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Mindfulness-Based Therapy – Does it Work? (Summary, Part 3)
Gareth John   Oct 7, 2015   Ethical Technology  

Which brings me to my critique of mindfulness as therapy:

1.  Firstly, mindfulness is not and should not be viewed as the latest cure-all for those with mental health issues. It is not a panacea. By the time the Buddha started employing it within his teachings it had already had a long history of incremental development within a broader spiritual tradition and this continued up until the end of the last century. Within this tradition it is viewed as a powerful tool designed to do to the brain what the brain specifically does not want to do, i.e. remain uninvolved with thought patterns and feelings as they pass before the practitioner.

Part 1

Part 2

There’s no question that mindfulness can lead to tranquillity and reductions in stress and anxiety. I have no doubt that it can help some people with depression to provide the necessary gap in their thought process which may allow them to see their triggers for what they are and take the appropriate action, whether that be a warm bath with candlelight or calling the Crisis Team. But everyone has to start somewhere and mindfulness practice is not an easy thing for anyone to approach initially.

Indeed, the Tibetan tantric tradition would argue that mindfulness in these early stages when one has not yet mastered the art – for it is an art – of remaining uninvolved with thoughts and feelings is akin, in itself, to an enforced depression. Without taking my words too literally, one begins one’s practice by effectively shutting down the sense fields as one tries to grapple with the ‘mad monkey mind’. For some people with depression this could be entirely counterproductive in that they are locking themselves in with their own affliction. In others it could be actively harmful in that there are deep, dark places to be explored as the mind settles and these can be hard enough to deal with even for the strongest minded. 

My concern is that in these early stages when the mind has not yet had the opportunity to relax into its own nature to even the smallest extent, the mentally ill (particularly depressive) person is extremely vulnerable to the power of their own darkest spaces and the demons within. One Buddhist monk, Shinzen Young, has described the ‘dark night’ phenomenon as an “irreversible insight into emptiness” and “enlightenment’s evil twin.”[17]

When I was a Buddhist teacher, my advice to anyone with severe mental illness who came looking for meditation instruction was to visit their GP and try to start to get a grip on their mood disorders prior to attempting the art of meditation. To return to Jon Kabat-Zinn, he was quoted as saying, “Mindfulness is so powerful that the fact that it comes out of Buddhism is irrelevant.” I would argue that it is this power that can harm as well as heal. Even yogis can and do suffer mental illness and it was not that unusual for Tibetan tantric practitioners in Tibet to fall on the wrong side of the fence separating tranquillity from madness. Arguably I am one of them myself.

2.  With regard the above, I’m concerned about the qualifications of the teachers who get to take responsibility for their – patients, students? – introduction to mindfulness and its potential discontents. In Tibetan the term nyams is used to describe anything that arises in meditation. Within that tradition it’s well-known and expected that at a certain point within one’s practice of mindfulness one will begin to experience nyams of one kind or another. These could be auditory or visual hallucinations, physical manifestations such as involuntary shaking or psychical feelings such as floating above the ground or losing touch with the reality around them or even in rare cases ‘depersonalisation’, where people feel like they are watching themselves in a film.

All to the well and good (arguably) if one has signed up to a spiritual tradition and where one is prepared to undergo such experiences with the guidance of a teacher who has probably experienced them herself and knows enough about the way the mind works in meditation to guide you through to the other side. But I find it hard to believe that teachers and/or students of secular mindfulness based therapies have that understanding after such a relatively short training period.

I could be wrong; after all, I spent thirteen years training as a Buddhist priest and have not attended any mindfulness based training of the sort being described here. Who knows, maybe I wasted an awful lot of my time and energy. But I don’t think so and that concerns me. There’s a reason you train for so long and in so many different meditation techniques. You will be responsible for the wellbeing of your students one day – you’d better know your stuff. The idea that someone with a severe mental illness could attend an eight week course in mindfulness and then be sent off to get on with it potentially without any further support is frightening. And I’m not alone in having these concerns – mounting public interest means more teachers are urgently needed and concern is growing about the adequacy of training. According to the Guardian Newspaper some NHS trusts are asking health professionals to teach mindfulness after only having completed a basic eight-week beginners’ course.

“It is worrying,” said Rebecca Crane, director of the Centre for Mindfulness Research and Practice in Bangor, which has trained 2,500 teachers in the past five years, “people come along to our week-long teacher training retreat and then are put under pressure to get teaching very quickly.”[18] Lokhadi, a mindfulness meditation teacher in London for the past nine years, has regular experience of some of the difficulties mindfulness meditation can throw up. “While mindfulness meditation doesn’t change people’s experience, things can feel worse before they feel better,” she said. “As awareness increases, your sensitivity to experiences increases. If someone is feeling vulnerable or is not well supported, it can be quite daunting. It can bring up grief and all kinds of emotions, which need to be capably held by an experienced and suitably trained teacher.”[19] Quite.

