosomatic" internal medicine was strongly attached to psychosocial relationships and conflicts including clinical phenomena generated by neuroimmunobiological networks.

#### **1.3 Hungarians' contributions to psychoneuroimmunology**

Reviewing contributions to the prehistory of psychoimmunology, we can find the researchers' sensitivity toward the neuro-immunobiological network response to environmental challenges, as a shared feature in oeuvre of Hungarian scientists, like Selye, Berczi and Nagy, Bertók, Bohus, or Jancsó Jr. Selye presented the first neuroendocrine-immunological insight to human adaptation in 1936 when he proved the somatic triad of general adaptation syndrome, including peptic ulcer, adrenal hypertrophy (endocrine), and thymic and lymphoid atrophy. Selye confirmed the effect of the adrenocortical extract on inducing thymic atrophy in rats in 1943, and he called attention to the role of corticosteroids in regulating the inflammatory response in 1949. This research resulted in the development of

the medication that is so important for autoimmune or allergic patients. However, Selye's Hungarian students also achieved important results in the field of endocrine immunology. István Berczi became a colleague of Selye in the 1960s, and he was exploring the immunological effects of hypophysis hormones together with Éva Nagy. They were among the first to confirm that not only cortisol but other stress hormones, such as the growth hormone or prolactin, also participate in the regulation of the hemo-lymphopoietic system and the immune functions. Lóránd Bertók, a guest researcher of Selye in the 1960s, can also be considered one of the pioneers of natural immunity research. He examined the protective role of bile acids against bacterial lipopolysaccharides. The toxic effect of the lipopolysaccharide endotoxins released by bacteria is an essential promoter of inflammation since their membrane-disrupting, capillary-penetrating, shock-inducing, and fever-inducing effects provide dramatic components of the illness. During endotoxic shock, the levels of ACTH, corticoids, and beta-endorphin increase; however, the levels of prolactin, TSH, T3, and T4 are reduced. These effects are mediated by immune mediators such as IL-1, IL-6, and TNF, which are secreted by the macrophages activated by endotoxins and monocytes. Lóránd Bertók's research also confirmed that the radiotherapeutic treatment of the endotoxins reduces their toxic effect and this harmless product, the so-called Tolerin, can increase the natural immune reaction and mobilize stem cells.

Hungarian researchers played a pioneering role in the discovery of another system of connections, the "neuroimmune network." Besides István Berczi, Andor Szentiványi also played a role in discovering the nature of the connections between neuroendocrine-immune networks when he prevented the anaphylactic response by lesions created in the tubular area of the hypothalamus. The work of Miklós Jancsó Jr. was also important. He investigated the effect of histamine on the endothelial vascular cells and the reticuloendothelial system as early as in the 1940s and identified histamine as the physiological activator of the reticuloendothelial system. However, he also identified another neuroimmune network, which played a large role in the understanding of the neuroimmune processes taking place on the internal and external surface of the body. Through research sensory neurons in the 1950s, Miklós Jancsó Jr. concluded for the first time that *a neuroimmune network must exist*, in which the sensory fibers play an important role. The antidromic electric excitation of the sensory nerves triggered an inflammatory response, which the researcher was able to prevent with capsaicin treatment and the selective destruction of C fibers. On the internal surfaces of the gut or joints, sensory fibers and the increase of substance P play an essential role in inflammatory processes. The discovery of Miklós Jancsó Jr. still provides a *paradigmatic network interpretation* framework for psycho-immune research today. This network might play a role in trigger point and referred pain theory of Janet Travell and other reflextherapy theories, too.

Béla Bohus and his colleagues also brought a new slice of reality into the range of interpretation of PNI, examining the correlations between social interactions, dominance, subordination, behavioral traits, and physiological indicators. Social hierarchy is a network structure at ethological/social levels, which is transferred to neuroendocrine-immune networks through cognitive behavioral networks.

We should mention further Hungarian think tanks as well, such as the works of Elemér Endrőczy Csaba Nyakas and Lajos Korányi, or the research group led by Szilveszter Vizy, among which Ilia Elenkov's or Judit Szelényi can be mentioned as outstanding representatives of the field. In the field of applied psychoimmunology, we have to mention the pioneering role of György Németh and András Guseo.

The turning points and parallel evolutionary pathways of psychosomatics and psychoneuroimmunology, listed in **Table 1**, share covert network logic.

**11**

*The Network Paradigm: New Niches for Psychosomatic Medicine*

socio-psychoimmunology lies across several layers of graphs.

expanded, narrative network analysis.

ships in them.

nological network model.

Networks are stand-alone factors in themselves, displayed by graphs depicting symmetrical or asymmetrical relations between cells, molecules, organs, and social relationships and life events. The network-type depiction is also warranted by the need to present regulatory cycles in block schematics, system theory modeling, and the communication and information paths and logical relationships. The neuroimmune networks are graphs, and the task is to identify the nodes (sometimes hubs) connecting them and the system of relations between them. However, under the socio-psychoimmunological approach, the limits of the graph's validity exceed the levels of the systems of molecules, organs, and organ systems and bypass the individual and personal as well. Under this approach, partnerships, social support, control, power, the territorial principle, dominance and submission, and social ranking are all presented in a set of relationships that can be outlined by graphs, edges, and hubs. However, connections over time are also aligned to the psychoimmunological interpretation of diseases as a graph and network, in the narrative framework of psychosomatics. Therefore, the particular "metagraph network" of

The anamnesis and history disclosed by the patient, the writing or conversation therapy for exploring and disclosing traumas, the research for early traumas, and the investigation of infection chains, learning about the dramatic dynamics underlying socio-somatic relations, are all possible using the toolset of this

This is the anatomy of experience embodied in text, the crystallography of the petrified personal suffering. Identifying the persons and events included in the fate-text and exploring the system of their relations pose the same kind of challenge for network theory as the exploring the "small-world" networks of relevant mediators, and comparison of the neural, endocrine, and immune networks, and locating the hubs that connect them and drawing the graph lines of the relation-

The identification of key players, dominant communities, groups, and the system of relationships between them, based on the personal narrative, and the understanding of tensions of social rank are an inevitable part of "decoding" the socio-psycho-immune network. This is how actual *dramatic hubs* connect patterns of vulnerable personality reactions, traumatic life events, social rank, and dominance relations and neuroimmune stress networks. As it is the person who explores and reveals it in the therapeutic process, psychoimmunotherapy includes a rearrangement of the representations of the external set of relations and the set of relations hidden by time generated in mind. This means a network analysis of social behavioral cognitive and clinical psychophysiological networks of relevance. This might offer revelatory rearrangements between the related set of life events, personality, and psychological network pattern and the narrative representation network, which may reach even the neuroimmune networks in the deep. This is why the social networks and their narrative reflection in life history should be analyzed together with biological networks of the socio-psychoimmu-

Situation assessment, psychophysiological, and neuroendocrine networks make up such extended networks, and so do the neuroendocrine and neuropeptide patterns, cytokine networks, extracellular messengers, and intracellular molecular paths, genetic programs, and transcription processes. Overrepresented hubs and edges that determine the dynamics and types of physiological and pathological

events, as well as possible therapies, are also outlined here.

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

**2. The neuroimmune networks**

#### **2. The neuroimmune networks**

Networks are stand-alone factors in themselves, displayed by graphs depicting symmetrical or asymmetrical relations between cells, molecules, organs, and social relationships and life events. The network-type depiction is also warranted by the need to present regulatory cycles in block schematics, system theory modeling, and the communication and information paths and logical relationships. The neuroimmune networks are graphs, and the task is to identify the nodes (sometimes hubs) connecting them and the system of relations between them. However, under the socio-psychoimmunological approach, the limits of the graph's validity exceed the levels of the systems of molecules, organs, and organ systems and bypass the individual and personal as well. Under this approach, partnerships, social support, control, power, the territorial principle, dominance and submission, and social ranking are all presented in a set of relationships that can be outlined by graphs, edges, and hubs. However, connections over time are also aligned to the psychoimmunological interpretation of diseases as a graph and network, in the narrative framework of psychosomatics. Therefore, the particular "metagraph network" of socio-psychoimmunology lies across several layers of graphs.

The anamnesis and history disclosed by the patient, the writing or conversation therapy for exploring and disclosing traumas, the research for early traumas, and the investigation of infection chains, learning about the dramatic dynamics underlying socio-somatic relations, are all possible using the toolset of this expanded, narrative network analysis.

This is the anatomy of experience embodied in text, the crystallography of the petrified personal suffering. Identifying the persons and events included in the fate-text and exploring the system of their relations pose the same kind of challenge for network theory as the exploring the "small-world" networks of relevant mediators, and comparison of the neural, endocrine, and immune networks, and locating the hubs that connect them and drawing the graph lines of the relationships in them.

The identification of key players, dominant communities, groups, and the system of relationships between them, based on the personal narrative, and the understanding of tensions of social rank are an inevitable part of "decoding" the socio-psycho-immune network. This is how actual *dramatic hubs* connect patterns of vulnerable personality reactions, traumatic life events, social rank, and dominance relations and neuroimmune stress networks. As it is the person who explores and reveals it in the therapeutic process, psychoimmunotherapy includes a rearrangement of the representations of the external set of relations and the set of relations hidden by time generated in mind. This means a network analysis of social behavioral cognitive and clinical psychophysiological networks of relevance. This might offer revelatory rearrangements between the related set of life events, personality, and psychological network pattern and the narrative representation network, which may reach even the neuroimmune networks in the deep. This is why the social networks and their narrative reflection in life history should be analyzed together with biological networks of the socio-psychoimmunological network model.

Situation assessment, psychophysiological, and neuroendocrine networks make up such extended networks, and so do the neuroendocrine and neuropeptide patterns, cytokine networks, extracellular messengers, and intracellular molecular paths, genetic programs, and transcription processes. Overrepresented hubs and edges that determine the dynamics and types of physiological and pathological events, as well as possible therapies, are also outlined here.

#### **2.1 Network features of Solomon postulates**

George Freeman Solomon was one of those pioneers who established the scientific paradigm of psychoimmunology in the 1960s and 1970s, pointing to the connections between brain, behavior, and immunity. He gathered the psychoimmunological revelations in a corpus of postulates [7]. We can test these postulates from the network perspective.

Graph of neuroendocrine-immune networks might be seen as real *small-world networks* in which most nodes are not neighbors of one another, but the neighbors of any given node are likely to be neighbors of each other, and most nodes can be reached from every other node by a small number of hops or steps.

#### *2.1.1 Neuroendocrine-immune chain*

IL-1, paraventricular NA secretion- CRH-ACTH-adrenocortical cortisol/(sickness behavior, neuroendocrine-immune feedback, inflammation theory of depression based on depletion of dopamine, or diminishing serotonin secretion)

Immunological abnormalities may be accompanied by psychological or mental disorders.

Activation of the immune system can lead to changes in the activity of the central nervous system.

Immune signaling can also affect the central nervous system.

Cytokines of the immune system, as part of the neuroimmune endocrine axis, play a role in endocrine regulation, including stress-induced endocrine processes.

Cytokines influence psychological processes and cause psychiatric symptoms. Immunity influences behavior, and behavior can aid in immune regulatory functions.

#### *2.1.2 Psychoneuro-endocrine-immune chain*

Psychological states/traits-neural networks-stress hormones-immune system (C-type personality, right frontal hemispherical dominance, chronic stress, depression, shame, submissive status)

Adaptive coping styles and enduring characteristics can improve the prognosis of immune diseases and protect susceptible patients from the disease.

Stress coping and traits, including personality traits that influence stress management, may influence the immune response to exogenous antigenic stimuli.

Emotional changes and distress (state characteristics) can influence the onset, severity, and course of disorders controlled by immune processes or resulting from disturbed immune processes (allergies, autoimmune, diseases, AIDS).

Severe emotional and mental disorders can cause immunological disorders. Immune functions may also be affected by altered states of consciousness. Experimental behavioral effects may lead to immunological changes.

Damage to and stimulation of some regions of the central nervous system may lead to immunological changes.

Substances produced and regulated by the central nervous system (neurotransmitters, neuropeptides, other neuroendocrine factors) must influence immune processes.

#### *2.1.3 Social-psychoneuroimmune network chains (social rank, social evaluative theory, shame, bereavement, social losses, social exclusion, voodoo, cultural nocebos)*

In extensive prospective studies, specific patterns of psychological risk should be associated with a higher incidence of immune disease.

**13**

*The Network Paradigm: New Niches for Psychosomatic Medicine*

mother-child relationship can affect the adult immune system.

Genetic, gender, and behavioral factors influence the immunological effects of

In addition to the influence on the adult psyche, early injury and the traumatic

Therapeutic influencing behavior (psychotherapy, relaxation, biofeedback, and

Immunocompetent cells have receptors for receiving neuropeptides, neurotrans-

Central nervous and hormonal factors may play a role in the regulation of

Lymphocyte receptors are also affected by changes in transducer sensitivities that are characteristic of mental disorders and cells of the central nervous system.

Thymic hormones that regulate immune function may be under central nervous

CRH plays a role in the processes and symptoms of depression and immunosup-

Immunological processes and specific personality characteristics (coping style,

Enzymes for the synthesis of brain neurotransmitters are found in immunocom-

Melatonin, a neuronal hormone involved in the regulation of circadian rhyth-

Mitogens, potent, non-specific immunostimulants, also act on the nervous

Immune cells influence the development and function of the surrounding

Lymphokines may affect pituitary hormones directly and via the central nervous

Some cells of the central nervous system are capable of lymphokine production. Cytokines of the immune system, as part of the neuroimmune endocrine axis, play a role in endocrine regulation, including stress-induced endocrine processes. These psychoimmunological facts support the profound relevance of social and psychological network changes exerting deep visceral influence through psychophysiological networks. It also supports the connection between psychosomatics

The network-based interpretation of crucial issues of psychosomatics mapped in **Table 1** follows the above principles. Social networks and neuro-immunobiological networks are linked with psycho developmental hubs. Common, hub-like narrative foci are the early mother–child relationships and the adverse childhood experiences, just like the syndrome of post-traumatic stress. Distorted early mother-child attachment organizations have an impact on the so-called internal working model and

Certain cell groups of the nervous and immune systems occur together. The prenatal hormonal environment has an effect on CNS and the development of the immune system, which can have lasting effects on both behavioral and

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

hypnosis) may also affect immune function.

feedback processes in the immune system.

pression associated with depression.

"hardiness") may play a role in longevity.

and broad areas of internal medicine.

Sleep affects both CNS and immune processes.

micity and affected by stress, affects immune function.

**2.2. Bridges in the network**

mitters, and endocrine signals.

**2.3 Hubs in the network**

system influence.

immune functions.

system.

system.

nervous system.

petent cells and neurons.

Positive emotions stimulate immune function.

stress.

Genetic, gender, and behavioral factors influence the immunological effects of stress.

In addition to the influence on the adult psyche, early injury and the traumatic mother-child relationship can affect the adult immune system.

Therapeutic influencing behavior (psychotherapy, relaxation, biofeedback, and hypnosis) may also affect immune function.

Positive emotions stimulate immune function.

#### **2.2. Bridges in the network**

Immunocompetent cells have receptors for receiving neuropeptides, neurotransmitters, and endocrine signals.

Central nervous and hormonal factors may play a role in the regulation of feedback processes in the immune system.

Lymphocyte receptors are also affected by changes in transducer sensitivities that are characteristic of mental disorders and cells of the central nervous system.

#### **2.3 Hubs in the network**

Thymic hormones that regulate immune function may be under central nervous system influence.

CRH plays a role in the processes and symptoms of depression and immunosuppression associated with depression.

Certain cell groups of the nervous and immune systems occur together.

The prenatal hormonal environment has an effect on CNS and the development of the immune system, which can have lasting effects on both behavioral and immune functions.

Sleep affects both CNS and immune processes.

Immunological processes and specific personality characteristics (coping style, "hardiness") may play a role in longevity.

Enzymes for the synthesis of brain neurotransmitters are found in immunocompetent cells and neurons.

Melatonin, a neuronal hormone involved in the regulation of circadian rhythmicity and affected by stress, affects immune function.

Mitogens, potent, non-specific immunostimulants, also act on the nervous system.

Immune cells influence the development and function of the surrounding nervous system.

Lymphokines may affect pituitary hormones directly and via the central nervous system.

Some cells of the central nervous system are capable of lymphokine production. Cytokines of the immune system, as part of the neuroimmune endocrine axis,

play a role in endocrine regulation, including stress-induced endocrine processes. These psychoimmunological facts support the profound relevance of social and psychological network changes exerting deep visceral influence through psychophysiological networks. It also supports the connection between psychosomatics and broad areas of internal medicine.

The network-based interpretation of crucial issues of psychosomatics mapped in **Table 1** follows the above principles. Social networks and neuro-immunobiological networks are linked with psycho developmental hubs. Common, hub-like narrative foci are the early mother–child relationships and the adverse childhood experiences, just like the syndrome of post-traumatic stress. Distorted early mother-child attachment organizations have an impact on the so-called internal working model and

other personality features creating enhanced risks for some somatic diseases. A-type anxious avoidant secondary attachment organization might diminish empathy and hypothetically create a tendency toward A-type personality development, strive for dominance, competition, and hostility and tendencies for cardiovascular vulnerability. In contrast, C-type secondary anxious/ambivalent attachment organization creates lower self-esteem, behavioral inhibition of aggression, and expression of emotions, high anxiety, and psychophysiological arousal [8, 9].

Epigenetic consequences of distorted mother-child attachment, like downregulation of hippocampal GR receptors via histone methylation, distorted HPA feedback, and distorted estrogen regulation with consequences on adult maternal behavior also prove the hub-like role of the mother-child relationship between socio-psychological and developmental personality networks, stress physiological networks, and neuroimmune network.

Relations between transactional events, traumas, feelings of submission, and loss of control, just as chronic psychosocial stressors, that carry psychological meaning are explored in the networks of the socio-psychological layer. Alexithymia or social inhibition and the psychological network patterns of the C-type personality convert all this into increased HPA activity, high arousal, and increased LC/ NAerg activity, so that all this is eventually embodied in the disruptions of the immune cell network controlled by cytokines. Then, IL-1 and IL-6 as result of modified protein synthesis in the cell reach the central nervous system, and via modified dopaminerg and serotoninerg molecular network changes is transcribed into psychological network patterns and depression. The disturbances of the rank position experienced in social networks (reduced motivation, lack of adequacy in the workplace, family conflicts, loss of socioeconomic status) are also embodied this way (via neural networks and proinflammatory cytokines).

#### **3. The psychoimmunology of social stress in the network context**

Human social relationships might be occasionally the source of severe conflicts. In the light of social exchange theory, it is apparent that the individual is often exposed to severe distress in the high-cost medium of the temporal, monetary, and emotional strain of social interactions. Plenty of evidence is available for presenting the social-psychoimmune consequences of distorted human relationships.

The negative or ambivalent social relationships and the resulting conflicts and associated negative emotions can influence immune processes. Hostility, which we primarily know as a cardiovascular risk factor of psychosomatics, promotes inflammatory processes as well, which is indicated by elevation of CRP and IL-6, according to the work of Suarez [10], and the increased level of the pro-inflammatory cytokines typical of depression as well.

Depression highlights a distinct area of research within social-psychoimmunology, taking the correlations between depression and social integration into account, as well as the relationship conflicts and its negative effect on social perception. Depression is proven to be a mediating factor between socioeconomic patterns (personal income) and physical consequences (number of sick days) in behavioral and epidemiological research called Hungarostudy, verified by route analysis [11]. Depression is proven to be also an independent risk factor of myocardial infarction [12].

The attitudes and emotions increasing the stress of social interaction and interpersonal emotional relationships, such as anger or the hardships caused by depression, are also reflected in the differences in the immune response. Social conflict influences the course of rheumatoid arthritis, in which case catecholamine

**15**

behavior.

findings of Denson et al. [21].

body that is the set of RNA typical of the cell.

