Wednesday, May 15, 2013

Mindfulness: Mending Minds vs Spiritual Practice

I had a coin-toss moment recently -- one of those instants when the coin is in the air and you suddenly realize which side you're on.

It wasn't so much a decision as a clarification of my true leanings on mindfulness as spiritual practice vs medically-proven therapy.  I would really like to  hold  Mindfulness in equipoise--simultaneously considering it as a scientific / medical practice AND an ancient spiritual discipline. But, in all honesty, I find my equipoise developing some cracks.

The Masters of Mindfulness™ would say you don't have to make a choice-- it is, indeed, an age-old spiritual practice, but now being studied--and its benefits confirmed--by scientific evidence. At least in the UK, Mindfulness teachers always hasten to say that Mindfulness is a secular practice and you don't have to be a Buddhist or change your religious beliefs to benefit from it.

But the link to Buddhism remains -- and prominently, even proudly so. A recent scientific review for example, defines Mindfulness in light of the connection:
"Mindfulness derives from Buddhist practice and is described in the psychological literature as an intentional and non-judgemental awareness of the present moment (Kabat-Zinn, 1990). Mindfulness is utilized in secularized interventions such as Mindfulness-Based Stress Reduction..." 

The Buddhist Backdrop

Evidence abounds of the pervasive Buddhist /Eastern / New Agey associations and influences in Mindfulness. For example, many teachers of Mindfulness in this area share office space with purveyors of unproven, semi-proven, or disproven holistic/ mind-body treatments such as crystal therapy, hydrotherapy, aroma therapy, massage, chiropractic, yoga, homeopathy, accupuncture, Qi Gong, reiki, Indian head massage, Hopi ear candling, reflexology, etc.  Association with yoga practices is especially prevalent.

My friend Tudor, who is a Naval chaplain training to be a Mindfulness teacher, has found that most Mindfulness retreats are held at New Age or Buddhist retreat centers. Another hint of the link: Meditation periods during Mindfulness classes will usually start with the ringing of a  ghanta (Buddhist temple bell) or  singing bowl --drawing on a ritual used for starting silent meditation in Tibetan Buddhist practice.

One type of Mindfulness meditation practice involves gentle yoga moves. While many Westerners today understand and practice yoga as a largely secular form of stretching for relaxation and fitness,  its origins lie in Eastern religions. Wikipedia says:
Yoga (Sanskrit: योग) is a commonly known generic term for the physical, mental, and spiritual practices or disciplines which originated in ancient India with a view to attain a state of permanent peace... Specifically, yoga is one of the six āstika ("orthodox") schools of Hindu philosophy. ... Yoga has also been popularly defined as "union with the divine" in other contexts and traditions... Various traditions of yoga are found in Buddhism, Hinduism, Jainism and Sikhism..
Tudor sees the links between Mindfulness and Buddhism as "inevitable, given that [Jon Kabat-Zinn, one of the fathers of modern Mindfulness-based treatment programs] borrowed heavily from the Buddhist tradition to put together his mindfulness meditation program. " Wikipedia notes:
 "Kabat-Zinn was a student of Zen Master Seung Sahn and a founding member of Cambridge Zen Center. His practice of yoga and studies with Buddhist teachers led him to integrate their teachings with those of Western science."

Cause for Concern?

I started to raise my eyebrows about the Buddhism connections when I noticed that training programs for Mindfulness teachers may require that applicants be assessed for "good dharma":
1. The teacher of MBSR teachers him or herself needs to have a longstanding grounding in meditative practices and be a committed student of the dharma, as it is expressed both within the Buddhist meditation traditions and in more mainstream and universal contexts exemplified by MBSR. This has nothing to do with being or not being a Buddhist.
2. MBSR is a vehicle for embodying and transmitting the dharma in a wholly secular and universal idiom. It is a recontextualizing of dharma, not a decontextualizing of it. 
Or, later in the same document (from my alma mater, the University of Massachusetts, home institution of Kabat-Zinn): 
We strongly recommend that all aspiring and engaged MBSR teachers and teacher trainers attend retreats in the Western Vipassana tradition, because this tradition closely reflects and serves as a foundation for the spirit, practice and attitudes of MBSR.
(I read the disclaimers that grounding in and transmission of the dharma has "nothing to do with being Buddhist" and is "wholly secular." But when"dharma" derives its very definition from Eastern faith traditions and is used with no attempt to translate or reconcile it with terms and concepts understood in secular Western culture, the disclaimers are unconvincing.)