3.  Woo. Upon coming across the transhumanist community I was a little taken aback by the number of prominent transhumanists who, at least in part, defined themselves as Buddhist. Taken aback because as someone who’s been there in the thick of it there’s an awful lot of woo mixed in with the philosophical, psychological or even, if pushed, spiritual aspects. I realise authors and teachers such as Stephen Batchelor have long espoused an ‘agnostic’ or ‘secular’ Buddhism which strips away the religious elements so why I was so shocked I’m still not quite sure.[20]

The transformative aspect of Buddhism – secular or traditional – fits well with the aspirations of transhumanists. It has long been called the technology of the mind. Yet mixed in with all this is Buddha being born from the side of an elephant, Padmasambhava being born from a lotus flower, or masters of Dzogchen being sown into tents for seven days when approaching death, leaving only hair and nails behind when the tents are opened after the allotted time, the master having attained a Rainbow Body and having dissolved into the ether. Even enlightenment itself is a bit of a puzzler. I have often wondered how secular Buddhists view it, if at all, and I wonder whether those transhumanists who describe themselves as Buddhists really are Buddhists or do they simply apply Buddhist methods, e.g. mindfulness and does it really matter anyway?

As a one-time practitioner and teacher of mindfulness myself, I wonder how many people with severe mental health problems are missing out on evidence-based interventions, primarily in terms of medication and psychiatric help, in favour of a mindfulness-only approach. After all, who wants the side effects of meds and the trauma of ongoing psychiatric assessments, hospitalisations and potential loss of all rights if one were to be sectioned under the Mental Health Act when you are told that you can simply manage your illness through sitting quietly doing nothing? And are mindfulness teachers in any way responsible for the outcomes of their intervention? Do they monitor their patients/students’ health and liaise with mental health services if they see a dramatic change for the worse? Are they in any way accountable? If not, my fear is that mindfulness simply becomes another new age sticking plaster, not dealing with the root cause at all. And that way truly lies madness.

So, there we have it. I’ve set out my stall. I fully expect to be roasting over the pit of the internet inferno pretty soon if people have got this far. So to sum up before I burn up: I do not in any way deny mindfulness’ transformative power to heal. But I do have concerns as to its usage not just for people with mental ill-health, but certainly for them as a particularly vulnerable subset of people for whom the practice of mindfulness may be actively harmful. Either way, my guess is that in a few years’ time we’ll be looking back at mindfulness as just another fad that human beings desperately grasped onto to make everything right. I’ve made my choice: I want Better Than Well and I’m prepared to work towards that goal shoulder to shoulder with other technoprogressives regardless of whether they are mindful or scatty or even, like myself, living with a severe mental illness.

The Buddha said ‘Work out your own salvation with diligence.’  I’m proud to be part of a movement that is attempting to do just that.
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NOTES

1 Centre for Mindfulness in Medicine, Health Care, and Society 2014. [Web Page]. Retrieved from http://www.umassmed.edu/cfm/about-us/people/2-meet-our-faculty/kabat-zinn-profile/

2 Centre for Mindfulness in Medicine, Health Care, and Society 2014. Retriieved from http://www.umassmed.edu/cfm/

3 Centre for Mindfulness in Medicine, Health Care, and Society 2014. About Us [Web Page]. Retrieved from http://www.umassmed.edu/cfm/about-us/

4 The Mindfulness Association Website 2015 Retrieved from http://www.mindfulnessassociation.org/

5 The British Mindfulness Institute Website 2015 Retrieved from http://www.britishmindfulnessinstitute.co.uk/6 The Work with Mindfulness Website 2015 Retrieved from http://mindfulnesswork.com/

6 The Work with Mindfulness Website 2015 Retrieved from http://mindfulnesswork.com/

7 Headspace 2015 Retrieved from https://www.headspace.com/

8 Centre for Mindfulness in Medicine, Health Care, and Society 2014. MBCT - Mindfulness-Based Cognitive Therapy [Web Page].Retrieved from http://www.umassmed.edu/cfm/mbct/

9 Science Direct 2011. [Web Page]. The effect of mindfulness­based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta­analysis. Retrieved from http://www.sciencedirect.com/science/article/pii/S0272735811000973

10 BMJ Open 2014. [Web Page]. Mindfulness online: an evaluation of the feasibility of a web­based mindfulness course for stress, anxiety and depression. Retrieved from http://bmjopen.bmj.com/content/3/11/e003498.full.