*The Network Paradigm: New Niches for Psychosomatic Medicine*

plays an important role among the neurohormonal factors mediating psychosocial distress. In the social network of ambivalent individuals (those who exert positive and negative influence as well), the ambivalent persons cause increased adrenergic reactions based on the work of Uchino et al. [13], and the contact and conflict with ambivalent persons can provoke an increase in systolic blood pressure. Longterm tight ambivalent human relationships, rich in conflicts, are common in bad marriages, where worse health indicators are also often observed according to the findings of Kiecolt-Glaser and Newton [14]. The dissatisfaction indicator of marriage is accompanied by worse immune indicators, as seen in the case of the ratio of anti-EBV antibodies, CD4+, or CD8+ cells. The hostile behavior typical of bad marriage, impulsivity resulting in cutting each other off when speaking, as well as critical and judgmental impatience, can be indicators of physiological differences and increased blood pressure and endocrine values, based on the work of Malarkey et al. [15]. Among newlywed couples, those who are more prone to adverse, hostile reactions, and this is recalled during a short, 30-min discussion, suppressed immune function was shown in samples taken 24 h later. Kiecolt-Glaser et al. [16] stated that the discrepancy indicating dysfunction of the endocrine-immune regulation was true to older couples as well during discussions where they had to recall their conflicts. The amount of negativistic behavior was in direct correlation with the weakening of the immune response. Mayne et al. [17] confirmed that as much as 45 minutes of exploratory discussion of conflict was enough to reduce lymphocyte proliferation in the examined women. During prospective research, Levenstein et al. [18] found a connection between ulcerative inflammation of the oral cavity and marital stress, while Kiecolt-Glaser et al. observed significantly approximately 60% longer wound healing in the case of couples exhibiting hostile

Trait-like hostility, characterized by aggression, anger, and cynicism, causes an even more evident immune regulatory disorder in the event of family conflicts, according to Mayne et al. [17]. Miller et al. [19] found a distinct correlation between hostile and cynical attitudes and behavior during conflict management and the cardiovascular response, cortisol, and immune discrepancies. Social stressors induce a rise of pro-inflammatory mediators as well and cause systematic inflammation in the body, based on the work of Steptoe et al. [20]. Partnership conflicts, rejection, and exclusion have significant pro-inflammatory effects even compared to depression and various life events, according to the

**4. Evolved network patterns in psychoimmunological risk situations**

The neuroendocrine effects triggered in the brain by threatening environmental stimuli can create a preparatory pathogen-host defense effect on the native immune system, as a result of which the redistribution of the cells of the native immune system and their migration toward the exposed area are detected. All of this ensures the increased rate of healing after an injury. This response can be mobilized by both the presence of predators and the emergence of a significant conflict situation. In the opinion of Slavich and Cole [22], the mobilization of innate immunity is not only an evolutionary remnant but something that can be triggered by symbolic threats, social conflict, rejection, isolation, and exclusion as well. If we consider the genetic basis of the neuroendocrine and immune systems of mammals when investigating their immune system, we can identify a typical pro-inflammatory/anti-inflammatory response pattern by examining the transcriptome of the leukocytes circulated in the

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

#### *The Network Paradigm: New Niches for Psychosomatic Medicine DOI: http://dx.doi.org/10.5772/intechopen.91885*

plays an important role among the neurohormonal factors mediating psychosocial distress. In the social network of ambivalent individuals (those who exert positive and negative influence as well), the ambivalent persons cause increased adrenergic reactions based on the work of Uchino et al. [13], and the contact and conflict with ambivalent persons can provoke an increase in systolic blood pressure. Longterm tight ambivalent human relationships, rich in conflicts, are common in bad marriages, where worse health indicators are also often observed according to the findings of Kiecolt-Glaser and Newton [14]. The dissatisfaction indicator of marriage is accompanied by worse immune indicators, as seen in the case of the ratio of anti-EBV antibodies, CD4+, or CD8+ cells. The hostile behavior typical of bad marriage, impulsivity resulting in cutting each other off when speaking, as well as critical and judgmental impatience, can be indicators of physiological differences and increased blood pressure and endocrine values, based on the work of Malarkey et al. [15]. Among newlywed couples, those who are more prone to adverse, hostile reactions, and this is recalled during a short, 30-min discussion, suppressed immune function was shown in samples taken 24 h later. Kiecolt-Glaser et al. [16] stated that the discrepancy indicating dysfunction of the endocrine-immune regulation was true to older couples as well during discussions where they had to recall their conflicts. The amount of negativistic behavior was in direct correlation with the weakening of the immune response. Mayne et al. [17] confirmed that as much as 45 minutes of exploratory discussion of conflict was enough to reduce lymphocyte proliferation in the examined women. During prospective research, Levenstein et al. [18] found a connection between ulcerative inflammation of the oral cavity and marital stress, while Kiecolt-Glaser et al. observed significantly approximately 60% longer wound healing in the case of couples exhibiting hostile behavior.

Trait-like hostility, characterized by aggression, anger, and cynicism, causes an even more evident immune regulatory disorder in the event of family conflicts, according to Mayne et al. [17]. Miller et al. [19] found a distinct correlation between hostile and cynical attitudes and behavior during conflict management and the cardiovascular response, cortisol, and immune discrepancies. Social stressors induce a rise of pro-inflammatory mediators as well and cause systematic inflammation in the body, based on the work of Steptoe et al. [20]. Partnership conflicts, rejection, and exclusion have significant pro-inflammatory effects even compared to depression and various life events, according to the findings of Denson et al. [21].

#### **4. Evolved network patterns in psychoimmunological risk situations**

The neuroendocrine effects triggered in the brain by threatening environmental stimuli can create a preparatory pathogen-host defense effect on the native immune system, as a result of which the redistribution of the cells of the native immune system and their migration toward the exposed area are detected. All of this ensures the increased rate of healing after an injury. This response can be mobilized by both the presence of predators and the emergence of a significant conflict situation. In the opinion of Slavich and Cole [22], the mobilization of innate immunity is not only an evolutionary remnant but something that can be triggered by symbolic threats, social conflict, rejection, isolation, and exclusion as well. If we consider the genetic basis of the neuroendocrine and immune systems of mammals when investigating their immune system, we can identify a typical pro-inflammatory/anti-inflammatory response pattern by examining the transcriptome of the leukocytes circulated in the body that is the set of RNA typical of the cell.

Under normal circumstances, the activity of the sympathetic nervous system increases the conserved transcriptional response to adversity (CTRA) with the help of the adrenergic receptors, and the activity of the HPA axis reduces the CTRAdependent inflammatory response as a result of the released cortisol.

However, in the case of chronic social isolation, the threat of grief, and posttraumatic stress, reduced activity of the anti-inflammatory glucocorticoid receptor (GR) can be detected. Therefore, the so-called conserved transcriptional response to adversity is triggered by threatening, stressful, or permanently uncertain adversity as well, as indicated in Antoni's report [23].

As mentioned above, the threat of grief, traumatic stress, social isolation, low socioeconomic status, or a cancer diagnosis all result in pro-inflammatory transcription disorders. In experimental animal models, social instability, low social rank, and repeated defeat also resulted in a CTRA. Such challenges increase the activity of the genes responsible for the inflammatory immune response to extracellular pathogens and bacterial infections and inhibit the genes responsible for the antiviral immune response to intracellular pathogens. The selective evolutionary advantage of all this is indicated by the fact that it increases the rate of CTRA, wound healing, and response to infection in the event of an actual physical threat. However, it is apparent from the observations that the CTRA is activated by several symbolic, social, anticipated, or imagined emergencies experienced in everyday life. In the event of prolonged perceived or real danger, social or physical threat, a glucocorticoid resistance might develop, which may lead to more severe inflammation or depression.

These phenomena had evolved as a result of the coevolution of hierarchic layers of social, cognitive, neural, immune, and transcriptomic, genetic layers of this hierarchical construction of different networks linked to each other. The highly conserved biological response to adversity, described above, is crucial to overcome the physical threats or injury. Modern-day social, symbolic, or perceived, even imagined, threats might also lead to a pro-inflammatory phenotype of (mal) adaptive answer. The elevation of pro-inflammatory cytokines, such as IL-1 and IL-6, may contribute to elicit depressive symptoms. The overlap of depression with several physical conditions, including asthma, rheumatoid arthritis, chronic pain, metabolic syndrome, cardiovascular disease, obesity, and neurodegeneration, shows the psychosomatic significance and network character of this civilizational paradox. It is a central issue of psychosomatics and roots in the nonadaptive linking of different, environmental, social, cognitive-emotional, neuroimmune, and genetic networks. Psychosomatics deals with this network of networks, where the informational pathways are the edges between nodes, hubs, and the more extensive network "patches." The so-called social signal transduction theory of depression is a proper example to track how social-environmental information activate biological processes that lead to depression.

The hypothesis that experiences of social threat and adversity upregulate components of the immune system involved in inflammation is central to the social signal transduction theory of depression. The key mediators or messengers, called *pro-inflammatory cytokines*, play a hub-like role in the network, which might induce profound changes in behavior like psychomotor retardation and social behavioral withdrawal, and influencing immune networks, and neural regulations of mood, anhedonia, and fatigue as symptoms of depression. Selfperceived/perceived lower social status is associated with higher pro-inflammatory cytokines (IL-6) in the dorsomedial prefrontal cortex (DMPFC) activity. The DMPFC plays a crucial role in the so-called mentalizing network, which is active in brain processes that model the thoughts and feelings of others, as well

**17**

representation.

*The Network Paradigm: New Niches for Psychosomatic Medicine*

as in evaluating the social status associated with this process. The ventromedial prefrontal cortex (VMPFC) plays an essential role in detecting and assessing signs of dominance. VMPFC damage leads to insensitivity to the social hierarchy and a lack of respect for age and gender. The amygdala plays an integrative role in the perception of dominance, learning processes are related to the social hierarchy, the perceived value of the individual within the group are linked to the amygdala, and its relationships with the hippocampus and striatum are productive. The lateral prefrontal cortex (LPFC) integrates social hierarchy information from the intraparietal sulcus and hippocampus, while VMPFC is responsible for organizing adaptive behavior. The network approach gives these centers a real

On the other hand, diverse anatomical connections connect it to the amygdala, hypothalamus, and periaqueductal gray matter, thus reaching the stress pathways affecting the immune processes. Beyond its role in empathy and mentalization, it is also part of the so-called "aversive amplification" subnetwork, which activates the appropriate limbic areas in the event of threatening stress. In this regard, it plays a role in the processing of social impulses, perceiving others' higher positions in social rank as a source of critical, negative, exclusionary, and punitive social impulses, as well as in their qualification of danger. The inferior social status

The hypothesis of social signal transduction theory of depression regarding experiences of psychoimmunological effects of social threat and adversity is central

In the network medicine, identification of networks, hubs, and edges represents a true "big data" challenge, as the protein synthesis is determined by nearly 25,000 genes and the network hubs of "interactomes" are created by numerous proteins and functional RNS molecules as cell builders, on a scale of thousands. The number of network interactions with functional relevance is even higher. Learning about these interactions and identifying biological networks are the tasks for network medicine. However, the logic of network pathology is followed by research on the connections between the brain, hormone organs, and the immune system, on physiological networks, exploration of which is also a mapping task for interactomes of different levels. Such a map, comprising nearly 7000 interactions, is drawn by the protein-protein interaction network map of Rual et al. [24], the metabolic network summary by Duarte et al. [25], as well as the cytokine maps. However, the concept of meaningful narratives, life events, personality types susceptible to disease, or Berne's transaction analysis also strives to draw up such maps. Exploring the connection between anamnesis and disease progression is also a similar effort at

The task is to identify interactomes as networks, within which the network patterns and relevant connection paths associated with the disease should be identified. Probably, the analysis of the socio-psychoimmunology paths is necessary as well, given that the "interactomes" of this mappable system of network relations can be identified*.* It is possible to explore the relationships between these factors, causal relations, and multidirectional pathways of influence, the network characteristics of the personality and the body, and the dynamics of the evolution and progression of diseases. Low socioeconomic status, discrimination, and subordination are accompanied by an increased level of pro-inflammatory cytokines, with the

presumption is associated with increased activity in this brain area.

**5. Network medicine as a psychosomatic metamodel**

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

social-psychoneuroimmune "hub" position.

in our network theory of psychosomatics.

#### *The Network Paradigm: New Niches for Psychosomatic Medicine DOI: http://dx.doi.org/10.5772/intechopen.91885*

as in evaluating the social status associated with this process. The ventromedial prefrontal cortex (VMPFC) plays an essential role in detecting and assessing signs of dominance. VMPFC damage leads to insensitivity to the social hierarchy and a lack of respect for age and gender. The amygdala plays an integrative role in the perception of dominance, learning processes are related to the social hierarchy, the perceived value of the individual within the group are linked to the amygdala, and its relationships with the hippocampus and striatum are productive. The lateral prefrontal cortex (LPFC) integrates social hierarchy information from the intraparietal sulcus and hippocampus, while VMPFC is responsible for organizing adaptive behavior. The network approach gives these centers a real social-psychoneuroimmune "hub" position.

On the other hand, diverse anatomical connections connect it to the amygdala, hypothalamus, and periaqueductal gray matter, thus reaching the stress pathways affecting the immune processes. Beyond its role in empathy and mentalization, it is also part of the so-called "aversive amplification" subnetwork, which activates the appropriate limbic areas in the event of threatening stress. In this regard, it plays a role in the processing of social impulses, perceiving others' higher positions in social rank as a source of critical, negative, exclusionary, and punitive social impulses, as well as in their qualification of danger. The inferior social status presumption is associated with increased activity in this brain area.

The hypothesis of social signal transduction theory of depression regarding experiences of psychoimmunological effects of social threat and adversity is central in our network theory of psychosomatics.

#### **5. Network medicine as a psychosomatic metamodel**

In the network medicine, identification of networks, hubs, and edges represents a true "big data" challenge, as the protein synthesis is determined by nearly 25,000 genes and the network hubs of "interactomes" are created by numerous proteins and functional RNS molecules as cell builders, on a scale of thousands. The number of network interactions with functional relevance is even higher. Learning about these interactions and identifying biological networks are the tasks for network medicine. However, the logic of network pathology is followed by research on the connections between the brain, hormone organs, and the immune system, on physiological networks, exploration of which is also a mapping task for interactomes of different levels. Such a map, comprising nearly 7000 interactions, is drawn by the protein-protein interaction network map of Rual et al. [24], the metabolic network summary by Duarte et al. [25], as well as the cytokine maps. However, the concept of meaningful narratives, life events, personality types susceptible to disease, or Berne's transaction analysis also strives to draw up such maps. Exploring the connection between anamnesis and disease progression is also a similar effort at representation.

The task is to identify interactomes as networks, within which the network patterns and relevant connection paths associated with the disease should be identified. Probably, the analysis of the socio-psychoimmunology paths is necessary as well, given that the "interactomes" of this mappable system of network relations can be identified*.* It is possible to explore the relationships between these factors, causal relations, and multidirectional pathways of influence, the network characteristics of the personality and the body, and the dynamics of the evolution and progression of diseases. Low socioeconomic status, discrimination, and subordination are accompanied by an increased level of pro-inflammatory cytokines, with the mediation of neurohumoral pathways, as demonstrated by Dickerson et al. [26]*,* for instance. Anxiety, depression, and post-traumatic stress disease, along with the accompanying social and behavioral phenomena, are connected to neurohumoral and immune network anomalies, such as increased pro-inflammatory cytokines (e.g., IL-6) or the activation of the NF-kappa B path, which has central significance in the activity of inflammatory networks, according to Haroon et al. [27].

Identifying the degree of distribution and identifying the hubs characterized by several connections are needed to find the characteristics of these networks. At a molecular level, these can be TLR4, NF-kappa B, caspase, or, at the cellular level, macrophages or the cellular elements of the HPA axis representing nodes of the network. More abstract network modeling makes neurological structures participating in the assessment of controllability, the psychological processes of social perception and assessment, and neurophysiological structures that organize the personality also such as hubs. This way, the early mother–child relationship, which is vital for the development of personality, in the evolution of neurobiological structures, and carries permanent immunobiological consequences, becomes a network hub, as described above. Similarly, several neural networks as centers might create a greater network system responsible for translating social events.

The network itself is held together by a few hubs that have many connections. This is why socio-psychoimmunology explores lifetime hubs pointing in so many directions (mother-child relationship, separation, loss of object, loss of control), positive or negative traits (pessimism, C-type personality, active or passive coping) that are sensitive in psychoimmunological terms, pathologic network patterns (blunted HPA activity, deregulation of glucocorticoid receptors, TH1/TH2 shift), and allergic or autoimmune disease patterns in patient narratives at the social level. (**Figure 3**). These various key "hubs" may connect several types of networks of correlations. These small worlds are features of complex networks. The interconnected molecular networks are surrounded by relatively short path connections where a large portion of the component proteins are responsible for a low number of interactions, while they may be along main routes affecting the entire body, influencing the entire network.

Therefore, the hubs responsible for specific local cellular processes may be deemed to be "party" hubs, while they may also be "date" hubs interconnecting processes and associating relationships that organize the interactome. Further characteristics of the network are the "subgraphs" having motif power and in charge of biological functions such as negative or positive feedback or the oscillator function. These subgraphs are the totality of the interconnected hubs that make up a subnetwork within the network. Most networks may be described by a substantial creation of beams and are accompanied by the generation of topology modules characterized by the emergence of a high local region with mutual connections. Hubs are characterized by a high *betweenness centrality that describes the number of the shortest paths running through the hub,* otherwise referred to as "bottleneck." This is the nature of regulatory networks with vector edges.

An essential part of network analysis is link analysis, which looks primarily at the relationships between factors, hubs, and objects. Psychoimmunology itself offers an excellent example for the analysis of key relationships and links between the various objects, as it identifies and maps relations between networks of different characters (wired neural, endocrine propagated by blood flow, immune cells and mediators moving through tissues). Socio-psychoimmunology allocates the anamnestic narrative network relations, life events, and the social and symbolic cultural hub networks, through personality patterns, social-neuroscientific insight to responsible neural circuits deep to the cellular transcriptomic level of neuroendocrine-immune networks, exposing their mutual interactions. This network

**19**

*The Network Paradigm: New Niches for Psychosomatic Medicine*

approach provides a new framework of cognitive mapping for anamnesis, diagnosis, and therapy. The result is a transversal metanetwork appearing through a series of information transcripts and translation mechanisms, which weaves a psychosomatic disease pattern through the network layers with its own heteronomous hubs.

**6. Network framework as the common denominator of psychosomatics** 

The integrated internal medicine/psychosomatic/lifestyle medicine method is beneficial in improving the treatment of the disease, including the psychosocial factors to be taken into account [28]. Such are loneliness, chronic stress, the role of life events, the loss of object, and the personal characteristics of coping. Psychosomatic diagnosis is supported by the Diagnostic Criteria for Psychosomatic Research (DCPR), which incorporates relevant psychological variables into the diagnostic system along the lines of the most important psychosomatic syndromes, like anxiety, functional physical and conversion symptoms, somatic symptom formation of psychiatric origin, somatic and hypochondriac perceptions and fears (disease phobia and fear of death), and suppression of the disease that refers to psychosomatically colored disease behavior. In contrast, alexithymia; risk patterns of A-, C-, and D-type personality; and behavior patterns include trait and state features of personality characteristics that affect the patient's condition, including psychophysiological risks [29, 30]. Patients may require appropriate anxietyreducing therapeutic support or cognitive behavioral therapy for psychophysiological involvement of chronic diseases. Clinical psychoimmunology offers new explanatory model and therapeutic framework for bronchial asthma, inflammatory bowel diseases, rheumatoid arthritis, specific autoimmune endocrine pathologies, and psychosomatic skin diseases. It is crucial if 25% of cardiovascular patients suffer from untreated depression, and the chronic inflammational process fed by

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

**and internal medicine**

*Psychosomatic network of networks.*

**Figure 3.**

*The Network Paradigm: New Niches for Psychosomatic Medicine DOI: http://dx.doi.org/10.5772/intechopen.91885*

**Figure 3.** *Psychosomatic network of networks.*

approach provides a new framework of cognitive mapping for anamnesis, diagnosis, and therapy. The result is a transversal metanetwork appearing through a series of information transcripts and translation mechanisms, which weaves a psychosomatic disease pattern through the network layers with its own heteronomous hubs.