Similarly, in the UK, the University of Bangor's course for training to be a Mindfulness teacher includes a unit on "Buddhist Background to Mindfulness-Based Courses." Exeter University's first year post-graduate training in Mindfulness includes two units in Buddhist Psychology.

My concern grew into worry when I noticed an abstract in the Journal of Religion and Health proposing a modified form of mindfulness based on  "Centering prayer, a form of Christian meditation that is rooted in Catholic mysticism." The author, Joshua J. Knabb, acknowledged that mindfulness-based conigitive therapy has proven effective in decreasing recurrences of depression,
"Yet, some Christian adults may prefer to turn to their own religious heritage, rather than the Buddhist tradition, in order to stave off depression relapse."
Next I found an abstract suggesting Sufism and the meditations of poet Rumi to create a sort of "Mindfulness for Muslims." Author Gretty M. Mirdal notes the dramatic growth in the use of mindfulness for treating a variety of interpersonal and health problems in the past decade and suggests elements of Sufism offer a more "culturally sensitive" method of mindfulness-based healing for people with Muslim backgrounds.
"The source of inspiration for mindfulness has traditionally been Buddhism, while Islamic thought has not been present in this development despite the similarities in philosophy and a growing need for mental health support among Muslim populations throughout the world. ... Introducing concepts, images and metaphors based on Rumi’s universe can constitute a meaningful alternative to Buddhist-inspired practices in the transcultural clinic, especially in encounters with clients with Muslim background."

Mirdal says it's understandable that many cultures would come up with similar basic techniques for healing.
These include generally a reframing, a new way of looking at problems of living; they provide new ways of coping, of unlearning bad habits and learning more constructive ways of dealing with stress, loss and grief; they offer rituals based on a myth or a theory of what constitutes 'a good life'; and finally, they impart belief and hope, that the process will restore health and well-being.
Mirdal says that both the Buddhist and Sufi orientations are helpful because "both approaches challenge the focus on the primacy of the individual self and on the narrow pursuit of mundane success which are not necessarily meaningful goals in non-western cultures."

Why Worry?

The fact that Mindfulness experts are now starting to see a need to develop more "culturally sensitive" versions of the practice suggests to me that Mindfulness may be on the brink of outgrowing or overplaying its Buddhist connections. My friend Tudor calls this "Remythologizing" Mindfulness. And requiring that people who want to train to teach Mindfulness have Buddhist credentials -- good dharma or training in Buddhist psychology is just asking for trouble, especially in America.

Both Tudor and I come at this as fans of Mindfulness AND Christians. Both of us feel we benefitted from learning Mindfulness meditation techniques--so much so that we want to share them with others. Tudor writes,
"As a chaplain working within the military I have found mindfulness meditation techniques to be useful in my pastoral work.  For those who have difficulty controlling anger and those who appear overly anxious, I have found mindfulness particularly effective in reducing their emotions to a manageable state. "
I don't think either of us find the Buddhist elements in Mindfulness to be a personal affront or challenge to our own faith or cultural sensibilities. So why are we worried Mindfulness may be veering too far into Buddhism?

1. Putting People Off: The main concern would be that conspicuously Buddhist elements in Mindfulness will put people off -- they'll cause a wide assortment of people to reject Mindfulness out-of-hand, without getting far enough in the door to see how it might be helpful. This could include people who identify strongly with non-Buddhist faith traditions; as well as militant atheists and agnostics; people (and institutions) who require that all aspects of medical treatment should be evidence-based; people who are suspicious of flaky New Agey stuff, and people who start out with apprehensions, misgivings, and doubts about psychological and psychiatric treatments.

As I've tried to describe in previous postings on this blog, Mindfulness is odd, delicate, chimeric, as well as amazing--approaching the magical or the "too good to be true." I find it difficult to tell people that something as simple as sitting in a chair, focusing kindly attention on the present moment (for example the breath you are drawing just now) REALLY DOES, with practice, accomplish wonderful, helpful things. Something as silly as ten minutes focusing on a raisin or 40 minutes lying on the floor in silence with a roomful of strangers, can, over time, change the structure and function of your brain and be your ticket to well-being. I fear that a pronounced layer of spirituality, be it Buddhism, Catholic Mysticism, or Sufism could be the last straw of airy-fairiness wafting Mindfulness into Cloud cuckoo land for many people.