11 The Guardian 2014. [Web Page]. Should we be mindful of mindfulness? Retrieved from http://www.theguardian.com/society/2014/feb/23/should­we­be­mindful­of­mindfulness­nhs­depression

12 PubMed.gov. [Web Page]. Mindfulness­based therapy: a comprehensive meta­analysis. Retrieved from http://www.sciencedirect.com/science/article/pii/S0272735811000973 

13 MiSP: Mindfulness in Schools Project 2015. [Web Page]..b Curriculum. Retrieved from https://mindfulnessinschools.org/what­is­b/b­curriculum/

14 The Telegraph 2015. [Web Page]. Mindfulness: the saddest trend of 2015. Retrieved from http://www.telegraph.co.uk/women/womens­life/11331034/Mindfulness­the­saddest­trend­of­2015.html

15 New Spectator 2014. [Web Page]. The cult of 'mindfulness': Separating meditation from faith is a dubious business, morally and sometimes in its effects. Retrieved from http://new.spectator.co.uk/2014/11/whats­wrong­with­mindfulness­more­than­you­might­think/

16 Cheetahhouse.org 2015. [Web Page]. Online Articles About the Dark Night. Retrieved from http://cheetahhouse.org/index.php/old­resources/articles/

17 Shinzen’s Blog 2015. [Web Page]. The Dark Night. Retrieved from http://shinzenyoung.blogspot.co.uk/2011/11/dark­night.html

18 The Guardian 2015. [Web Page]. Mindfulness therapy comes at a high price for some, say experts: Much­hyped therapy can reduce relapses into depression – but it can have troubling side effects. Retrieved from http://www.theguardian.com/society/2014/aug/25/mental­health­meditation

19 The Guardian 2015. [Web Page]. Mindfulness therapy comes at a high price for some, say experts:Much­hyped therapy can reduce relapses into depression – but it can have troubling side effects. Retrieved from http://www.theguardian.com/society/2014/aug/25/mental­health­meditation

20 See the Secular Buddhist Association website 2015. Retrieved from http://secularbuddhism.org/

Gareth John lives in Mid Wales; he’s an ex-Buddhist priest with a MA in Buddhist Studies at the University of Bristol, and has performed studies on non-monastic traditions of Tibetan tantric Buddhism.



COMMENTS

Really appreciate your articles John. I do think mindfulness has become something of a faddish, cure-all and may not be appropriate for severe mental illness. Thanks for going against the prevailing winds.

Thanks John (although I’m actually Gareth!) - it’s been a personal bugbear for me for some time so it’s been a really fantastic opportunity to get to put down in words my concerns. Glad you found it of interest. Sorry it was so long!

Too late for the article, but directly relevant on BBC Radio 4 today:

Can mindfulness take the stress out of school? Cumbrian secondaries have added meditation techniques to the curriculum, but is it money well spent? http://goo.gl/zYy7V9

Interestingly, I read an article in The Times (London, not New York!) a few months ago about the possible downsides of mindfulness, so the dissident movement does seem to be gaining ground. One reason I think mindfulness is important is that we really do seem to be living in an age of distraction, our attention becoming narrowly goal-oriented (but without of ever focusing for long on the same goal), to an extent that is physically unhealthy and counterproductive in terms of leading a meaningful, happy life. I certainly have the impression that mindfulness has helped me to break out of that trap, reduce my tendency to get stuck back in it for long periods of time, and generally boost my psychological flexibility. But there is almost certainly an allegiance effect going on, so of course we need to continue sifting the evidence and questioning our beliefs. Fortunately, mindfulness also facilitates that.

Regarding risks and training, I certainly agree that for severe mental health problems mindfulness should not necessarily be one’s first port of call. As for any genuinely urgent situation, more bespoke treatments are required. I should also add by way of disclaimer that I have no formal training in this whatsoever. I learned Christian meditation in my youth, Ericsonian hypnosis from my GP, and mindfulness from a self-help book (The Happiness Trap by Russ Harris, which I thoroughly recommend, not least because it doesn’t cost $10,000 or require anyone to go on an 8-week course). At the same time, my experience leads me to suspect that it must be possible to design mindfulness-based training and practices that do not require years of training to be safe and effective.

In summary, I agree that there is a lot of woo and faddishness surrounding mindfulness currently, but personally I expect and hope that it won’t just fade into a memory of a passing fad. It’s too useful for that. But we need to be sceptical.

Exactly.

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