#### **6. Network framework as the common denominator of psychosomatics and internal medicine**

The integrated internal medicine/psychosomatic/lifestyle medicine method is beneficial in improving the treatment of the disease, including the psychosocial factors to be taken into account [28]. Such are loneliness, chronic stress, the role of life events, the loss of object, and the personal characteristics of coping. Psychosomatic diagnosis is supported by the Diagnostic Criteria for Psychosomatic Research (DCPR), which incorporates relevant psychological variables into the diagnostic system along the lines of the most important psychosomatic syndromes, like anxiety, functional physical and conversion symptoms, somatic symptom formation of psychiatric origin, somatic and hypochondriac perceptions and fears (disease phobia and fear of death), and suppression of the disease that refers to psychosomatically colored disease behavior. In contrast, alexithymia; risk patterns of A-, C-, and D-type personality; and behavior patterns include trait and state features of personality characteristics that affect the patient's condition, including psychophysiological risks [29, 30]. Patients may require appropriate anxietyreducing therapeutic support or cognitive behavioral therapy for psychophysiological involvement of chronic diseases. Clinical psychoimmunology offers new explanatory model and therapeutic framework for bronchial asthma, inflammatory bowel diseases, rheumatoid arthritis, specific autoimmune endocrine pathologies, and psychosomatic skin diseases. It is crucial if 25% of cardiovascular patients suffer from untreated depression, and the chronic inflammational process fed by

depression, or similar psychoimmunological processes might contribute to the atherosclerotic vascular processes. Oncological patients have similar problems with untreated depression and the immunosuppressive effects of depression (in the case of NK cells) on the disease process.

Significant evidence-based research has indicated the increasing importance of a psychosocial approach in the field of internal medicine diseases, such as the SPIRR-CAD study among depressed patients suffering from coronary arterial disease [31]; the PISO study, somatoform disorders [32]; or DAD study, diabetes [33]. Although the SPIRR-CAD study did not demonstrate the overall benefit of cascading interventional psychotherapy among depressed coronary artery patients, it showed the success of therapy in a "bond-damaged" group of patients and among adult bypasslinked ISB patients [34]. Katon et al. [35] integrated "behavioral medicine" and psychosomatic approach to primary care. Lower HbA1c, blood pressure, and serum cholesterol was demonstrated among diabetic patients in the TEAM-care program than the control group receiving average care. Psychosomatics is not an alternative but an extension of the perspective of internal medicine. Lipowski [2] emphasizes that "psychosomatics" is an expression of the inseparability and interdependence of psychosocial and biological (physiological, somatic) aspects of human existence. This extension includes the extension of networks, too.

#### **7. Risk factors and lifestyle risks of internal medicine diseases**

Independent risk factors that increase the risk of internal medical diseases are also objects of a separate discipline, lifestyle medicine, addressing the relationship between avoidable risk factors and lifestyle. However, lifestyle medicine links biomedicine and psychosomatics, also. Obesity; distorted coping that escalates into addictions (smoking, alcohol, drugs, sedatives, chemical comforters); sedentary lifestyle, or, on the contrary, overtraining due to a distorted body image; eating disorders; and high carbohydrate and fat intake may affect the risk of developing cardiovascular and metabolic disorders.

The Framingham study was one of the early follow-up studies that demonstrated the role of hypertension, smoking, and high blood fats among independent risk factors for coronary sclerosis. Today, depression and anxiety must also be considered an independent risk factor for coronary artery disease [12].

Life events can also affect the development and course of the disease. Bereavement, divorce with high values in the Holmes-Rahe scale, and common everyday stress experience called daily hassles all might play a role. For example, in respiratory diseases, a correlation is observed between stressful life events, perceived stress, and upper respiratory symptoms. The risk of provoking asthma is known for severe adverse life events. Rheumatoid arthritis often flares up after bereavement, divorce, and job loss. Serious conflict, divorce, bereavement, or love disappointment might induce or worsen course of ulcerative colitis.

Lifestyle medicine offers network-like interventions along with behavioral modification. One of these is regular exercise. In a plague of sedentarism, physical exercise might be a panacea for many lifestyle problems. The active muscles are part of the neuroendocrine-immune network of the human organism and exert significant influence on the metabolic system, the immune system, the brain, and the abdominal fat, which is also part of the complex informational network. Exercise induces endorphin secretion. Myokines exert their influence by the presence of their receptors on muscle, fat, liver, pancreatic, bone, heart, immune, and brain cells. Myokines like myostatin, IL-6, IL-8, IL-15, FGF21, follistatinlike 1, brain-derived neurotrophic factor (BDNF), hepatocyte growth factor,

**21**

and education.

*The Network Paradigm: New Niches for Psychosomatic Medicine*

fibroblast growth factor, and insulin-like growth factor play role in metabolism and tissue regeneration. IL-15 reduces abdominal adipose tissue, while in heavy physical exercise, the secreted IL-6 as myokine rises to 100-fold of resting level and increases IL-1 and IL-10 as an anti-inflammatory mediator. Brain-derived neurotrophic factor might be secreted as a myokine, and muscle-derived BDNF

**8. Discourses and institutions: networks of psychosomatic agency**

On the other side, psychosomatic medicine as a unique professional medical specialization is not universal at all. In Europe, one can find such psychosomatic professional specialization only in Germany, while psychotherapy applied by somatic experts is practiced in many other countries. The new niches for psychosomatic orientation offered by integrative frameworks of stress medicine, mind-body medicine, or lifestyle medicine and network medicine are based on the above insights of linked biopsychosocial networks. Is this a trans/interdisciplinary challenge or a constraint for networking of different disciplines? If we compare the definition of behavioral medicine by Schwartz and Weiss in 1978 [36] and the 2019 proposal for its renewal by the ISBM consensus boards, we find meaningful shifts. The "interdisciplinary field" was exchanged to "field characterized by the collaboration among multiple disciplines" with the meaning of networking of disciplines instead of filling the

This way, network medicine means double challenge, to see the patient as sociopsycho-biological "network of networks" and organize his/her healing in networks

Psychosomatic medicine has its permanent revival fed by new findings in social neuroscience, clinical psychophysiology, or the new public health; nevertheless, its institutional network shows a narrow picture. Mental disorders (depression, chronic stress) proved to be independent risk factors in the development of autoimmune, allergic and neoplastic diseases, and myocardial infarction. It has been confirmed by evidence-based basic research (social neuroscience, psychoneuroim-

However, the institutionalization of psychosomatic clinical discourse showed a rather marginal status in the shadow zone of the high-tech, evidence-based practical development of biomedicine in the frontline. The discourse dynamics reflects the power inequities of health economic, academic, educational, and clinical health

In some countries (e.g., Germany, Japan), psychosomatic medicine can be practiced as a specialist field, with specialized psychosomatic clinical departments, separate institutes, and somatic and psychotherapeutic care in a joint framework, in teamwork. In Germany, there are over 5000 specialist physicians with psychosomatic and psychotherapist certifications. Outpatient care employs 3058 psychosomatic professionals, while 10,269 physicians hold the title of the psychotherapist, and a total of 21,312 physicians with somatic background have the title of psychotherapist. There are 120 psychosomatic institutions in Germany with a total of approx. 20,000 beds (Statistik-Portal, 2014). Institutional care is also highly developed, and psychosomatic wards providing regional care in regional central hospitals provide patient care. Although the number of hospital beds is limited (9 to 36 beds), the units also provide consultation-liaison psychosomatic care for other clinical departments. The university and teaching hospitals (20–70 beds) have a higher supply capacity, where in addition to healing, there is research

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

enhances fat oxidation.

intermediary disciplinal gaps.

service networks.

of disciplines, discourses, and institutions.

munology, psychocardiology) and epidemiological analyses.

fibroblast growth factor, and insulin-like growth factor play role in metabolism and tissue regeneration. IL-15 reduces abdominal adipose tissue, while in heavy physical exercise, the secreted IL-6 as myokine rises to 100-fold of resting level and increases IL-1 and IL-10 as an anti-inflammatory mediator. Brain-derived neurotrophic factor might be secreted as a myokine, and muscle-derived BDNF enhances fat oxidation.

#### **8. Discourses and institutions: networks of psychosomatic agency**

On the other side, psychosomatic medicine as a unique professional medical specialization is not universal at all. In Europe, one can find such psychosomatic professional specialization only in Germany, while psychotherapy applied by somatic experts is practiced in many other countries. The new niches for psychosomatic orientation offered by integrative frameworks of stress medicine, mind-body medicine, or lifestyle medicine and network medicine are based on the above insights of linked biopsychosocial networks. Is this a trans/interdisciplinary challenge or a constraint for networking of different disciplines? If we compare the definition of behavioral medicine by Schwartz and Weiss in 1978 [36] and the 2019 proposal for its renewal by the ISBM consensus boards, we find meaningful shifts. The "interdisciplinary field" was exchanged to "field characterized by the collaboration among multiple disciplines" with the meaning of networking of disciplines instead of filling the intermediary disciplinal gaps.

This way, network medicine means double challenge, to see the patient as sociopsycho-biological "network of networks" and organize his/her healing in networks of disciplines, discourses, and institutions.

Psychosomatic medicine has its permanent revival fed by new findings in social neuroscience, clinical psychophysiology, or the new public health; nevertheless, its institutional network shows a narrow picture. Mental disorders (depression, chronic stress) proved to be independent risk factors in the development of autoimmune, allergic and neoplastic diseases, and myocardial infarction. It has been confirmed by evidence-based basic research (social neuroscience, psychoneuroimmunology, psychocardiology) and epidemiological analyses.

However, the institutionalization of psychosomatic clinical discourse showed a rather marginal status in the shadow zone of the high-tech, evidence-based practical development of biomedicine in the frontline. The discourse dynamics reflects the power inequities of health economic, academic, educational, and clinical health service networks.

In some countries (e.g., Germany, Japan), psychosomatic medicine can be practiced as a specialist field, with specialized psychosomatic clinical departments, separate institutes, and somatic and psychotherapeutic care in a joint framework, in teamwork. In Germany, there are over 5000 specialist physicians with psychosomatic and psychotherapist certifications. Outpatient care employs 3058 psychosomatic professionals, while 10,269 physicians hold the title of the psychotherapist, and a total of 21,312 physicians with somatic background have the title of psychotherapist. There are 120 psychosomatic institutions in Germany with a total of approx. 20,000 beds (Statistik-Portal, 2014). Institutional care is also highly developed, and psychosomatic wards providing regional care in regional central hospitals provide patient care. Although the number of hospital beds is limited (9 to 36 beds), the units also provide consultation-liaison psychosomatic care for other clinical departments. The university and teaching hospitals (20–70 beds) have a higher supply capacity, where in addition to healing, there is research and education.

#### *Psychosomatic Medicine*

In March 2016, the Japanese Psychosomatic Society had 3300 members, 71.6% of whom were physicians (general practitioners, psychiatrists, pediatricians, obstetricians-gynecologists, dentists, and dermatologists). Psychosomatic internal therapists also formed a separate association with 1200 members (Japanese Society of Psychosomatic Internal Medicine) [37].

Although there are widespread organized discourse communities, academic associations of psychosomatic experts from gynecology and obstetrics, internal medicine, cardiology, and gastroenterology, just as numerous clinical departments all around the medical world, one can find significant disproportion between psychosomatic *medical specialization* and mainstream organized health care in most of the contemporary medical systems.

Psychosomatics might be absorbed by psychiatry, as C-L psychiatry might be seen as a branch of mainstream psychiatry. It shows the significant disciplinary distance from internal medicine and other disciplines, while issues of psychoimmunology and psychocardiology are deeply embedded in the health-care system of internal medicine. This way, the emerging network centered renewal of behavioral medicine remains only an ideology than everyday clinical practice.

If clinical practice incorporates psychosomatics as part of mainstream medical discourse, guaranteeing the possibility of specialist examinations and specialized care and creating such specialist care units and scenes, the institutional and economic "emancipation" of the field is assured. In 2004, the so-called DAK/AHG study weighed the cost/benefit of long-term institutional psychosomatic treatment burdened with costly hotel services in 338 insured persons treated in psychosomatic hospital wards between January 1999 and February 2000. The results supported its "raison d'etre" and profitable values for *health economic* point of view [38].

One might see the reason of these contradictions even in nature of psychosomatic disease, as a patient complaining of somatic symptoms used to be reluctant to classify his or her complaints as psychiatric. One can overcome this situation by an invited consultation-liaison psychiatrist, as the patient is not seeking psychological treatment but a somatic care provider for his/her psychosomatic disorders. All of this requires collaboration, a psychosomatically informed professional organizational culture, and a genuinely competent psychosomatic therapeutic delivery environment for the other treatments offered. Psychosomatic patients travel through routes of somatic care with their symptoms because of their interpretation. Once treated in a somatic ward, they are strongly attached to the physical origin of their complaints based on their explanatory model. Psychological assessment of symptoms is often considered offensive. Therefore, psychosomatic care is highly dependent on patient choice. If the primary and specialist care systems do not offer this type of care, the patient will not make such a decision either. Few people turn to psychiatric care providers for physical complaints of psychological origin, and the fear of stigmatization is a barrier, too. It follows that the internal structural features of institutionalized discourse impede the proper care of a large group of patients. Whereas in general medical practice, about one-third of patients suffer from psychiatric symptoms, and 23% of patients in primary care experience depression, 22% with anxiety, and 20% with somatization, it may be relevant for primary care physicians to have additional psychosomatic licensure training. One-third of cardiological patients have mild depression without treatment; oncological patients have a similar situation, frequently. Beyond these institutional difficulties, there is a great need for integrating psychosomatic to biomedicine, as argued above.

Katon et al. [35] also demonstrated that the so-called TEAM-care program, integrating behavioral and psychosomatic approaches with the somatic practice of primary care, lowered HbA1c, blood pressure, and serum cholesterol levels. Psychosomatic patients also increase the costs of somatic care because of hotel costs

**23**

interest.

ology networks.

based prevention and intervention.

*The Network Paradigm: New Niches for Psychosomatic Medicine*

and ineffective, sometimes unnecessary diagnostics efforts. This costly, unnecessary "evidence-driven" defensive medical practice consumes energy, time, and space in patients requiring care. Specified psychosomatic care is mostly related/ reducted to clinical "elite institutions" and does not form part of general public hospital and outpatient practice. A few psychosomatic centers are connected to the university education (e.g., like the Psychosomatic Outpatient Department at the Institute of Behavioral Sciences, Semmelweis University) or occasionally as a department of the psychiatry clinic or elements of hospital psychiatric wards. The concept of networked medicine in medical systems can also create new theoretical "niches" for psychosomatic clinical thinking. All of this may be important to connect biomedicine with social neuroscience, clinical psychophysiology (e.g., psychoimmunology), stress medicine, or mind-body medicine. All these conceptual spaces, theoretical niches, also designate real institutional niches. There are vacant clinical spaces that can be filled with training, a new competent workforce, and purely organizational innovation. As the affected patient population is unaware of the psychological roots or modifiers of their complaints, and even this non-knowledge often forms the mechanics of symptom formation (suppression, complexation, alexithymia, traumatic learning,), therefore their care is closely linked to extension of somatic specialists' competence toward the psychosomatic horizon (specialist exam, license exam). On the other hand, the involvement of highly trained psychologists with clinical psychology specialization might also have an essential part of this organizational change. Such psychosomatic development can also affect oncology, dermatology, rheumatology, cardiology, and gastroenter-

The occupational health services offer a wide surface for preventive network medicine, too. Occupational health might have an important priority area for psychosomatic preventive work and early disease detection. Recognizing the increasing work-related stress in the industrial space of globalization and the consequent economic loss of nearly EUR 40 billion to European Member States' budgets has prompted European Union decision-makers to do the management of work-related stress management and mental health support, as a Member State's duty from 2007. Preventive stress management can be part of health promotion and may be of interest to both the employee and the employer in health psychological and psychosomatic practice, linked to screening and other public health preventive practices. The use of de-*medicalized* cognitive behavioral elements of mind-body preventive agency might be applied as worksite stress management training (like in case of Williams Life Skills training), new screening ways of psychophysiological risks, and available psychometric methods might help to implement worksite and community-

Psychologists with such skills, and occupational health practitioners sensitized in this regard, would achieve economically demonstrable results. Occupational health is the apparent scene for preventive and early psychosomatic intervention, as such screening of employees is easy to do and suits to the personal and corporate

Psychosomatic diagnostic and counseling work or psychosomatic "lifestyle medicine" might have their niches in spa health, wellness network. They are, like the occupational health or specialist network, empty niches to fill with psychosomatics. The map of diverse, nevertheless, coherent discourses of psychosomatics can be reframed by the network medicine concept, a common denominator. If clinical practice incorporates psychosomatics as part of mainstream medical discourse, guaranteeing the possibility of specialist examinations and specialized care and creating such specialist care units and scenes, the institutional and economic "emancipation" of the field is assured. The hermeneutic bridge, which had

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

#### *The Network Paradigm: New Niches for Psychosomatic Medicine DOI: http://dx.doi.org/10.5772/intechopen.91885*

and ineffective, sometimes unnecessary diagnostics efforts. This costly, unnecessary "evidence-driven" defensive medical practice consumes energy, time, and space in patients requiring care. Specified psychosomatic care is mostly related/ reducted to clinical "elite institutions" and does not form part of general public hospital and outpatient practice. A few psychosomatic centers are connected to the university education (e.g., like the Psychosomatic Outpatient Department at the Institute of Behavioral Sciences, Semmelweis University) or occasionally as a department of the psychiatry clinic or elements of hospital psychiatric wards.

The concept of networked medicine in medical systems can also create new theoretical "niches" for psychosomatic clinical thinking. All of this may be important to connect biomedicine with social neuroscience, clinical psychophysiology (e.g., psychoimmunology), stress medicine, or mind-body medicine. All these conceptual spaces, theoretical niches, also designate real institutional niches. There are vacant clinical spaces that can be filled with training, a new competent workforce, and purely organizational innovation. As the affected patient population is unaware of the psychological roots or modifiers of their complaints, and even this non-knowledge often forms the mechanics of symptom formation (suppression, complexation, alexithymia, traumatic learning,), therefore their care is closely linked to extension of somatic specialists' competence toward the psychosomatic horizon (specialist exam, license exam). On the other hand, the involvement of highly trained psychologists with clinical psychology specialization might also have an essential part of this organizational change. Such psychosomatic development can also affect oncology, dermatology, rheumatology, cardiology, and gastroenterology networks.

The occupational health services offer a wide surface for preventive network medicine, too. Occupational health might have an important priority area for psychosomatic preventive work and early disease detection. Recognizing the increasing work-related stress in the industrial space of globalization and the consequent economic loss of nearly EUR 40 billion to European Member States' budgets has prompted European Union decision-makers to do the management of work-related stress management and mental health support, as a Member State's duty from 2007. Preventive stress management can be part of health promotion and may be of interest to both the employee and the employer in health psychological and psychosomatic practice, linked to screening and other public health preventive practices. The use of de-*medicalized* cognitive behavioral elements of mind-body preventive agency might be applied as worksite stress management training (like in case of Williams Life Skills training), new screening ways of psychophysiological risks, and available psychometric methods might help to implement worksite and communitybased prevention and intervention.

Psychologists with such skills, and occupational health practitioners sensitized in this regard, would achieve economically demonstrable results. Occupational health is the apparent scene for preventive and early psychosomatic intervention, as such screening of employees is easy to do and suits to the personal and corporate interest.