Of course, connecting to Buddhist roots might well make Mindfulness more credible to Buddhists and people who are comfortable with Eastern traditions--or sufficiently urbane that they can put the Buddhist elements in a liberal, tolerant, non-personal, historic perspective. But I wouldn't guess this group is very large in either the United States or the United Kingdom. (And if this blog weren't already too long, I'd argue that people with these open attitudes and those already given to the loving-kindness favored by Buddhism are probably less urgently in need of Mindfulness. Studies have linked belief in a loving God to reduced risk of Social Anxiety, Paranoia, Obsession, and Compulsion. Belief in in a punitive God elevates the risk of these.) Given their training in the Buddhist roots of Mindfulness, I'm sure Mindfulness teachers can logically explain and defend elements of Buddhist spirituality and their therapeutic relevance. But when will they get the chance to do that if most people won't even have a look in the door?

I wish the world were already disposed to the accepting, rational attitude that Mindfulness teaches (possibly thanks to its Buddhist roots). But it's not. As Jonathan Haidt describes, especially when it comes to the essentials such as well-being and faith, people are largely driven by intuition and emotion. They make choices that fit in with the values of their home tribes and groups -- including religion-based groups -- and may be suspicious of the practices of others. I especially wish Christians could put down clan loyalties long enough to see what treasures might be gleaned from other faiths -- and Mindfulness. But many can't or won't.

You say you don't believe me? Consider this: Six years ago, in the very same town where I studied Mindfulness, a series of churches kicked out or turned down a toddlers' exercise group that had been renting or trying to rent a room in their (Christian) church halls. Why? Because the class was called yoga. A pastor of a Baptist church was quoted in the local papers:
...Rev Simon Farrar said some toddler groups used the church hall. But he added: "We are a Christian organisation and when we let rooms to people, we want them to understand that they must be fully in line with our Christian ethos.
"Clearly yoga impinges on the spiritual life of people in a way which we as Christians don't believe is the same as our ethos. If it was just a group of children singing nursery rhymes, there wouldn't be a problem. But, [the teacher] she's called it yoga and therefore there is a dividing line we're not prepared to cross."
An Anglican priest told the "YumYum Yoga" teacher "it was unlikely any Christian organisation would accommodate her."

Buddhists may see themselves as peace-loving and tolerant, but currently groups focused on religious persecution are now putting Sri Lankan Buddhists on the list of tormentors of Christian pastors and Muslims. My experience with groups targeting "Christian Persecution" has left me suspicious and distrustful of their message and charity; nonetheless, I think they have the power to turn neutral views of Buddhism to close-mindedness and hate which could spillover to strongly Buddhist-tinged Mindfulness.

The toddler yoga and anti-persecution examples come not from the U.S. Bible Belt--where they really take religious affiliation seriously -- but from supposedly tolerant England!  As you'd expect, there's an evangelical anti-yoga/ anti-meditation U.S. movement as well. This sentiment features in a book by the lieutenant governor of Virginia, who writes:
When one hears the word meditation, it conjures an image of Maharishi Yoga talking about finding a mantra and striving for nirvana. . . . The purpose of such meditation is to empty oneself. . . . [Satan] is happy to invade the empty vacuum of your soul and possess it.
This isn't about rational thought or the actual content and effect of Mindfulness training (which does not, in my experience, advocate you empty yourself). What counts with the guy on the street is impression, appearance, and gut reactions. Buddhist-based psychology, you say? No way!

Bringing Mindfulness closely to heel with research-based science will probably also put some people off, but this is bound to be a much smaller group than would be driven away with a conspicuous Buddhist affiliation. Religion-based anti-science attitudes never got much of a foothold in Darwin's homeland, and they seem to have lost ground in America. The courts and even most religious groups now accept that science --even evolution -- should be taught in public schools as matters of fact, not  faith. This gives me hope that most people would accept Mindfulness if it sticks close to the growing scientific evidence that supports it.

2. Separation of Church and State: This isn't as relevant in the UK as in the United States, where the First Amendment of the Constitution prohibits government endorsement of any religion and  insists "no religious Test shall ever be required as a Qualification to any Office or public Trust under the United States." Would a pupil denied access to UMass's Mindfulness teacher training because they failed the  dharma test have the grounds for a Supreme Court Case? Since UMass is a state-supported institution receiving Federal grant money, I should think this might be a possibility.