Psychosomatic diagnostic and counseling work or psychosomatic "lifestyle medicine" might have their niches in spa health, wellness network. They are, like the occupational health or specialist network, empty niches to fill with psychosomatics. The map of diverse, nevertheless, coherent discourses of psychosomatics can be reframed by the network medicine concept, a common denominator. If clinical practice incorporates psychosomatics as part of mainstream medical discourse, guaranteeing the possibility of specialist examinations and specialized care and creating such specialist care units and scenes, the institutional and economic "emancipation" of the field is assured. The hermeneutic bridge, which had been already established in the biopsychosocial framework, did not lead to closer hybridization. The neuroimmune biological network frame might help the social and psychological aspects join to the evidence-based biomedical disciplines including the molecular and genomic transcriptomic level.

#### **9. Conclusion**

Steps in the history of psychosomatics share common heuristics in connecting different levels of environmental, psychological, neural, and visceral phenomena. This "multilayer" approach reflects the scientific will to follow the information flow from the social through the psychoneural and the visceral down to the molecular and genetic sphere and back. The psychophysiological core of psychosomatics has a human ecological context and deals with regulative network patterns of evolutionary roots. Concept of behavioral medicine shifted psychosomatics from a comprehensive psychodynamic explanatory model toward an integrative, multidisciplinary framework including levels of social, psychological, and somatic networks. Specific subfields of behavioral medicine, like psychoneuroimmunology, offer insights to the multilayered network-based interpretation of diseases. Dysregulation of evolutionary-based adaptive network activities like *the conserved transcriptional response to adversity* or the *social signal transduction theory of depression* reflects the clinical significance of network approach.

Depression itself is proven to be a mediating element between SES and sick days, between social and somatic, just as between the immunological and the psychological networks. Network theory offers an inclusive metanarrative for the description of the different social, narrative, and psychosomatic network layers and their interconnections as well anamnestic, diagnostic, and therapeutic significance. Behavioral medicine has shifted from an "*interdisciplinary field*" to the promoter of the collaboration among multiple disciplines, so this collaboration might be reframed by the extended and comprehensive network approach. Network medicine [39] as shared conceptual explanatory frame might bring closer behavioral epidemiology, the preventive lifestyle medicine, behavioral medicine, and occupational health and biomedicine. The exploring and implementing efforts based on the above defined "networks of networks" includes medical sociology, medical ecology, behavioral epidemiology, new public health, health promotion on the social side, and clinical psychophysiological depth of psychosomatic therapies including several cognitive behavioral approaches, hypnosis, psychodynamic approaches, and narrative medicine on the psychological side. Internal medicine, behavioral medicine, and psychosomatics with related disciplines overlap in the different social and psychophysiological network layers; network medicine might be the common denominator and the widest inclusive conceptual framework for collaboration.

**25**

**Author details**

Semmelweis University, Budapest, Hungary

provided the original work is properly cited.

of Social and Communication Sciences, Budapest, Hungary

\*Address all correspondence to: lazar.imre@med.semmelweis-univ.hu

1 Head of Medical Humanities Research Group, Institute of Behavioral Sciences,

2 Faculty of Humanities and Social Sciences, Károli Gáspár University, Institution

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Imre Lázár1,2

*The Network Paradigm: New Niches for Psychosomatic Medicine*

*DOI: http://dx.doi.org/10.5772/intechopen.91885*

*The Network Paradigm: New Niches for Psychosomatic Medicine DOI: http://dx.doi.org/10.5772/intechopen.91885*

### **Author details**

Imre Lázár1,2

1 Head of Medical Humanities Research Group, Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary

2 Faculty of Humanities and Social Sciences, Károli Gáspár University, Institution of Social and Communication Sciences, Budapest, Hungary

\*Address all correspondence to: lazar.imre@med.semmelweis-univ.hu

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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[31] Herrmann-Lingen C, Beutel ME, Bosbach A, Deter HC, Fritzsche K, Hellmich M, et al. A stepwise psychotherapy intervention for reducing risk in coronary artery disease (SPIRR-CAD): Results of an observerblinded, multicenter, randomized trial in depressed patients with coronary artery disease. SPIRR-CAD Study Group. Psychosomatic Medicine. 2016;**78**(6):704-715

[32] Sattel H, Lahmann C, Gündel H, Guthrie E, Kruse J, Noll-Hussong M, et al. Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: Randomised controlled trial. British Journal of Psychiatry. 2012;**200**(1):60-67

[33] Petrak F, Herpertz S, Albus C, Hermanns N, Hiemke C, Hiller W, et al. Cognitive behavioral therapy versus sertraline in patients with depression and poorly controlled diabetes: The Diabetes and Depression (DAD) study: A randomized controlled multicenter trial. Diabetes Care. 2007;**38**:767-775

[34] Söllner W, Müller MM, Albus C, Behnisch R, Beutel ME, de Zwaan M, et al. The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial. Journal of Psychosomatic Research. 2018;**108**:39-46

[35] Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman EJ, Young B, et al. Collaborative care for patients with depression and chronic illness. New England Journal of Medicine. 2010;**363**(27):2611-2620

[36] Schwartz GE, Weiss SM. Behavioral medicine revisited: An amended definition. Journal of Behavioral Medicine. 1978;**1**(3):249-251

[37] Murakami M, Nakai Y. Current state and future prospects for psychosomatic medicine in Japan. BioPsychoSocial Medicine. 2017;**11**:1

[38] Zielke M, Limbacher K. Fehlversorgung bei psysychischen Erkrankungen: Studie im Auftrag der DAK. Verhaltentherapie und Psychosoziale Praxis. 2004; **36**(Suppl. 3):S.8-S.12

[39] Loscalzo J, Barabási A-L, Silverman EK, editors. Network Medicine: Complex Systems in Human Disease and Therapeutics. Harvard University Press; 2017

**29**

**Chapter 2**

**Abstract**

requires consideration.

**1. Introduction**

rlung disease, unconscious, dakini

Psychological and Societal

Shadow on the Feminine in

Tibetan Buddhist Contexts

*Anne Iris Miriam Anders*

Implications of Projecting the

Idealizing and medicalizing of methods ascribed to Buddhism has led to individualizing their structural and societal challenges. Although the longundervalued need for introspection may get addressed, people are now caught under the cloak of spirituality hoping for quick enlightenment or a panacea solving mental diseases. Thus, at this point, the impact of decontextualizing concepts, unreflectively copying feudal structures into Tibetan Buddhist seminar- and meditation-centers, as well as of lacking knowledge required for the gradual application-oriented learning processes taught in traditional Buddhist philosophy have become clear. This shows in recent testimony of economical, psychological, and physical abuse in international Tibetan Buddhist organizations. The violence against individuals and man-made trauma in such contexts need to get analyzed before the background of neologisms, that is concepts allowing for arbitrariness and violence in the name of spirituality, as well as of the sophisticated systems of rationalizing damage and silencing trauma and victims. Furthermore, though those in the '*inner circles*' run the risk of traumatization and of being held accountable, it is women who are at higher risk, particularly those who engage in secret relationships. Thus, in terms of treatment, the collectively projecting the shadow on the feminine, leading to an attitude of exploitation and control against women,

**Keywords:** trauma, silencing of trauma, depression, psychosis, Buddhism, inner circle, secret consort, manipulation, exploitation, abuse, guru yoga, double bind, indoctrination in Buddhist groups, Vajrayāna, rationalization, decontextualization of concepts, cults, crazy wisdom, karma purification, pure view, Buddhist meditation, Buddhist seminar centers, Buddhist philosophy, mindfulness, mental diseases,

In international Tibetan Buddhist seminar-, meditation-, and retreat-centers, patterns of violence and exploitation have developed over the past decades. Recently, economical, psychological, and physical abuse [1–12] was reported. It has evolved against the background of structures that systematically devalue and control the

#### **Chapter 2**

## Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan Buddhist Contexts

*Anne Iris Miriam Anders*

#### **Abstract**

Idealizing and medicalizing of methods ascribed to Buddhism has led to individualizing their structural and societal challenges. Although the longundervalued need for introspection may get addressed, people are now caught under the cloak of spirituality hoping for quick enlightenment or a panacea solving mental diseases. Thus, at this point, the impact of decontextualizing concepts, unreflectively copying feudal structures into Tibetan Buddhist seminar- and meditation-centers, as well as of lacking knowledge required for the gradual application-oriented learning processes taught in traditional Buddhist philosophy have become clear. This shows in recent testimony of economical, psychological, and physical abuse in international Tibetan Buddhist organizations. The violence against individuals and man-made trauma in such contexts need to get analyzed before the background of neologisms, that is concepts allowing for arbitrariness and violence in the name of spirituality, as well as of the sophisticated systems of rationalizing damage and silencing trauma and victims. Furthermore, though those in the '*inner circles*' run the risk of traumatization and of being held accountable, it is women who are at higher risk, particularly those who engage in secret relationships. Thus, in terms of treatment, the collectively projecting the shadow on the feminine, leading to an attitude of exploitation and control against women, requires consideration.

**Keywords:** trauma, silencing of trauma, depression, psychosis, Buddhism, inner circle, secret consort, manipulation, exploitation, abuse, guru yoga, double bind, indoctrination in Buddhist groups, Vajrayāna, rationalization, decontextualization of concepts, cults, crazy wisdom, karma purification, pure view, Buddhist meditation, Buddhist seminar centers, Buddhist philosophy, mindfulness, mental diseases, rlung disease, unconscious, dakini

#### **1. Introduction**

In international Tibetan Buddhist seminar-, meditation-, and retreat-centers, patterns of violence and exploitation have developed over the past decades. Recently, economical, psychological, and physical abuse [1–12] was reported. It has evolved against the background of structures that systematically devalue and control the

feminine. Such structures effect on the individuals of the respective groups and engrave into their bodies and minds. Thus, in a cultural-insensitive, unreflected transfer of knowledge of Buddhist philosophy and respective training techniques, the culturally ingrained ways in dealing with the feminine and its unconscious attitudes were absorbed. A visualization concept of females merely forming the passive counterparts to male characters, their devaluation in comments and acquired behavior patterns as well as misunderstood visualization techniques leading to narcissistic self-aggrandizing patterns contribute to confusion. This disorientation in turn not only forms the basis for developing self-devaluation and uncertainty regarding the individuals social positions in the groups, but also causes a *double bind*-based inability to act. Thus, one option seems to be the proximity to the spiritual master, the identifying of women with the male master, which somehow is supposed to define their position and seemingly would enhance their spiritual progress towards enlightenment as well. The undefined social positions of women in such groups, which encourage projecting undesirable aspects onto them, and sexualized aspects, such as the role of a secret lover, pose a cultural challenge for them. However, besides uncertainties due to a lack of cultural socialization, and the opportunities for honest communication on this issue, usually prevented by vows of secrecy, damage to group members is incurred by those regarding themselves as Vajrayāna practitioners, even preaching Vajrayāna, for whom gender equality ought to be standard in their training. Thus, in neglecting individual and institutional betrayal trauma [13], the implicit traumatization of people, despite being undeniable injuries, has been successfully silenced for decades. And control of the feminine has also been achieved by projecting the shadow, one's own unwanted aspects, at the women.

Moreover, the narrative of Buddhism being a panacea for mental health not only misinterprets its spiritual methods to be psychological or medical ones. Damage is also caused by seducing and misleading sick individuals and by misinterpreting any trauma of those severely injured by the leadership or group members. Thus, the shadows behind the devaluation of females and seducing some of them into neglected social positions reveal a blind spot in Tibetan Buddhism and its seminar-, meditation-, and retreat-centers in the West, where it has continued to grow over decades. In rationalizing misconduct of the leadership and their helpers to be '*crazy wisdom*' [1, 2, 5, 8] or even so-called '*karma purification*' [1, 2], it was possible to even cover the injury to individuals and structural defects.

Due to the ongoing efforts to whitewash, denigrate those concerned, and silence the required discourse on leadership responsibility and accountability in the respective international contexts and head organizations, it is now crucial to broaden the perspective and consider the societal impact of such offences which, even as Buddhism and spirituality, have already been injuring and traumatizing many people. In the following subchapter, the descriptions of eleven probands are presented.

#### **2. Narratives of members of Buddhist groups**

#### **2.1 Methods**

Qualitative data of the research project *TransTibMed* from eleven participants in different international Tibetan Buddhist groups are presented covering the following eleven questions: *Which kind of abuse or violence have you experienced in Buddhist groups; how did you react to abuse or violence*; *how have your experiences in Buddhist groups had an impact on you; which kind of indoctrination, abuse, or violence against others have you witnessed*; *how have you reacted in the face of this indoctrination, violence, or abuse towards others*; *how did the experiences in Buddhist groups change you*;

**31**

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan…*

*how did the experiences in Buddhist groups change your relationships and your ways of relating to others*; *how did your experiences in Buddhist groups change the way you work*;

The questions *when you think of abuse in Buddhist groups - the abuse of people who have been manipulated and of minors, including sexual abuse - how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what* and *why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality* were replied

Probands were recruited through information at university, the *German Buddhist Union* (*DBU*), and indirectly through (former) group members informing others at

All probands presented wrote about their experiences in international Tibetan Buddhist organizations. Some of them were in several groups. All together, these statements refer to eleven different international Buddhist organizations. In order to protect the individuals, the names of the respective organizations are not provided here. The following results are structured as follows: All answers of one person are presented in one subchapter. The first nine questions were replied to by #1, #2, #3, #4, and #8 and the last two questions were replied to by #3, #5, #6, #7, #9, #10,

Questions are written in italics and the replies in straight letters. All answers of

and #11. The first six persons (#1–#6) are female and #7–#11 are male.

*Which kind of abuse or violence have you experienced in Buddhist groups?*: "Psychological abuse - gaslighting (stating everything is simply in my mind), manipulation to accept abuse by the abuser himself stating that he was my teacher, that everything 'is empty' therefore he couldn't be an abuser. Psychological abuse through an email attack to my workplace claiming I am having a nervous breakdown" (#1). *How did you react to abuse or violence*: "At the time of the individual abuse within […] I felt inadequate, I did not acknowledge that the perpetrator should be able to take some responsibility for their behaviors. I felt abandoned and inadequate because of the way the group reacted to the abuse - they did not acknowledge it had happened and when I disclosed it they did not view it as abuse. I was minimized by the 'spiritual director' when I disclosed it to her - she said that my 'practice was enduring suffering'. At the time this made me feel more inadequate. Later I understood this as a minimizing activity, and I became very angry about six months later after reading testimonies of other former members. Following my workplace receiving an email from […] management using a fake identity I experienced rage, could not concentrate, my boundaries were poor, I turned to alcohol to cope, I experienced suicidality. I felt paranoid, I did not understand how much danger I might be in or not. I did not know who could help, I felt abandoned by people who did not understand and could not help me. I had digestion problems due to the anxiety and shame for several months. I had little energy and could not exercise, experienced stiffness and rigidity in my face, I had slow speech and slow processing speed. I dissociated frequently e.g. not remembering where I had put things, where I had parked my car. I had nightmares about being murdered by the leadership" (#1). *How have your experiences in Buddhist groups had an impact on you*: "Severe post traumatic stress, anxiety, shame, and post traumatic growth. I am now connected to

probands in German were translated by the author.

and *have you parted with one or more Buddhist groups or teachers*? *If so, why*?

to by others and one person who also replied to the above.

*DOI: http://dx.doi.org/10.5772/intechopen.93297*

social networks.

*2.2.1 #1*

**2.2 Recent testimony**

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan… DOI: http://dx.doi.org/10.5772/intechopen.93297*

*how did the experiences in Buddhist groups change your relationships and your ways of relating to others*; *how did your experiences in Buddhist groups change the way you work*; and *have you parted with one or more Buddhist groups or teachers*? *If so, why*?

The questions *when you think of abuse in Buddhist groups - the abuse of people who have been manipulated and of minors, including sexual abuse - how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what* and *why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality* were replied to by others and one person who also replied to the above.

Probands were recruited through information at university, the *German Buddhist Union* (*DBU*), and indirectly through (former) group members informing others at social networks.

#### **2.2 Recent testimony**

*Psychosomatic Medicine*

feminine. Such structures effect on the individuals of the respective groups and engrave into their bodies and minds. Thus, in a cultural-insensitive, unreflected transfer of knowledge of Buddhist philosophy and respective training techniques, the culturally ingrained ways in dealing with the feminine and its unconscious attitudes were absorbed. A visualization concept of females merely forming the passive counterparts to male characters, their devaluation in comments and acquired behavior patterns as well as misunderstood visualization techniques leading to narcissistic self-aggrandizing patterns contribute to confusion. This disorientation in turn not only forms the basis for developing self-devaluation and uncertainty regarding the individuals social positions in the groups, but also causes a *double bind*-based inability to act. Thus, one option seems to be the proximity to the spiritual master, the identifying of women with the male master, which somehow is supposed to define their position and seemingly would enhance their spiritual progress towards enlightenment as well. The undefined social positions of women in such groups, which encourage projecting undesirable aspects onto them, and sexualized aspects, such as the role of a secret lover, pose a cultural challenge for them. However, besides uncertainties due to a lack of cultural socialization, and the opportunities for honest communication on this issue, usually prevented by vows of secrecy, damage to group members is incurred by those regarding themselves as Vajrayāna practitioners, even preaching Vajrayāna, for whom gender equality ought to be standard in their training. Thus, in neglecting individual and institutional betrayal trauma [13], the implicit traumatization of people, despite being undeniable injuries, has been successfully silenced for decades. And control of the feminine has also been achieved by

projecting the shadow, one's own unwanted aspects, at the women.

even cover the injury to individuals and structural defects.

**2. Narratives of members of Buddhist groups**

Moreover, the narrative of Buddhism being a panacea for mental health not only misinterprets its spiritual methods to be psychological or medical ones. Damage is also caused by seducing and misleading sick individuals and by misinterpreting any trauma of those severely injured by the leadership or group members. Thus, the shadows behind the devaluation of females and seducing some of them into neglected social positions reveal a blind spot in Tibetan Buddhism and its seminar-, meditation-, and retreat-centers in the West, where it has continued to grow over decades. In rationalizing misconduct of the leadership and their helpers to be '*crazy wisdom*' [1, 2, 5, 8] or even so-called '*karma purification*' [1, 2], it was possible to

Due to the ongoing efforts to whitewash, denigrate those concerned, and silence the required discourse on leadership responsibility and accountability in the respective international contexts and head organizations, it is now crucial to broaden the perspective and consider the societal impact of such offences which, even as Buddhism and spirituality, have already been injuring and traumatizing many people. In the following subchapter, the descriptions of eleven probands are presented.

Qualitative data of the research project *TransTibMed* from eleven participants in different international Tibetan Buddhist groups are presented covering the following eleven questions: *Which kind of abuse or violence have you experienced in Buddhist groups; how did you react to abuse or violence*; *how have your experiences in Buddhist groups had an impact on you; which kind of indoctrination, abuse, or violence against others have you witnessed*; *how have you reacted in the face of this indoctrination, violence, or abuse towards others*; *how did the experiences in Buddhist groups change you*;

**30**

**2.1 Methods**

All probands presented wrote about their experiences in international Tibetan Buddhist organizations. Some of them were in several groups. All together, these statements refer to eleven different international Buddhist organizations. In order to protect the individuals, the names of the respective organizations are not provided here.

The following results are structured as follows: All answers of one person are presented in one subchapter. The first nine questions were replied to by #1, #2, #3, #4, and #8 and the last two questions were replied to by #3, #5, #6, #7, #9, #10, and #11. The first six persons (#1–#6) are female and #7–#11 are male.

Questions are written in italics and the replies in straight letters. All answers of probands in German were translated by the author.

#### *2.2.1 #1*

*Which kind of abuse or violence have you experienced in Buddhist groups?*: "Psychological abuse - gaslighting (stating everything is simply in my mind), manipulation to accept abuse by the abuser himself stating that he was my teacher, that everything 'is empty' therefore he couldn't be an abuser. Psychological abuse through an email attack to my workplace claiming I am having a nervous breakdown" (#1).

*How did you react to abuse or violence*: "At the time of the individual abuse within […] I felt inadequate, I did not acknowledge that the perpetrator should be able to take some responsibility for their behaviors. I felt abandoned and inadequate because of the way the group reacted to the abuse - they did not acknowledge it had happened and when I disclosed it they did not view it as abuse. I was minimized by the 'spiritual director' when I disclosed it to her - she said that my 'practice was enduring suffering'. At the time this made me feel more inadequate. Later I understood this as a minimizing activity, and I became very angry about six months later after reading testimonies of other former members. Following my workplace receiving an email from […] management using a fake identity I experienced rage, could not concentrate, my boundaries were poor, I turned to alcohol to cope, I experienced suicidality. I felt paranoid, I did not understand how much danger I might be in or not. I did not know who could help, I felt abandoned by people who did not understand and could not help me. I had digestion problems due to the anxiety and shame for several months. I had little energy and could not exercise, experienced stiffness and rigidity in my face, I had slow speech and slow processing speed. I dissociated frequently e.g. not remembering where I had put things, where I had parked my car. I had nightmares about being murdered by the leadership" (#1).

*How have your experiences in Buddhist groups had an impact on you*: "Severe post traumatic stress, anxiety, shame, and post traumatic growth. I am now connected to people who I find kind and who listen to me and appreciate my perspective on the groups. I therefore feel heard and understood, and no longer gaslighted" (#1).

*Which kind of indoctrination, abuse, or violence against others have you witnessed*: "I witnessed long term members so highly indoctrinated that they repeated teachings verbatim all the time, they did not have vocabulary from outside the group anymore. I saw people force the teachings on each other to invalidate the other persons feelings and dismiss their needs. I have read testimonies and seen evidence of threats against former members - threats to ruin peoples reputations and livelihoods. I heard people with mental health problems be spoke about disrespectfully" (#1).

*How have you reacted in the face of this indoctrination, violence, or abuse towards others*: "At the time I believed what was said about former members - that they had 'lost patience in their spiritual path' or had 'developed an angry mind and were blaming the centre'. When I came to realize that this was gaslighting of whistleblowers (after leaving) I became very distressed that the centre could avoid taking responsibility for people's wellbeing by blaming their 'mind' for everything. When I saw the threats and character assassination of former members I went into shock, and then experienced righteous anger" (#1).

*How did the experiences in Buddhist groups change you*: "I now understand spiritual abuse and am very sensitive to coercion. I am suspicious of all spiritual teachers. I only trust survivors of abuse and a few friends and family. I have more highly developed critical thinking skills and enjoy being disobedient. I now struggle to follow rules I believe are unnecessary, I trust my intuition more" (#1).

*How did the experiences in Buddhist groups change your relationships and your ways of relating to others*: "I recognise my needs and when someone is not good for me, I do not automatically put other people first. I do not practice accepting everything, I feel more in touch with righteous anger. I try to communicate my emotions more. I trust few people, especially religious people" (#1).

*How did your experiences in Buddhist groups change the way you work*: "I am suspicious of meditation and mindfulness, I read all about the under reported adverse effects. I understand abusive systems of power and abusive group dynamics. I don't trust cognitive therapies so much anymore, I only trust interventions that are also systemic" (#1).

*Have you parted with one or more Buddhist groups or teachers? If so, why*: "Yes both […] after reading testimonies of abuse and reading cultic studies literature, I understand that they are personality cults and that they do not understand trauma. They claim to help you with stress and teach you mindfulness when they actually believe you should be practising dissociation from your emotions. They have obscured and whitewashed serious abuse, appointed only internal safeguarding officers who are invested in the continuation of the movements, and who are interested in saving their reputations" (#1).

#### *2.2.2 #2*

*Which kind of abuse or violence have you experienced in Buddhist groups*: "Sexual assaults, however without violence, we were servile, so there was no need for it. Men were instrumentalized, delegated by relocation, assigned as secretaries of centers, to work for the Lama was an honour, sometimes for little or no payment, many did not longer pursue their own lives, partnerships were interrupted, separations and uniting were arranged" (#2).

*How did you react to abuse or violence*: "I did not perceive it as such. It was only when my best friend revealed herself to me that I could see it as abuse on her and then on me as well" (#2).

**33**

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan…*

The questions *how have your experiences in Buddhist groups had an impact on you* and *which kind of indoctrination, abuse, or violence against others have you witnessed*

*How have you reacted in the face of this indoctrination, violence, or abuse towards others*: "later I also learned about sexual assaults against very young women" (#2). *How did the experiences in Buddhist groups change you*: "have become more suspi-

*How did the experiences in Buddhist groups change your relationships and your ways of relating to others*: "Sometimes one gets arrogant, considering oneself as something better, but one also becomes more compassionate. That we are all essentially the same and can simply be on equal level with each other has reached me and I have internalized it to this day. In a therapeutic context it has helped to make encounters on equal level, but also endangered for much closeness and confluence" (#2).

The questions *how did your experiences in Buddhist groups change the way you work* and *have you parted with one or more Buddhist groups or teachers? If so, why* were not

*Which kind of abuse or violence have you experienced in Buddhist groups?*: "spiri-

The question *how have your experiences in Buddhist groups had an impact on you*

*Which kind of indoctrination, abuse, or violence against others have you witnessed*: "Gaslighting, shaming, slander, emotional manipulation, violation of confidentiality, outright lies, telling the Executive Director to fire someone because 'she was too neurotic', psychologizing every single student, punishment sending people away

*How have you reacted in the face of this indoctrination, violence, or abuse towards* 

The questions *how did the experiences in Buddhist groups change your relationships and your ways of relating to others*, *how did your experiences in Buddhist groups change the way you work* and *have you parted with one or more Buddhist groups or teachers? If* 

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "Angry. Sad. Helpless. The teachers are responsible for the abuse, the board of directors is responsible for not intervening and for allowing a spiritual director who is also paid employee to have veto power over the board (absolute control of the whole organization, which is legally questionable and the board knew it)" (#3).

*How did the experiences in Buddhist groups change you*: "Sustained attention, strength to do multi day ritual, I am not afraid to be alone in the woods, I accept pain and negative experiences as just part of life. I feel a tremendous union with the divine available in my body. I regularly experience space that feels between life and death, no self, and primordial. I will also never ever become a student of a male spiritual teacher again. I will never give my power away to any human teacher ever

from group retreats into solitary or banning people from retreats" (#3).

*others*: "I was often not aware or stood by quietly and watched" (#3).

again. I have learned a lot about this and still feel very hurt" (#3).

*How did you react to abuse or violence*: "Anger, helplessness, eventually some deference to my teacher for survival and to maintain my position in the group. Basically you have to tell him he is right and you are wrong to preserve your standing

*DOI: http://dx.doi.org/10.5772/intechopen.93297*

cious, but also more adult and autonomous" (#2).

were not answered by #2.

answered by #2.

as a student" (#3).

was not answered by #3.

*so, why* were not answered by #3.

tual, psychological, emotional" (#3).

*2.2.3 #3*

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan… DOI: http://dx.doi.org/10.5772/intechopen.93297*

The questions *how have your experiences in Buddhist groups had an impact on you* and *which kind of indoctrination, abuse, or violence against others have you witnessed* were not answered by #2.

*How have you reacted in the face of this indoctrination, violence, or abuse towards others*: "later I also learned about sexual assaults against very young women" (#2).

*How did the experiences in Buddhist groups change you*: "have become more suspicious, but also more adult and autonomous" (#2).

*How did the experiences in Buddhist groups change your relationships and your ways of relating to others*: "Sometimes one gets arrogant, considering oneself as something better, but one also becomes more compassionate. That we are all essentially the same and can simply be on equal level with each other has reached me and I have internalized it to this day. In a therapeutic context it has helped to make encounters on equal level, but also endangered for much closeness and confluence" (#2).

The questions *how did your experiences in Buddhist groups change the way you work* and *have you parted with one or more Buddhist groups or teachers? If so, why* were not answered by #2.

#### *2.2.3 #3*

*Psychosomatic Medicine*

and then experienced righteous anger" (#1).

I trust few people, especially religious people" (#1).

people who I find kind and who listen to me and appreciate my perspective on the groups. I therefore feel heard and understood, and no longer gaslighted" (#1). *Which kind of indoctrination, abuse, or violence against others have you witnessed*: "I witnessed long term members so highly indoctrinated that they repeated teachings verbatim all the time, they did not have vocabulary from outside the group anymore. I saw people force the teachings on each other to invalidate the other persons feelings and dismiss their needs. I have read testimonies and seen evidence of threats against former members - threats to ruin peoples reputations and livelihoods. I heard people with mental health problems be spoke about disrespectfully" (#1). *How have you reacted in the face of this indoctrination, violence, or abuse towards others*: "At the time I believed what was said about former members - that they had 'lost patience in their spiritual path' or had 'developed an angry mind and were blaming the centre'. When I came to realize that this was gaslighting of whistleblowers (after leaving) I became very distressed that the centre could avoid taking responsibility for people's wellbeing by blaming their 'mind' for everything. When I saw the threats and character assassination of former members I went into shock,

*How did the experiences in Buddhist groups change you*: "I now understand spiritual abuse and am very sensitive to coercion. I am suspicious of all spiritual teachers. I only trust survivors of abuse and a few friends and family. I have more highly developed critical thinking skills and enjoy being disobedient. I now struggle to

*How did the experiences in Buddhist groups change your relationships and your ways of relating to others*: "I recognise my needs and when someone is not good for me, I do not automatically put other people first. I do not practice accepting everything, I feel more in touch with righteous anger. I try to communicate my emotions more.

*How did your experiences in Buddhist groups change the way you work*: "I am suspicious of meditation and mindfulness, I read all about the under reported adverse effects. I understand abusive systems of power and abusive group dynamics. I don't trust cognitive therapies so much anymore, I only trust interventions that are also

*Have you parted with one or more Buddhist groups or teachers? If so, why*: "Yes both […] after reading testimonies of abuse and reading cultic studies literature, I understand that they are personality cults and that they do not understand trauma. They claim to help you with stress and teach you mindfulness when they actually believe you should be practising dissociation from your emotions. They have obscured and whitewashed serious abuse, appointed only internal safeguarding officers who are invested in the continuation of the movements, and who are interested in saving

*Which kind of abuse or violence have you experienced in Buddhist groups*: "Sexual assaults, however without violence, we were servile, so there was no need for it. Men were instrumentalized, delegated by relocation, assigned as secretaries of centers, to work for the Lama was an honour, sometimes for little or no payment, many did not longer pursue their own lives, partnerships were interrupted, separa-

*How did you react to abuse or violence*: "I did not perceive it as such. It was only when my best friend revealed herself to me that I could see it as abuse on her and

follow rules I believe are unnecessary, I trust my intuition more" (#1).

**32**

systemic" (#1).

their reputations" (#1).

then on me as well" (#2).

tions and uniting were arranged" (#2).

*2.2.2 #2*

*Which kind of abuse or violence have you experienced in Buddhist groups?*: "spiritual, psychological, emotional" (#3).

*How did you react to abuse or violence*: "Anger, helplessness, eventually some deference to my teacher for survival and to maintain my position in the group. Basically you have to tell him he is right and you are wrong to preserve your standing as a student" (#3).

The question *how have your experiences in Buddhist groups had an impact on you* was not answered by #3.

*Which kind of indoctrination, abuse, or violence against others have you witnessed*: "Gaslighting, shaming, slander, emotional manipulation, violation of confidentiality, outright lies, telling the Executive Director to fire someone because 'she was too neurotic', psychologizing every single student, punishment sending people away from group retreats into solitary or banning people from retreats" (#3).

*How have you reacted in the face of this indoctrination, violence, or abuse towards others*: "I was often not aware or stood by quietly and watched" (#3).

*How did the experiences in Buddhist groups change you*: "Sustained attention, strength to do multi day ritual, I am not afraid to be alone in the woods, I accept pain and negative experiences as just part of life. I feel a tremendous union with the divine available in my body. I regularly experience space that feels between life and death, no self, and primordial. I will also never ever become a student of a male spiritual teacher again. I will never give my power away to any human teacher ever again. I have learned a lot about this and still feel very hurt" (#3).

The questions *how did the experiences in Buddhist groups change your relationships and your ways of relating to others*, *how did your experiences in Buddhist groups change the way you work* and *have you parted with one or more Buddhist groups or teachers? If so, why* were not answered by #3.

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "Angry. Sad. Helpless. The teachers are responsible for the abuse, the board of directors is responsible for not intervening and for allowing a spiritual director who is also paid employee to have veto power over the board (absolute control of the whole organization, which is legally questionable and the board knew it)" (#3).

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "We all participate in patriarchy. Tibetan Buddhism encourages mind control, submissiveness, and patriarchal hierarchy. I believe that we allow it because we are so disconnected from our own power that we are willing to let some guy and some exotic tradition tell us what to do. We are eager to hand the reigns over, and Tibetan Buddhism in its sleek ways explains why we should. I believe that men have been suing the tradition for their own agendas for so many centuries that perhaps it has only become a vehicle for patriarchal abuse and I seriously question if the Vajrayana is of benefit in the world now" (#3).

#### *2.2.4 #4*

#4 did not answer the question: *which kind of abuse or violence have you experienced in Buddhist groups*?

*How did you react to abuse or violence*: "I got super angry with myself, blaming myself very badly for not being good enough" (#4).

*How have your experiences in Buddhist groups had an impact on you*: "Lack of trust, no direction in life, I cannot see my future, I'm afraid of making decisions, I feel helpless and good for nothing" (#4).

*Which kind of indoctrination, abuse, or violence against others have you witnessed*: "Later on I heard for a community member that the senior teacher had sexual abuse on different women. Even one of the women contacted me and [was] telling me her story. Also I saw people leaving abruptly and getting very confused. Some left with anger. And I heard in the community that there was a woman who got crazy and left. Whatever that means. I guess mentally ill" (#4).

*How have you reacted in the face of this indoctrination, violence, or abuse towards others?*: "I was blaming myself and asking help from others. I saw everyone else right and I thought they are the best people on Earth, I wanted to get back to the community. I was scared of my family. The community members were immaculate and wise. They even sent me pictures, messages, poems I couldn't understand because I so much wanted to figure out the messages behind" (#4).

*How did the experiences in Buddhist groups change you*: "I doubt myself, I had better periods but I keep falling back. I lost trust in life, I lost trust in myself and others, I have a lot of tension and fear in me. I cannot imagine to be capable of anything. Study or move away from my parents" (#4).

*How did the experiences in Buddhist groups change your relationships and your ways of relating to others*: "I can be still opened but deep down I have fear, doubt and it is not easy to trust people in a deeper level. I feel alone" (#4).

*How did your experiences in Buddhist groups change the way you work*: "I cannot imagine myself to have a job with responsibility. I don't work much a week and sometimes I just sleep for the whole day" (#4).

*Have you parted with one or more Buddhist groups or teachers? If so, why*: "Yes, two groups, because I had psychosis and got sick" (#4).

#### *2.2.5 #5*

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "I think leaders of Buddhist groups are individuals and it is unavoidable to find some 'black sheep' among them. Certainly I regret such incidents and would feel a serious betrayal of trust if I were to experience this from someone at the centre where I

**35**

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan…*

frequently visit. Once someone in the group hears about such, I believe it is their

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "I would not allow this, but have not had any experience with it, usually I would take action or at

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "Abuse is unethical and illegal and we always have an obligation to stop it. I don't think most groups are capable of policing themselves. They are too insular and secretive and outside law enforcement should be contacted. I tried to contact the Dalai Lama

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "Because some people actually believe these men have special rights and powers and don't have the balls to stand up for people being exploited. People are blinded by robes

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "This should not happen at all and ought to lead to an immediate criminal report. The person abusing is responsible, however, depending on the circumstances, also the group involved and the structures prevailing within it. The veneration of the teacher in Tibetan Buddhism unfortunately also creates conditions for abuse, be it physical or authoritative, even if the teachings clearly do not provide for that. In my opinion, Tibetan Buddhism needs some effort towards adjustment to at least make

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "Teachers are often held sacrosanct, and criticism of them is mostly unwanted. Sometimes a strong relationship of superiority/subordination can be seen, which facilitates abuse" (#7).

*Which kind of abuse or violence have you experienced in Buddhist groups*: "Humiliation, exposure, psychological violence, repression, deprivation of healthy self-esteem, intrigues, defamation campaigns, systematic manipulation and lies. Theft: do not take what is not given = misuse of tied donations" (#1) [cited in 2]. *How did you react to abuse or violence*: "denial, reality negation, rationalization, first insights, perception, evaluation, attempts to communicate, departure" (#8). *How have your experiences in Buddhist groups had an impact on you*: "I no longer conform to any group consensus I consider inappropriate. I insist on discussing openly without individual participants manipulating others first. I advocate transparency and truthfulness, even if this is not popular, including financial issues, and try to convey democratic values. My position is that ethics could make a difference,

before talking about philosophy and religion" (#8).

*DOI: http://dx.doi.org/10.5772/intechopen.93297*

*2.2.6 #6*

*2.2.7 #7*

*2.2.8 #8*

abuse more difficult" (#7).

responsibility to communicate to stop it" (#5).

least distance myself in case this would not be possible" (#5).

and other leaders repeatedly, but they never respond" (#6).

and spiritual authority and it's dangerous" (#6).

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan… DOI: http://dx.doi.org/10.5772/intechopen.93297*

frequently visit. Once someone in the group hears about such, I believe it is their responsibility to communicate to stop it" (#5).

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "I would not allow this, but have not had any experience with it, usually I would take action or at least distance myself in case this would not be possible" (#5).

#### *2.2.6 #6*

*Psychosomatic Medicine*

the world now" (#3).

*enced in Buddhist groups*?

myself very badly for not being good enough" (#4).

feel helpless and good for nothing" (#4).

*2.2.4 #4*

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "We all participate in patriarchy. Tibetan Buddhism encourages mind control, submissiveness, and patriarchal hierarchy. I believe that we allow it because we are so disconnected from our own power that we are willing to let some guy and some exotic tradition tell us what to do. We are eager to hand the reigns over, and Tibetan Buddhism in its sleek ways explains why we should. I believe that men have been suing the tradition for their own agendas for so many centuries that perhaps it has only become a vehicle for patriarchal abuse and I seriously question if the Vajrayana is of benefit in

#4 did not answer the question: *which kind of abuse or violence have you experi-*

*How did you react to abuse or violence*: "I got super angry with myself, blaming

*How have your experiences in Buddhist groups had an impact on you*: "Lack of trust, no direction in life, I cannot see my future, I'm afraid of making decisions, I

"Later on I heard for a community member that the senior teacher had sexual abuse on different women. Even one of the women contacted me and [was] telling me her story. Also I saw people leaving abruptly and getting very confused. Some left with anger. And I heard in the community that there was a woman who got

crazy and left. Whatever that means. I guess mentally ill" (#4).

so much wanted to figure out the messages behind" (#4).

anything. Study or move away from my parents" (#4).

sometimes I just sleep for the whole day" (#4).

groups, because I had psychosis and got sick" (#4).

not easy to trust people in a deeper level. I feel alone" (#4).

*Which kind of indoctrination, abuse, or violence against others have you witnessed*:

*How have you reacted in the face of this indoctrination, violence, or abuse towards others?*: "I was blaming myself and asking help from others. I saw everyone else right and I thought they are the best people on Earth, I wanted to get back to the community. I was scared of my family. The community members were immaculate and wise. They even sent me pictures, messages, poems I couldn't understand because I

*How did the experiences in Buddhist groups change you*: "I doubt myself, I had better periods but I keep falling back. I lost trust in life, I lost trust in myself and others, I have a lot of tension and fear in me. I cannot imagine to be capable of

*How did the experiences in Buddhist groups change your relationships and your ways of relating to others*: "I can be still opened but deep down I have fear, doubt and it is

*How did your experiences in Buddhist groups change the way you work*: "I cannot imagine myself to have a job with responsibility. I don't work much a week and

*Have you parted with one or more Buddhist groups or teachers? If so, why*: "Yes, two

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "I think leaders of Buddhist groups are individuals and it is unavoidable to find some 'black sheep' among them. Certainly I regret such incidents and would feel a serious betrayal of trust if I were to experience this from someone at the centre where I

**34**

*2.2.5 #5*

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "Abuse is unethical and illegal and we always have an obligation to stop it. I don't think most groups are capable of policing themselves. They are too insular and secretive and outside law enforcement should be contacted. I tried to contact the Dalai Lama and other leaders repeatedly, but they never respond" (#6).

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "Because some people actually believe these men have special rights and powers and don't have the balls to stand up for people being exploited. People are blinded by robes and spiritual authority and it's dangerous" (#6).

#### *2.2.7 #7*

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "This should not happen at all and ought to lead to an immediate criminal report. The person abusing is responsible, however, depending on the circumstances, also the group involved and the structures prevailing within it. The veneration of the teacher in Tibetan Buddhism unfortunately also creates conditions for abuse, be it physical or authoritative, even if the teachings clearly do not provide for that. In my opinion, Tibetan Buddhism needs some effort towards adjustment to at least make abuse more difficult" (#7).

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "Teachers are often held sacrosanct, and criticism of them is mostly unwanted. Sometimes a strong relationship of superiority/subordination can be seen, which facilitates abuse" (#7).

#### *2.2.8 #8*

*Which kind of abuse or violence have you experienced in Buddhist groups*: "Humiliation, exposure, psychological violence, repression, deprivation of healthy self-esteem, intrigues, defamation campaigns, systematic manipulation and lies. Theft: do not take what is not given = misuse of tied donations" (#1) [cited in 2].

*How did you react to abuse or violence*: "denial, reality negation, rationalization, first insights, perception, evaluation, attempts to communicate, departure" (#8).

*How have your experiences in Buddhist groups had an impact on you*: "I no longer conform to any group consensus I consider inappropriate. I insist on discussing openly without individual participants manipulating others first. I advocate transparency and truthfulness, even if this is not popular, including financial issues, and try to convey democratic values. My position is that ethics could make a difference, before talking about philosophy and religion" (#8).

*Which kind of indoctrination, abuse, or violence against others have you witnessed*: "Anyone at […] should have seen quite a lot. For me, these subtle constant manipulations have been the worst, and that behind the scenes the violence was brutal" (#8).

*How have you reacted in the face of this indoctrination, violence, or abuse towards others*: "First I rationalized. I found many 'old students' so unpleasant that I considered more drastic measures to possibly be an option. Today I look at it differently. I do not count the eight letter writers among the 'old students', nor all students of […]. After realizing that all of this at […] is a dead end, and being frustrated to find out my fellow sanghaists lacked understanding, I left. They were in a 'tunnel'. Particularly the many people afraid of losing their 'dzogchen', whatever that might mean to the individual" (#8).

*How did the experiences in Buddhist groups change you*: "Now I look at the world more openly, in its entirety, with all of its problems and opportunities" (#8).

*How did the experiences in Buddhist groups change your relationships and your ways of relating to others*: "I live quite isolated, beyond my professional and family life. I keep considerable distance from Buddhists" (#8).

*How did your experiences in Buddhist groups change the way you work*: "I take care of myself and my environment as much as I can. People who want to preach to me, I send away" (#8).

*Have you parted with one or more Buddhist groups or teachers? If so, why*: "Of all of them. My disgust with Buddhist groups is an impulse way too strong to be ignored. It either will subside or it doesn't. I am a Buddhist who pretends he is not" (#8).

#### *2.2.9 #9*

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "I feel angry and a huge sense of injustice about it, because it totally goes against the spirit of Buddhism, which is compassion, kindness, and bringing people to enlightenment. The teacher and the Buddhist institution the teacher is affiliated with is responsible" (#9).

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "It is an issue to do with the dominant patriarchal society we are part of today, where men are in positions of authority. This, unfortunately has extended to religion" (#9).

#### *2.2.10 #10*

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "Every single person has his share of responsibility, even if he acted in blind trust. These are mitigating circumstances, of a sort. In […]: The higher the position, the greater is the degree of blindness. And the fish is always stinking from its head. Those at the top of an authoritarian structure, and who, due to their position as lama per se are endowed with particular abilities, ought to take responsibility for the consequences of their actions. Responsibility in groups is usually given to older students, who might have been accordingly indoctrinated and bring the relevant skills. Sociological studies might show 80% of leadership in Western Buddhist groups are female, except for the top positions. A psychologist and Buddhist, who I know well, even claims that women are more susceptible to manipulating behaviors in these positions" (#10).

**37**

assumed.

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan…*

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "Ignorance, lack of awareness, lack of ethical conscience. This is true for all genders, although it is mainly women who are currently victims of male offenders. Mostly all is well, as

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "Disgusted and annoyed. Everyone is responsible in particular the people who know directly about it and keep silent. However I know some people did try to bring abuse to light in the group I knew many years ago. Everything was ignored. They kept files they later gave to an investigation. Yet the group or the lama has still not

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "Because it happens behind closed doors and unless the women themselves speak out it is difficult to prove. Also Tibetan Buddhism like most religions use fear of hell and damnation to silence. Also women are told they are dakini and as such special with

The current issues in so-called Buddhist centers unfold against the background of oversimplifications of terms and concepts of Buddhist philosophy as well as of damaging neologisms. In particular, however, traditional application-oriented learning processes crucial for understanding and teaching are missing. The individual effects of these substantial and structural deficiencies are evident as health damage, specifically mental health, and traumatization of group members. Unreflected decontextualized use of Buddhist terminology and concepts and the neologisms in these contexts thus negatively impact on group dynamics and the health of a group and its members. Since the indoctrination described by the testimonies and the traumatization is still attempted to be denied by the mainstream within these organizations as well as the victims silenced [2], the latter are not compensated in any ways by precisely these organizations which have often previously enriched themselves on them. Furthermore, by propagating Buddhism a panacea for mental diseases, even persons with mental disorders are misled in highly irresponsible ways. Although oaths of secrecy associated with seemingly Buddhist concepts render it difficult for those affected to talk, testimonies regarding indoctrination and systematic abuse causing trauma and mental illness are available now. However, a high number of unrecorded cases of those, who for various reasons are unable to communicate, ought to be

The kind of abuse described by the probands covers psychological abuse (#2, #3), especially those aspects of the students' submission, which serve as a basis for sexual assault (#2), the indoctrinative interpretations that are suggesting the abuse itself would take place in the mind of the student (#1) only, as well as psychological violence (#8). This questioning of one's own autonomous understanding of situations and even one's perception leads to a continuous state of disorientation, which initially may contribute to psychological damage and is particularly important to consider in later processes of treatment. By means of neologisms such as '*karma purification*' and '*crazy wisdom*', which serve to rationalize any misconduct of group leaders and entourage

*DOI: http://dx.doi.org/10.5772/intechopen.93297*

long as one isn't victimized oneself" (#10).

*2.2.11 #11*

admitted abuse" (#11).

**2.3 Interpretation**

special merit when they die" (#11).

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan… DOI: http://dx.doi.org/10.5772/intechopen.93297*

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "Ignorance, lack of awareness, lack of ethical conscience. This is true for all genders, although it is mainly women who are currently victims of male offenders. Mostly all is well, as long as one isn't victimized oneself" (#10).

#### *2.2.11 #11*

*Psychosomatic Medicine*

mean to the individual" (#8).

send away" (#8).

with is responsible" (#9).

in these positions" (#10).

*2.2.9 #9*

*2.2.10 #10*

keep considerable distance from Buddhists" (#8).

*Which kind of indoctrination, abuse, or violence against others have you witnessed*: "Anyone at […] should have seen quite a lot. For me, these subtle constant manipulations have been the worst, and that behind the scenes the violence was brutal" (#8). *How have you reacted in the face of this indoctrination, violence, or abuse towards others*: "First I rationalized. I found many 'old students' so unpleasant that I considered more drastic measures to possibly be an option. Today I look at it differently. I do not count the eight letter writers among the 'old students', nor all students of […]. After realizing that all of this at […] is a dead end, and being frustrated to find out my fellow sanghaists lacked understanding, I left. They were in a 'tunnel'. Particularly the many people afraid of losing their 'dzogchen', whatever that might

*How did the experiences in Buddhist groups change you*: "Now I look at the world

*How did the experiences in Buddhist groups change your relationships and your ways of relating to others*: "I live quite isolated, beyond my professional and family life. I

*How did your experiences in Buddhist groups change the way you work*: "I take care of myself and my environment as much as I can. People who want to preach to me, I

*Have you parted with one or more Buddhist groups or teachers? If so, why*: "Of all of them. My disgust with Buddhist groups is an impulse way too strong to be ignored. It either will subside or it doesn't. I am a Buddhist who pretends he is not" (#8).

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "I feel angry and a huge sense of injustice about it, because it totally goes against the spirit of Buddhism, which is compassion, kindness, and bringing people to enlightenment. The teacher and the Buddhist institution the teacher is affiliated

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "It is an issue to do with the dominant patriarchal society we are part of today, where men are in

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "Every single person has his share of responsibility, even if he acted in blind trust. These are mitigating circumstances, of a sort. In […]: The higher the position, the greater is the degree of blindness. And the fish is always stinking from its head. Those at the top of an authoritarian structure, and who, due to their position as lama per se are endowed with particular abilities, ought to take responsibility for the consequences of their actions. Responsibility in groups is usually given to older students, who might have been accordingly indoctrinated and bring the relevant skills. Sociological studies might show 80% of leadership in Western Buddhist groups are female, except for the top positions. A psychologist and Buddhist, who I know well, even claims that women are more susceptible to manipulating behaviors

positions of authority. This, unfortunately has extended to religion" (#9).

more openly, in its entirety, with all of its problems and opportunities" (#8).

**36**

*When you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it? How do you evaluate the responsibility in the group? Who is responsible for what*: "Disgusted and annoyed. Everyone is responsible in particular the people who know directly about it and keep silent. However I know some people did try to bring abuse to light in the group I knew many years ago. Everything was ignored. They kept files they later gave to an investigation. Yet the group or the lama has still not admitted abuse" (#11).

*Why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality*: "Because it happens behind closed doors and unless the women themselves speak out it is difficult to prove. Also Tibetan Buddhism like most religions use fear of hell and damnation to silence. Also women are told they are dakini and as such special with special merit when they die" (#11).

#### **2.3 Interpretation**

The current issues in so-called Buddhist centers unfold against the background of oversimplifications of terms and concepts of Buddhist philosophy as well as of damaging neologisms. In particular, however, traditional application-oriented learning processes crucial for understanding and teaching are missing. The individual effects of these substantial and structural deficiencies are evident as health damage, specifically mental health, and traumatization of group members. Unreflected decontextualized use of Buddhist terminology and concepts and the neologisms in these contexts thus negatively impact on group dynamics and the health of a group and its members. Since the indoctrination described by the testimonies and the traumatization is still attempted to be denied by the mainstream within these organizations as well as the victims silenced [2], the latter are not compensated in any ways by precisely these organizations which have often previously enriched themselves on them. Furthermore, by propagating Buddhism a panacea for mental diseases, even persons with mental disorders are misled in highly irresponsible ways. Although oaths of secrecy associated with seemingly Buddhist concepts render it difficult for those affected to talk, testimonies regarding indoctrination and systematic abuse causing trauma and mental illness are available now. However, a high number of unrecorded cases of those, who for various reasons are unable to communicate, ought to be assumed.

The kind of abuse described by the probands covers psychological abuse (#2, #3), especially those aspects of the students' submission, which serve as a basis for sexual assault (#2), the indoctrinative interpretations that are suggesting the abuse itself would take place in the mind of the student (#1) only, as well as psychological violence (#8). This questioning of one's own autonomous understanding of situations and even one's perception leads to a continuous state of disorientation, which initially may contribute to psychological damage and is particularly important to consider in later processes of treatment. By means of neologisms such as '*karma purification*' and '*crazy wisdom*', which serve to rationalize any misconduct of group leaders and entourage

towards the goal of the students' enlightenment, a form of dependence is constructed, in which they even bind themselves to the insulting leadership. In such ways their identification processes [14] are enhanced and self-reliance and autonomy reduced.

Emotional abuse (#3) was presented as humiliation (#8), exposure (#8), and repression (#8), which explains the very reduction in self-esteem (#8) of students in such groups. However, by using misunderstood visualizations of the Vajrayāna, also narcissistic tendencies get encouraged, resulting in severe arrogance, particularly among those seeking to establish themselves in positions of authority in such contexts, and in such ways forming a kind of spiritual narcissism. This, in turn, may explain their lack of empathy and compassion towards the victims, even whilst still proclaiming Buddhist compassion.

The abuse of authority for slandering any current or former students was reported as interfering with lies even at the workplace, outside the so-called Buddhist organization (#1). The lies (#8), intrigues (#8), and defamation campaigns (#8) mentioned have a huge impact on the individuals, particularly when used to irritate or destroy their reputation, social networks, and income. Since one has grown accustomed to such situations in these contexts, it seems necessary to emphasize that such is far from the basic ethical values taught within traditional Tibetan Buddhism.

The indoctrination saying the abuser would be allowed for the abuse, because of being a spiritual teacher (#1) already indicates an utterly inappropriate way of defining spiritual authority. Groups propagating such dangerous concepts concerning their spiritual teacher, devoid of ethics and adherence to national legislation, together with any authorities imposing their authoritative rules at will, endanger group members as well as visitors.

Any manipulation of students, interpreting the work for a lama, who is regarded a spiritual authority in the group, being an honor (#2), which in turn meant sexual abuse of servile (female) students (#2) and the instrumentalization of men for all kinds of little or unpaid services (#2), as well as systematic manipulation (#8), were also described as abuse (#2). Interpreting work for a spiritual authority as honor already indicates narcissistic group dynamics, where autonomous authentic training of Buddhist ethics and meditation has been replaced by rivalry over physical proximity to the leadership, which in turn has been redefined and also implies power over the group through identification processes. Thus, such concepts shape not only the group's structures and behavior patterns but also its economic handling, that is expecting donations for certain group members. Furthermore, manipulation is not only for complying with financial and other service expectations, but often people are played off against each other and exchanged after their exploitation at will. Over the years of affiliation, however, these kinds of interactions, which are accompanied by psychological and financial dependencies as well as mental identification processes, can cause serious damage. Theft in the sense of misuse of tied donations (#8) was also mentioned to be abuse. And the manipulation with the conceptual distortion of the Buddhist concept of emptiness used to explain away abuse and abuser (#1) severely devaluates Buddhist philosophy and undermines sound and informed terminological and conceptual discourse.

The testimony of indoctrination, abuse, or violence against others was described as follows: subtle constant manipulations (#8), highly indoctrinated long-term members lacking vocabulary from outside the group (#1), and repeating verbatim all the time (#1). For so-called Buddhist seminar- and retreat-participants the following methods were described: psychologizing every single student (#3), emotional manipulation (#3), violation of confidentiality (#3), gaslighting (#3), shaming (#3), slander (#3), and outright lies (#3). Someone also testified disrespectful speech about people with mental health problems (#1). Furthermore, blackmailing

**39**

(#1), caused rage (#1).

victims.

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan…*

of the management was described, such as telling the executive director to fire someone because of being diagnosed neurotic (#3) by nonprofessionals. Furthermore, there is testimony on punishment in the form of sending people away from group into solitary retreats or banning people from retreats (#3) and brutal violence behind the scenes (#8). Someone interpreted dismissing people's needs by invalidating their feelings (#1) through forcing what was called 'teachings' on them. There is also testimony on threats to ruin people's reputations and livelihoods (#1) and on sexual abuse of different women by a senior teacher (#4). Whereas sexual abuse of minors is a clearly defined a criminal offense, currently also severely manipulated and indoctrinated adults, who have mostly initially made their way up to the '*inner circle*' [2, 5] and have then moved on to physical proximity or agreed to the position of secret lovers, claim the same for themselves. Thus, the overloaded phrase of 'sexual abuse' in current contextual discourses ought to be further differentiated, taking into account unequal balance of power, indoctrination, seduction, untrue promises, coercive control, self-responsibility of adults, as well as victimizing collaborators and witnesses. Moreover, the dynamics of controlling the feminine, which have been adopted unreflectively from Tibetan Buddhism, manifest in seemingly impersonal attitudes towards the women concerned, which thus results in a high number of

Three successive states of individual reaction to indoctrination, abuse or violence in the respective Buddhist group showed: continuous close affiliation, critical reflection, and departure. For the period of close affiliation to a group helplessness (#3), denial (#8), feeling of inadequacy (#1), not acknowledging that the perpetrator should be able to take some responsibility for their behaviors (#1), feeling abandoned and inadequate because of the reactions of the leadership and group to the abuse (who did not view it as abuse) (#1), oneself not perceiving abuse and violence as such, but only understanding it when seeing it on someone else first (#2) and anger (#3) were reported. One person severely turned against herself and reported getting seriously angry at herself (#4) with putting herself down (#4). Another person in high position in her group and dependent on financial terms told she has taken over the opinion of the teacher to preserve her own standing and maintain her position in the group (#3). Thus, these replies also may show some implications and limitations of holding positions in such groups. In phase two, the period of reflection and doubts, there were communication attempts before departure (#8). In phase three, after departure from the group, there were feelings to be abandoned by those who did not understand and could not help (#1), anxiety and shame for several months causing digestion problems (#1), frequent dissociation (#1), which might have been accompanied by stiffness and rigidity in the face (#1), little energy (#1), and slow speech and slow processing speed (#1). Furthermore, doubts regarding the dangers (#1) with nightmares about being murdered by the leadership (#1), lack of concentration (#1), poor boundaries (#1), turning to alcohol to cope (#1), and suicidality (#1) were reported. Reading testimonies of former members (#1) was reported having caused anger. And the workplace receiving an email from the so-called Buddhist organization's management, who was even using a fake identity

The above three successive states of individual reaction were reported to be accompanied by two inner processes when observing indoctrination, abuse, or violence of others: the identifying and indoctrinating phase and the reflection phase. These observations show concepts and behavior far from the attitude of traditional Buddhist practice of having the individual's autonomy, awareness and self-reflection as its basis. At the period of being indoctrinated, identifying and merging with the leadership, management or group expectations reactions such as lack of one's own awareness of it (#3), standing quietly (#3) and watching (#3),

*DOI: http://dx.doi.org/10.5772/intechopen.93297*

#### *Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan… DOI: http://dx.doi.org/10.5772/intechopen.93297*

of the management was described, such as telling the executive director to fire someone because of being diagnosed neurotic (#3) by nonprofessionals. Furthermore, there is testimony on punishment in the form of sending people away from group into solitary retreats or banning people from retreats (#3) and brutal violence behind the scenes (#8). Someone interpreted dismissing people's needs by invalidating their feelings (#1) through forcing what was called 'teachings' on them. There is also testimony on threats to ruin people's reputations and livelihoods (#1) and on sexual abuse of different women by a senior teacher (#4). Whereas sexual abuse of minors is a clearly defined a criminal offense, currently also severely manipulated and indoctrinated adults, who have mostly initially made their way up to the '*inner circle*' [2, 5] and have then moved on to physical proximity or agreed to the position of secret lovers, claim the same for themselves. Thus, the overloaded phrase of 'sexual abuse' in current contextual discourses ought to be further differentiated, taking into account unequal balance of power, indoctrination, seduction, untrue promises, coercive control, self-responsibility of adults, as well as victimizing collaborators and witnesses. Moreover, the dynamics of controlling the feminine, which have been adopted unreflectively from Tibetan Buddhism, manifest in seemingly impersonal attitudes towards the women concerned, which thus results in a high number of victims.

Three successive states of individual reaction to indoctrination, abuse or violence in the respective Buddhist group showed: continuous close affiliation, critical reflection, and departure. For the period of close affiliation to a group helplessness (#3), denial (#8), feeling of inadequacy (#1), not acknowledging that the perpetrator should be able to take some responsibility for their behaviors (#1), feeling abandoned and inadequate because of the reactions of the leadership and group to the abuse (who did not view it as abuse) (#1), oneself not perceiving abuse and violence as such, but only understanding it when seeing it on someone else first (#2) and anger (#3) were reported. One person severely turned against herself and reported getting seriously angry at herself (#4) with putting herself down (#4). Another person in high position in her group and dependent on financial terms told she has taken over the opinion of the teacher to preserve her own standing and maintain her position in the group (#3). Thus, these replies also may show some implications and limitations of holding positions in such groups. In phase two, the period of reflection and doubts, there were communication attempts before departure (#8). In phase three, after departure from the group, there were feelings to be abandoned by those who did not understand and could not help (#1), anxiety and shame for several months causing digestion problems (#1), frequent dissociation (#1), which might have been accompanied by stiffness and rigidity in the face (#1), little energy (#1), and slow speech and slow processing speed (#1). Furthermore, doubts regarding the dangers (#1) with nightmares about being murdered by the leadership (#1), lack of concentration (#1), poor boundaries (#1), turning to alcohol to cope (#1), and suicidality (#1) were reported. Reading testimonies of former members (#1) was reported having caused anger. And the workplace receiving an email from the so-called Buddhist organization's management, who was even using a fake identity (#1), caused rage (#1).

The above three successive states of individual reaction were reported to be accompanied by two inner processes when observing indoctrination, abuse, or violence of others: the identifying and indoctrinating phase and the reflection phase. These observations show concepts and behavior far from the attitude of traditional Buddhist practice of having the individual's autonomy, awareness and self-reflection as its basis. At the period of being indoctrinated, identifying and merging with the leadership, management or group expectations reactions such as lack of one's own awareness of it (#3), standing quietly (#3) and watching (#3),

*Psychosomatic Medicine*

Tibetan Buddhism.

proclaiming Buddhist compassion.

group members as well as visitors.

informed terminological and conceptual discourse.

towards the goal of the students' enlightenment, a form of dependence is constructed, in which they even bind themselves to the insulting leadership. In such ways their identification processes [14] are enhanced and self-reliance and autonomy reduced. Emotional abuse (#3) was presented as humiliation (#8), exposure (#8), and repression (#8), which explains the very reduction in self-esteem (#8) of students in such groups. However, by using misunderstood visualizations of the Vajrayāna, also narcissistic tendencies get encouraged, resulting in severe arrogance, particularly among those seeking to establish themselves in positions of authority in such contexts, and in such ways forming a kind of spiritual narcissism. This, in turn, may explain their lack of empathy and compassion towards the victims, even whilst still

The abuse of authority for slandering any current or former students was reported as interfering with lies even at the workplace, outside the so-called Buddhist organization (#1). The lies (#8), intrigues (#8), and defamation campaigns (#8) mentioned have a huge impact on the individuals, particularly when used to irritate or destroy their reputation, social networks, and income. Since one has grown accustomed to such situations in these contexts, it seems necessary to emphasize that such is far from the basic ethical values taught within traditional

The indoctrination saying the abuser would be allowed for the abuse, because of being a spiritual teacher (#1) already indicates an utterly inappropriate way of defining spiritual authority. Groups propagating such dangerous concepts concerning their spiritual teacher, devoid of ethics and adherence to national legislation, together with any authorities imposing their authoritative rules at will, endanger

Any manipulation of students, interpreting the work for a lama, who is regarded a spiritual authority in the group, being an honor (#2), which in turn meant sexual abuse of servile (female) students (#2) and the instrumentalization of men for all kinds of little or unpaid services (#2), as well as systematic manipulation (#8), were also described as abuse (#2). Interpreting work for a spiritual authority as honor already indicates narcissistic group dynamics, where autonomous authentic training of Buddhist ethics and meditation has been replaced by rivalry over physical proximity to the leadership, which in turn has been redefined and also implies power over the group through identification processes. Thus, such concepts shape not only the group's structures and behavior patterns but also its economic handling, that is expecting donations for certain group members. Furthermore, manipulation is not only for complying with financial and other service expectations, but often people are played off against each other and exchanged after their exploitation at will. Over the years of affiliation, however, these kinds of interactions, which are accompanied by psychological and financial dependencies as well as mental identification processes, can cause serious damage. Theft in the sense of misuse of tied donations (#8) was also mentioned to be abuse. And the manipulation with the conceptual distortion of the Buddhist concept of emptiness used to explain away abuse and abuser (#1) severely devaluates Buddhist philosophy and undermines sound and

The testimony of indoctrination, abuse, or violence against others was described

as follows: subtle constant manipulations (#8), highly indoctrinated long-term members lacking vocabulary from outside the group (#1), and repeating verbatim all the time (#1). For so-called Buddhist seminar- and retreat-participants the following methods were described: psychologizing every single student (#3), emotional manipulation (#3), violation of confidentiality (#3), gaslighting (#3), shaming (#3), slander (#3), and outright lies (#3). Someone also testified disrespectful speech about people with mental health problems (#1). Furthermore, blackmailing

**38**

which could be interpreted as a kind of freezing in shock about what was seen, as well as rationalizing (#8) and even believing what was said about former members (#1) were reported. Someone did not respond to the question directly, but stated sexual assaults against very young women (#2). Yet another person told she was even blaming herself (#4) for the above behavior of other group members while regarding everyone else right. At the period of reflection, when interpreting the issues leading to decisions, someone described realizing all of it a dead end (#8) and his frustration about his fellows narrowing their understanding like in a 'tunnel' (#8) before he left. Others responded to the manipulation and indoctrination tactics in the group with shock and later righteous anger (#1), because of the threats and character assassination of former members (#1) as well as with high distress about the center avoiding to take responsibility by blaming people's 'mind' for anything (#1).

The question on how the person was changed him- or herself by their experiences in these groups was replied to with some positive aspects such as sustained attention (#3), strength to do multi-day ritual (#3), being not afraid to be alone in the woods (#3), and the feeling of union with the divine (#3). However, the positively connotated aspect of accepting pain and negative experiences as just a part of life (#3) may already endanger this individual in highly manipulative contexts. Aspects with negative connotations, such as doubting oneself (#4), not being able to imagine to be capable of anything (#4), having a lot of tension and fear (#4), as well as having lost trust in oneself and others (#4) and in life (#4), were reported as well. People also described having become more suspicious (#2), particularly of all spiritual teachers (#1), being sensitive to coercion (#1) and understanding spiritual abuse (#1), the latter of which may not only protect the individual but also enable them to protect others from unreasonable nonsense and misuse. The phrase spiritual abuse might be interpreted as people being seduced into giving up their own strength as if dependent on a master providing them access to their own spirituality. Furthermore, with reporting greater autonomy (#2) and trusting one's own intuition more (#1), an individual process of change was addressed, which is also found in phrases such as becoming more adult (#2), having developed critical thinking skills (#1), and probably even in enjoying being disobedient (#1) after experiencing abuse in highly authoritative structures to some extent. Also, the result of a process, such as looking at the world more openly (#8), was referred to, and decisions were shared such as never becoming a student of a male spiritual teacher again (#3) and never ever giving one's power away to any human teacher (#3).

The scope of the personal impact of these experiences in Buddhist groups was described with adverse effects such as severe self-devaluation (#4), posttraumatic stress (#1), and feelings of helpless (#4), shame (#1), and anxiety (#1). Furthermore, lack of trust (#4) was described at the interpersonal level, which might impact considerably on future relationships and work decisions. Although the fear of making decisions (#4) and loss of direction in life (#4) may come up in an early period of leaving an abusive group, they sometimes continue for even years. The refusal to conform to any group consensus considered inappropriate (#8) is often part of the separating process and might stay as a lesson learned. Furthermore, there are positive connotations for a time period after having left the group and making new personal and working relationships, which were called new connections to kind people (#1) and posttraumatic growth (#1). Also, the values of the person were described to be discussing openly without individual participants manipulating others first (#8) and advocating transparency and truthfulness (#8), even if this is not popular, including financial issues (#8), as well as trying to convey democratic values (#8) and ethics (#8). The reflection of absorbed values

**41**

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan…*

and integration of one's own value system are aspects of the process of separation, which often occur long after the physical separation. Sometimes this also encompasses referring to traditional basic Buddhist ethics. In therapeutic processes, it takes place in the phase of dealing with introjects and in the phase of integration. The impact on relationships and ways of relating to others was described as getting arrogant sometimes (#2) for the period in the group, which is regarding oneself higher or more spiritually advanced than others. Negative impact of fear and doubt with feeling lonely and difficulties to trust people (#4) was described as well. Furthermore, it was said recognizing one's own needs (#1), which seems to be a key issue to reconnect to oneself, not practicing accepting everything (#1) and not automatically putting other people first (#1), trusting few people (#1), as well as trying to communicate emotions more (#1), which may show as becoming more compassionate (#2) or feeling in touch with righteous anger (#1). The making of encounters on equal level at a therapeutic context with dangers for too much confluence (#2) was an impact for a professional therapist. Someone also shared keeping a considerable distance from Buddhists (#8) and living quite isolated beyond profes-

The impact on one's work was described as taking care to the best of one's abilities of oneself and surrounding (8), understanding abusive systems of power and abusive group dynamics (#1) and also as suspiciousness of meditation and mindfulness (#1). A young person shared a highly negative impact for her life saying she could not imagine herself at a job with responsibility (#4), she would not work

The following two questions refer to open letters and ongoing investigations widely discussed in the context. They were asked to understand not only the persons' opinion but also their position in the group and their behavior. Not everyone replied to the questions: *when you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it*? *How do you evaluate the responsibility in the group? Who is responsible for what*? Whereas someone told abuse to be unethical and illegal (#6) and in this way referred to basic values, another person simply stripped the leadership of its exaggerated superiority saying the leaders of Buddhist groups were individuals and it would be unavoidable to find some 'black sheep' among them (#5). #7 judged that it should not happen at all and ought to lead to an immediate criminal report. Someone replied the veneration of the teacher in Tibetan Buddhism unfortunately would also create conditions for abuse (#7). Reports on one's own feelings range from helpless (#3), sadness (#3), and anger (#3) to disgust and annoyance (#11). Furthermore, someone told to regret such incidents (#5) and feel a serious betrayal of trust (#5). Someone reported feeling anger and a huge sense of injustice about it (#9) and gave reasons for such behavior going against the spirit of Buddhism, which would be defined as compassion, kindness, and bringing people to enlightenment (#9). Regarding the assignment of responsibilities, one woman said people always have an obligation to stop abuse (#6), and similarly another person told it would be the responsibility of anyone hearing about abuse to communicate to stop it (#5). A man told the person abusing is responsible (#7), however, depending on the circumstances, also the group involved, and the structures prevailing within (#7). Another man told that the teacher and the Buddhist institution the teacher is affiliated with were responsible (#9) and someone else that every single person had his share of responsibility, even if they acted in blind trust (#10), and that the latter would be mitigating circumstances (#10). Furthermore, one woman regarded the leadership and its teachers to be responsible for the abuse (#3) and the board of directors for not intervening (#3) and she analyzed challenging power structures

much (#4) and sometimes sleep for the whole day (#4).

*DOI: http://dx.doi.org/10.5772/intechopen.93297*

sional and family life (#8).

#### *Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan… DOI: http://dx.doi.org/10.5772/intechopen.93297*

and integration of one's own value system are aspects of the process of separation, which often occur long after the physical separation. Sometimes this also encompasses referring to traditional basic Buddhist ethics. In therapeutic processes, it takes place in the phase of dealing with introjects and in the phase of integration. The impact on relationships and ways of relating to others was described as getting arrogant sometimes (#2) for the period in the group, which is regarding oneself higher or more spiritually advanced than others. Negative impact of fear and doubt with feeling lonely and difficulties to trust people (#4) was described as well. Furthermore, it was said recognizing one's own needs (#1), which seems to be a key issue to reconnect to oneself, not practicing accepting everything (#1) and not automatically putting other people first (#1), trusting few people (#1), as well as trying to communicate emotions more (#1), which may show as becoming more compassionate (#2) or feeling in touch with righteous anger (#1). The making of encounters on equal level at a therapeutic context with dangers for too much confluence (#2) was an impact for a professional therapist. Someone also shared keeping a considerable distance from Buddhists (#8) and living quite isolated beyond professional and family life (#8).

The impact on one's work was described as taking care to the best of one's abilities of oneself and surrounding (8), understanding abusive systems of power and abusive group dynamics (#1) and also as suspiciousness of meditation and mindfulness (#1). A young person shared a highly negative impact for her life saying she could not imagine herself at a job with responsibility (#4), she would not work much (#4) and sometimes sleep for the whole day (#4).

The following two questions refer to open letters and ongoing investigations widely discussed in the context. They were asked to understand not only the persons' opinion but also their position in the group and their behavior. Not everyone replied to the questions: *when you think of abuse in Buddhist groups—the abuse of people who have been manipulated and of minors, including sexual abuse—how do you think and feel about it*? *How do you evaluate the responsibility in the group? Who is responsible for what*? Whereas someone told abuse to be unethical and illegal (#6) and in this way referred to basic values, another person simply stripped the leadership of its exaggerated superiority saying the leaders of Buddhist groups were individuals and it would be unavoidable to find some 'black sheep' among them (#5). #7 judged that it should not happen at all and ought to lead to an immediate criminal report. Someone replied the veneration of the teacher in Tibetan Buddhism unfortunately would also create conditions for abuse (#7). Reports on one's own feelings range from helpless (#3), sadness (#3), and anger (#3) to disgust and annoyance (#11). Furthermore, someone told to regret such incidents (#5) and feel a serious betrayal of trust (#5). Someone reported feeling anger and a huge sense of injustice about it (#9) and gave reasons for such behavior going against the spirit of Buddhism, which would be defined as compassion, kindness, and bringing people to enlightenment (#9). Regarding the assignment of responsibilities, one woman said people always have an obligation to stop abuse (#6), and similarly another person told it would be the responsibility of anyone hearing about abuse to communicate to stop it (#5). A man told the person abusing is responsible (#7), however, depending on the circumstances, also the group involved, and the structures prevailing within (#7). Another man told that the teacher and the Buddhist institution the teacher is affiliated with were responsible (#9) and someone else that every single person had his share of responsibility, even if they acted in blind trust (#10), and that the latter would be mitigating circumstances (#10). Furthermore, one woman regarded the leadership and its teachers to be responsible for the abuse (#3) and the board of directors for not intervening (#3) and she analyzed challenging power structures

*Psychosomatic Medicine*

anything (#1).

which could be interpreted as a kind of freezing in shock about what was seen, as well as rationalizing (#8) and even believing what was said about former members (#1) were reported. Someone did not respond to the question directly, but stated sexual assaults against very young women (#2). Yet another person told she was even blaming herself (#4) for the above behavior of other group members while regarding everyone else right. At the period of reflection, when interpreting the issues leading to decisions, someone described realizing all of it a dead end (#8) and his frustration about his fellows narrowing their understanding like in a 'tunnel' (#8) before he left. Others responded to the manipulation and indoctrination tactics in the group with shock and later righteous anger (#1), because of the threats and character assassination of former members (#1) as well as with high distress about the center avoiding to take responsibility by blaming people's 'mind' for

The question on how the person was changed him- or herself by their experiences in these groups was replied to with some positive aspects such as sustained attention (#3), strength to do multi-day ritual (#3), being not afraid to be alone in the woods (#3), and the feeling of union with the divine (#3). However, the positively connotated aspect of accepting pain and negative experiences as just a part of life (#3) may already endanger this individual in highly manipulative contexts. Aspects with negative connotations, such as doubting oneself (#4), not being able to imagine to be capable of anything (#4), having a lot of tension and fear (#4), as well as having lost trust in oneself and others (#4) and in life (#4), were reported as well. People also described having become more suspicious (#2), particularly of all spiritual teachers (#1), being sensitive to coercion (#1) and understanding spiritual abuse (#1), the latter of which may not only protect the individual but also enable them to protect others from unreasonable nonsense and misuse. The phrase spiritual abuse might be interpreted as people being seduced into giving up their own strength as if dependent on a master providing them access to their own spirituality. Furthermore, with reporting greater autonomy (#2) and trusting one's own intuition more (#1), an individual process of change was addressed, which is also found in phrases such as becoming more adult (#2), having developed critical thinking skills (#1), and probably even in enjoying being disobedient (#1) after experiencing abuse in highly authoritative structures to some extent. Also, the result of a process, such as looking at the world more openly (#8), was referred to, and decisions were shared such as never becoming a student of a male spiritual teacher again

(#3) and never ever giving one's power away to any human teacher (#3).

described with adverse effects such as severe self-devaluation (#4), posttraumatic stress (#1), and feelings of helpless (#4), shame (#1), and anxiety (#1). Furthermore, lack of trust (#4) was described at the interpersonal level, which might impact considerably on future relationships and work decisions. Although the fear of making decisions (#4) and loss of direction in life (#4) may come up in an early period of leaving an abusive group, they sometimes continue for even years. The refusal to conform to any group consensus considered inappropriate (#8) is often part of the separating process and might stay as a lesson learned. Furthermore, there are positive connotations for a time period after having left the group and making new personal and working relationships, which were called new connections to kind people (#1) and posttraumatic growth (#1). Also, the values of the person were described to be discussing openly without individual participants manipulating others first (#8) and advocating transparency and truthfulness (#8), even if this is not popular, including financial issues (#8), as well as trying to convey democratic values (#8) and ethics (#8). The reflection of absorbed values

The scope of the personal impact of these experiences in Buddhist groups was

**40**

allowing for abuse (#3). #6 assumed most of these so-called Buddhist groups would not be capable of policing themselves (#6) arguing them to be too insular (#6) and secretive (#6) and outside law enforcement (#6). This woman also reported having tried to contact the Dalai Lama and other leaders repeatedly without ever having received any response (#6). Someone else told that Tibetan Buddhism would need some effort towards adjustment to at least make abuse more difficult (#7), and #10 analyzed the degree of higher position in the group to positively correlate with the degree of blindness (#10). He continued to elaborate that responsibility in groups were usually given to older students, who might have been be accordingly indoctrinated and bring the relevant skills (#10). He argued they ought to take responsibility for the consequences of their actions (#10). Yet another person replied that everyone would be responsible, in particular those people who knew but kept silent (#11). This person then reported to know some people who were first ignored when they tried to bring abuse to light in the group (#11) and that neither the lama nor his group would have admitted abuse (#11), even after they later have given the files to an investigation (#11). Despite singularizing individuals with shifting the issues on them, the persons in the groups acting in such ways are "agents in violent betrayal" [15].

The question *why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality* was replied to as follows: Someone telling to have no experience with it assumes she would not allow this (#5) by taking action (#5) or at least distancing herself (#5). A man called it ignorance, lack of awareness, and lack of ethical conscience (#10) and elaborated this to be true for all genders, although currently mainly women were victims of male offenders (#10) and that as long as one is not victimized oneself (#10) people would perceive everything to be fine (#10). Another man analyzed the secrecy behind closed doors (#11) telling unless the women themselves speak out, it would be difficult to prove (#11). He described the fear of hell used in Tibetan Buddhism for silencing (#11) and the seduction with calling the women a dakini promising them special merit at the time of their death (#11). Another man analyzed it as an issue to do with the dominant patriarchal society (#9), where men are in positions of authority having extended to religion (#9). A man analyzed that teachers would be often held sacrosanct (#7), telling criticism of them were mostly unwanted (#7). Furthermore, he argued the strong relationship of superiority facilitating abuse (#7). One women responded with participation in patriarchy (#3) accused what she thinks is Tibetan Buddhism encouraging mind control, submissiveness, and patriarchal hierarchy (#3) and interprets people disconnected from their own power (#3) being willing to let someone tell them what to do (#3). She accused men suing the tradition for their own agendas for many centuries (#3) and regards what she has learned to be so-called Vajrayana even a vehicle for patriarchal abuse (#3). Another woman argued with attributing special rights and powers to certain men (#6), saying people were blinded by robes and spiritual authority, judging this to be dangerous (#6). She also attributes lack of courage to protect those exploited (#6).

Thus, the opening of any closed elitist circles to the wider societal discourse, the democratization processes required within the strictly hierarchical structures of Tibetan Buddhist centers and a supervised training of group members in traditional interpretations of Buddhist terms, concepts and ethics as well as the urgently needed cultural discourses are a vital condition for differentiated, linguistically and scientifically sound processes of knowledge transfer and exchange. However, whereas these concerns contribute to overcoming structural and conceptual inadequacies, the view of and behavior towards women remains a key issue. Particularly, the tacit transfer of projecting the shadow onto the female

**43**

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan…*

and the implicit mechanisms of their control ought to be reflected and addressed. In this context, the role and function of a teacher's secret lover and unreflective copying culturally shaped structures and behavior with regards to her are crucial. Given the lack of reference within their own cultural context, this raises questions about the psychological effects of such kind of social isolation of these women as well as about their secret position of power, which is even defined highly desirable in some circles. This issue raises further questions about leadership responsibility with regard to the group dynamics induced by it and the effects on the women concerned and their self-responsibility. The societal challenge of correcting individual damages that have been recurring throughout generations, which negatively impact on the knowledge of Buddhism itself, however, is directly opposed to the current mainstream of secrecy and individualizing these issues as so-called '*bad karma*' [1, 2] in such contexts. But although those who still draw their individual profits from these structures try to influence their followers with refusing to listen to the victims and authoritative and confusing definitions, such as trauma being even the aggression of the victim, and in such ways continue to manipulate seminar participants and publicly ridicule and slander victims, now the wider social surrounding has started to counteract the strategy of individualizing issues.

Lacking intercultural exchange of scientific knowledge and its integration into the education in Buddhist philosophy and Tibetan medicine resulted in oversimpli-

Furthermore, the collective projection of the shadow onto the feminine reveals through the current individual and structural challenges in these contexts. This pattern being passed down through generations and unreflectively transferred to Western centers has contributed to forming a subculture spreading internationally under Buddhist cover, with its own secrecy rules, use of language in rationalizing neologisms for the silencing of trauma and the traumatized [2] and trauma dynamics. Ignoring the unconscious in teacher-student relationships and group dynamics has led to the superelevation of persons, even loosing ethics, which form the basis of every Buddhist tradition. Thus, based on the demands for identification with the

For individuals coming from Buddhist contexts, it is therefore important to replace the convenient ways of handing over responsibility, which are leading to patterns of dependency and serving exploitation, with freedom to autonomy along with self-responsibility regarding their own training and ethics. The autonomy in one's own spirituality can never be substituted by an intermediary who is regarded as the sole access to one's own resource. And the role of the lineage holder in

Society, which provides care for the shamelessly exploited, diseased, and traumatized people, now faces several challenges. Apart from prevention through dismantling common idealizations and providing information about the circumstances, terminology involved in indoctrination and the dangers in hypnotising techniques or dissociation sold for so-called Buddhist meditation, it is crucial to develop treatment concepts for those with complex diseases to provide therapeutic care. Furthermore, broadening of the perspective is needed to enable improvement of these closed systems with their seminar-, meditation-, and retreat-centers, particularly concerning education as well as conveying human rights and national legislation to those group members who assume their spiritual masters and entourage are above legislation. For preserving the knowledge of Buddhist philosophy

spiritual master and his entourage, mental diseases were induced.

*DOI: http://dx.doi.org/10.5772/intechopen.93297*

**3. Conclusion**

fication and misguided practice.

Vajrayāna is not meant for such.

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan… DOI: http://dx.doi.org/10.5772/intechopen.93297*

and the implicit mechanisms of their control ought to be reflected and addressed. In this context, the role and function of a teacher's secret lover and unreflective copying culturally shaped structures and behavior with regards to her are crucial. Given the lack of reference within their own cultural context, this raises questions about the psychological effects of such kind of social isolation of these women as well as about their secret position of power, which is even defined highly desirable in some circles. This issue raises further questions about leadership responsibility with regard to the group dynamics induced by it and the effects on the women concerned and their self-responsibility. The societal challenge of correcting individual damages that have been recurring throughout generations, which negatively impact on the knowledge of Buddhism itself, however, is directly opposed to the current mainstream of secrecy and individualizing these issues as so-called '*bad karma*' [1, 2] in such contexts. But although those who still draw their individual profits from these structures try to influence their followers with refusing to listen to the victims and authoritative and confusing definitions, such as trauma being even the aggression of the victim, and in such ways continue to manipulate seminar participants and publicly ridicule and slander victims, now the wider social surrounding has started to counteract the strategy of individualizing issues.

#### **3. Conclusion**

*Psychosomatic Medicine*

betrayal" [15].

allowing for abuse (#3). #6 assumed most of these so-called Buddhist groups would not be capable of policing themselves (#6) arguing them to be too insular (#6) and secretive (#6) and outside law enforcement (#6). This woman also reported having tried to contact the Dalai Lama and other leaders repeatedly without ever having received any response (#6). Someone else told that Tibetan Buddhism would need some effort towards adjustment to at least make abuse more difficult (#7), and #10 analyzed the degree of higher position in the group to positively correlate with the degree of blindness (#10). He continued to elaborate that responsibility in groups were usually given to older students, who might have been be accordingly indoctrinated and bring the relevant skills (#10). He argued they ought to take responsibility for the consequences of their actions (#10). Yet another person replied that everyone would be responsible, in particular those people who knew but kept silent (#11). This person then reported to know some people who were first ignored when they tried to bring abuse to light in the group (#11) and that neither the lama nor his group would have admitted abuse (#11), even after they later have given the files to an investigation (#11). Despite singularizing individuals with shifting the issues on them, the persons in the groups acting in such ways are "agents in violent

The question *why do we allow male Buddhist teachers to not only denigrate but also exploit women for their own (mostly hidden) agendas in the name of spirituality* was replied to as follows: Someone telling to have no experience with it assumes she would not allow this (#5) by taking action (#5) or at least distancing herself (#5). A man called it ignorance, lack of awareness, and lack of ethical conscience (#10) and elaborated this to be true for all genders, although currently mainly women were victims of male offenders (#10) and that as long as one is not victimized oneself (#10) people would perceive everything to be fine (#10). Another man analyzed the secrecy behind closed doors (#11) telling unless the women themselves speak out, it would be difficult to prove (#11). He described the fear of hell used in Tibetan Buddhism for silencing (#11) and the seduction with calling the women a dakini promising them special merit at the time of their death (#11). Another man analyzed it as an issue to do with the dominant patriarchal society (#9), where men are in positions of authority having extended to religion (#9). A man analyzed that teachers would be often held sacrosanct (#7), telling criticism of them were mostly unwanted (#7). Furthermore, he argued the strong relationship of superiority facilitating abuse (#7). One women responded with participation in patriarchy (#3) accused what she thinks is Tibetan Buddhism encouraging mind control, submissiveness, and patriarchal hierarchy (#3) and interprets people disconnected from their own power (#3) being willing to let someone tell them what to do (#3). She accused men suing the tradition for their own agendas for many centuries (#3) and regards what she has learned to be so-called Vajrayana even a vehicle for patriarchal abuse (#3). Another woman argued with attributing special rights and powers to certain men (#6), saying people were blinded by robes and spiritual authority, judging this to be dangerous (#6). She also attributes lack of courage to

Thus, the opening of any closed elitist circles to the wider societal discourse, the democratization processes required within the strictly hierarchical structures of Tibetan Buddhist centers and a supervised training of group members in traditional interpretations of Buddhist terms, concepts and ethics as well as the urgently needed cultural discourses are a vital condition for differentiated, linguistically and scientifically sound processes of knowledge transfer and exchange. However, whereas these concerns contribute to overcoming structural and conceptual inadequacies, the view of and behavior towards women remains a key issue. Particularly, the tacit transfer of projecting the shadow onto the female

**42**

protect those exploited (#6).

Lacking intercultural exchange of scientific knowledge and its integration into the education in Buddhist philosophy and Tibetan medicine resulted in oversimplification and misguided practice.

Furthermore, the collective projection of the shadow onto the feminine reveals through the current individual and structural challenges in these contexts. This pattern being passed down through generations and unreflectively transferred to Western centers has contributed to forming a subculture spreading internationally under Buddhist cover, with its own secrecy rules, use of language in rationalizing neologisms for the silencing of trauma and the traumatized [2] and trauma dynamics. Ignoring the unconscious in teacher-student relationships and group dynamics has led to the superelevation of persons, even loosing ethics, which form the basis of every Buddhist tradition. Thus, based on the demands for identification with the spiritual master and his entourage, mental diseases were induced.

For individuals coming from Buddhist contexts, it is therefore important to replace the convenient ways of handing over responsibility, which are leading to patterns of dependency and serving exploitation, with freedom to autonomy along with self-responsibility regarding their own training and ethics. The autonomy in one's own spirituality can never be substituted by an intermediary who is regarded as the sole access to one's own resource. And the role of the lineage holder in Vajrayāna is not meant for such.

Society, which provides care for the shamelessly exploited, diseased, and traumatized people, now faces several challenges. Apart from prevention through dismantling common idealizations and providing information about the circumstances, terminology involved in indoctrination and the dangers in hypnotising techniques or dissociation sold for so-called Buddhist meditation, it is crucial to develop treatment concepts for those with complex diseases to provide therapeutic care. Furthermore, broadening of the perspective is needed to enable improvement of these closed systems with their seminar-, meditation-, and retreat-centers, particularly concerning education as well as conveying human rights and national legislation to those group members who assume their spiritual masters and entourage are above legislation. For preserving the knowledge of Buddhist philosophy

#### *Psychosomatic Medicine*

and practice, curing the transgenerational patterns of traumatization of individuals, compensating victims and deciding on how to deal with perpetrators, accomplices and collaborators are crucial.

### **Acknowledgements**

This research was funded by the German Federal Ministry of Education and Research, grant reference number 01UL1823X.

### **Author details**

Anne Iris Miriam Anders Institute of Social and Cultural Anthropology, Ludwig Maximilians University Munich, Germany

\*Address all correspondence to: miriam.anders@campus.lmu.de

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**45**

15 May 2020]

*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan…*

okcinfo.news/en/timeline/ [Accessed:

l0U2yejz3O4vcqaCMfusIa/view?fbclid=I wAR0Qo3zbWkJ3E5wjPUhLoVwOJnKw Zee\_AAzA79kvgj9K6DcOfh5uU7p5pM0

[8] Standlee M, Sangye D, Pistono M, Standlee J, Price G, et al. Open letter to Sogyal Lakar [Internet]. 2017. Available from: https://www.lionsroar. com/wp-content/uploads/2017/07/ Letter-to-Sogyal-Lakar-14-06-2017-.pdf

[9] The Charity Commission. New Charity Inquiry: Rigpa Fellowship. Charity Commission investigates Rigpa Fellowship [Internet]. 2018. Available from: https://www.gov.uk/government/ news/new-charity-inquiry-rigpafellowship [Accessed: 15 May 2020]

[10] Winn AM. Project Sunshine: Final Report A Firebird Year

01 June 2020]

[Accessed: 01 June 2020]

Initiative to Bring Light and Healing to Sexualized Violence Embedded Within the Shambhala Community [Internet]. 2018. Available from: www. andreamwinn.com/pdfs/Project\_ Sunshine\_Final\_Report.pdf [Accessed:

[11] Winn AM, Merchasin C. Buddhist Project Sunshine Phase 3 Final Report The Nail: Bringing Things to a Clear Point A 2-Month Initiative to Bring Activating Healing Light to Sexualized Violence at the Core of the Shambhala Buddhist Community [Internet]. 2018. Available from: andreamwinn.com/ project\_sunshine/Buddhist\_Project\_ Sunshine\_Phase\_3\_Final\_Report.pdf

[7] Morman C, Leslie L, Fitch L, Ellerton D, Canepa A. An Open Letter to the Shambhala Community from Long-Serving Kusung [Internet]. 2019. Available from: https://drive. google.com/file/d/1W3fN12nEY-

[Accessed: 16 February 2019]

[Accessed: 15 May 2020]

01 June 2020]

*DOI: http://dx.doi.org/10.5772/intechopen.93297*

[1] Anders AIM. Psychische Auswirkungen von Machtmissbrauch in buddhistischen Gruppierungen und essenzielle Aspekte bei psychotherapeutischen Interventionen für Betroffene. SFU Forschungsbulletin. 2019;**7**(1):32-49. DOI: 10.15135/2019.7.1.32- 49. Available in English from: https:// www.en.transtibmed.ethnologie.unimuenchen.de/publications/index.html

[2] Anders AIM. Silencing and oblivion of psychological trauma, its unconscious aspects, and their impact on the inflation of Vajrayāna. An analysis of cross-group dynamics and recent developments in Buddhist groups based on qualitative data. Religion. 2019;**622**:1-23. DOI: 10.3390/

[3] An Olive Branch. Shambhala Final Project Report [Internet]. 2019. Available from: https://www.dropbox.

com/s/eloezy0vc0nhgro/AOB\_

[4] An Olive Branch. Report on the Shambhala Listening Post [Internet]. 2019. Available from: https://www. dropbox.com/s/111arue9y4gtk73/AOB\_ ListeningPostReport\_March2019\_final. pdf?dl=0 [Accessed: 20 March 2019]

[5] Baxter K. Report to the boards of trustees of: Rigpa fellowship UK, and Rigpa fellowship US. Outcome of an investigation into allegations made against Sogyal Lakar (also known as Sogyal Rinpoche) in a letter dated 14 July 2017 [Internet]. 2018. Available from: https://static1.squarespace.com/ static/580dbe87e6f2e16700cb79fe/t/5b8 f7c1e1ae6cfb38491e668/1536130081917/ Lewis+Silkin+report.pdf [Accessed:

[6] Ex-OKC born-kids. 40 Years of Abuse in the name of Dharma [Internet]. 2020. Available from: https://

[Accessed: 20 March 2019]

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*Psychological and Societal Implications of Projecting the Shadow on the Feminine in Tibetan… DOI: http://dx.doi.org/10.5772/intechopen.93297*

#### **References**

*Psychosomatic Medicine*

**Acknowledgements**

plices and collaborators are crucial.

Research, grant reference number 01UL1823X.

**44**

**Author details**

Munich, Germany

Anne Iris Miriam Anders

provided the original work is properly cited.

Institute of Social and Cultural Anthropology, Ludwig Maximilians University

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

and practice, curing the transgenerational patterns of traumatization of individuals, compensating victims and deciding on how to deal with perpetrators, accom-

This research was funded by the German Federal Ministry of Education and

\*Address all correspondence to: miriam.anders@campus.lmu.de

[1] Anders AIM. Psychische Auswirkungen von Machtmissbrauch in buddhistischen Gruppierungen und essenzielle Aspekte bei psychotherapeutischen Interventionen für Betroffene. SFU Forschungsbulletin. 2019;**7**(1):32-49. DOI: 10.15135/2019.7.1.32- 49. Available in English from: https:// www.en.transtibmed.ethnologie.unimuenchen.de/publications/index.html

[2] Anders AIM. Silencing and oblivion of psychological trauma, its unconscious aspects, and their impact on the inflation of Vajrayāna. An analysis of cross-group dynamics and recent developments in Buddhist groups based on qualitative data. Religion. 2019;**622**:1-23. DOI: 10.3390/ rel10110622

[3] An Olive Branch. Shambhala Final Project Report [Internet]. 2019. Available from: https://www.dropbox. com/s/eloezy0vc0nhgro/AOB\_ FinalReport\_March2019\_final.pdf?dl=0 [Accessed: 20 March 2019]

[4] An Olive Branch. Report on the Shambhala Listening Post [Internet]. 2019. Available from: https://www. dropbox.com/s/111arue9y4gtk73/AOB\_ ListeningPostReport\_March2019\_final. pdf?dl=0 [Accessed: 20 March 2019]

[5] Baxter K. Report to the boards of trustees of: Rigpa fellowship UK, and Rigpa fellowship US. Outcome of an investigation into allegations made against Sogyal Lakar (also known as Sogyal Rinpoche) in a letter dated 14 July 2017 [Internet]. 2018. Available from: https://static1.squarespace.com/ static/580dbe87e6f2e16700cb79fe/t/5b8 f7c1e1ae6cfb38491e668/1536130081917/ Lewis+Silkin+report.pdf [Accessed: 15 May 2020]

[6] Ex-OKC born-kids. 40 Years of Abuse in the name of Dharma [Internet]. 2020. Available from: https:// okcinfo.news/en/timeline/ [Accessed: 01 June 2020]

[7] Morman C, Leslie L, Fitch L, Ellerton D, Canepa A. An Open Letter to the Shambhala Community from Long-Serving Kusung [Internet]. 2019. Available from: https://drive. google.com/file/d/1W3fN12nEYl0U2yejz3O4vcqaCMfusIa/view?fbclid=I wAR0Qo3zbWkJ3E5wjPUhLoVwOJnKw Zee\_AAzA79kvgj9K6DcOfh5uU7p5pM0 [Accessed: 16 February 2019]

[8] Standlee M, Sangye D, Pistono M, Standlee J, Price G, et al. Open letter to Sogyal Lakar [Internet]. 2017. Available from: https://www.lionsroar. com/wp-content/uploads/2017/07/ Letter-to-Sogyal-Lakar-14-06-2017-.pdf [Accessed: 15 May 2020]

[9] The Charity Commission. New Charity Inquiry: Rigpa Fellowship. Charity Commission investigates Rigpa Fellowship [Internet]. 2018. Available from: https://www.gov.uk/government/ news/new-charity-inquiry-rigpafellowship [Accessed: 15 May 2020]

[10] Winn AM. Project Sunshine: Final Report A Firebird Year Initiative to Bring Light and Healing to Sexualized Violence Embedded Within the Shambhala Community [Internet]. 2018. Available from: www. andreamwinn.com/pdfs/Project\_ Sunshine\_Final\_Report.pdf [Accessed: 01 June 2020]

[11] Winn AM, Merchasin C. Buddhist Project Sunshine Phase 3 Final Report The Nail: Bringing Things to a Clear Point A 2-Month Initiative to Bring Activating Healing Light to Sexualized Violence at the Core of the Shambhala Buddhist Community [Internet]. 2018. Available from: andreamwinn.com/ project\_sunshine/Buddhist\_Project\_ Sunshine\_Phase\_3\_Final\_Report.pdf [Accessed: 01 June 2020]

[12] Winn AM, Edelman R, Merchasin C, Monson E, Women Survivors. Buddhist Project Sunshine Phase 2 Final Report. A 3-month Initiative to Bring Healing Light to Sexualized Violence at the Core of the Shambhala Buddhist Community [Internet]. 2018. Available from: andreamwinn.com/project\_sunshine/ Buddhist\_Project\_Sunshine\_Phase\_2\_ Final\_Report.pdf [Accessed: 01 June 2020]

[13] Dockler L, Mueller J. Introduction to the special issue on institutional and betrayal trauma. Journal of Aggression, Maltreatment and Trauma. 2017;**26, 1**: 1-2. DOI: 10.1080/10926771.2016.1263707

[14] Jung CG. Die Beziehungen zwischen dem Ich und dem Unbewußten. 2nd ed. Dt. Taschenbuch-Verlag: München; 2014

Section 2

Organic Diseases and

Psychosomatic Approach

**47**

[15] Gentile K. Assembling justice: Reviving nonhuman subjectivities to examine institutional betrayal around sexual misconduct. Journal of the American Psychoanalytic Association. 2018;**66**(4):647-678. DOI: 10.1177/0003065118797138

### Section 2