Other meeting points of Mindfulness with government or the public sector should also be considered thin ice. I've mentioned before that the U.S. Marines are experimenting with advance Mindfulness training as a form of psychological armour to prevent post-traumatic stress disorder (PTSD). Veterans' Administration researchers are studying post-combat Mindfulness as therapy for PTSD. And I would guess that most larger Mindfulness research studies, in the U.S. at least, are being paid for with taxpayers' dollars-- from the National Institutes of Health, the National Science Foundation, or state-supported Universities and Medical Colleges, for example.

Again, I would like to think the awarding of public funding for research was rationally based on the merits of the science, as judged by peer grant review. But sadly, this again is a place where politics and religious and moral values intrude. I've seen, for example, presidential bans on embryonic stem cell research and congressional bans on funding studies of abortion, sex education, condom distribution, and clean needle distribution (to intravenous-drug users to prevent needle sharing, which fosters transmission of HIV-AIDS). (I've also seen Congress earmark funds for flakey projects that had no scientific basis -- but that was in a wealthier era...) Would Congress turn off the spigot of funding for Mindfulness research if they thought it promoted Buddhism? I think it's distinctly possible.

3. Ruining the Research: Standardizing Mindfulness into a tidy 8-week training package with defined instruction, practices, and teachers trained to a standard has given researchers around the world a (fairly) uniform common entity to work with. Researchers can be reasonably confident that they are studying, comparing, and making hypotheses about the same thing when they test this or that aspect of Mindfulness-based Stress Reduction, for example.

Remarkable studies on the effects of MBSR are coming out each week. Scientists are formulating testable hypotheses on how MBSR works. If the common standard holds for a bit longer, there's no telling how far this work will advance. I'm quite excited about it. Scientists may well find more efficient ways to convey the benefits of Mindfulness. They may precisely identify which aspects of Mindfulness training are key -- and then transfer these keys to other forms of therapy that could be accepted by people who can't take it as it is now.

But faith and spiritual practice don't lend themselves to standardization or scientific study. If Muslim and Christian versions of Mindfulness are the tip of an iceberg of modifications, adaptations and morphs to fit different groups, the uniform, common study subject vanishes. It's not impossible to accommodate and account for the added complexity, but I would guess that it would slow research progress and make between-study comparisons much more problematic.

Within individual studies, I would suspect that the more spirituality is part of Mindfulness, the fuzzier outcomes will be and the more difficult it will be to understand what's going on. It's a testable hypothesis, of course.

Should we care if research goes downhill? Yes, at least for now. I think there's still lots to be discovered about Mindfulness. Lots to be checked; maybe some earlier discoveries won't hold up. Science will learn more about how it works and can be made even more useful to humankind. But this is contingent on Mindfulness maintaining its popularity and credibility.

 Mindfulness without Buddhism?

I am a complete fool to write anything about Buddhism when I know so little about it. But some things I've read and heard suggest that the aims of at least some flavors of Buddhism are not incompatible with science. The Buddhist bits of Mindfulness might be well able to bend to assist Mindfulness silently--without speaking its own name.

I've started listening to a talk by Theravada Buddhist monk Ajahn Brahm. The talk is about the Buddhist view of creation, but in the long introduction, the monk (who was trained in Physics at Cambridge) makes some observations about religion, Buddhism, and science--which he sees as dedicated to truth, above all else--including "Being right." Ajahn Brahm says Buddhism is the same in that regard. So if it were to be true that there is a better way to do Mindfulness that doesn't involve Buddhism explicitly, wouldn't real Buddhists put the truth of better Mindfulness above historical pride, "being right" and displaying the Buddhist origins?

Brahm sees two types of religion-- those that bend the truth to fit the faith and those that bend the faith to fit the truth. Buddhism should be of the latter type, he says. "It doesn't matter what I say; It doesn't matter what Buddha says. You have to follow the truth. There are no sacred cows. " As with science,  people should be encouraged to challenge the teachings of Buddhism as a way of coming to truth. So here I am, eyeing the sacred cow, and wondering if we might challenge him. Does he really have to be a cow? Or could Mindfulness just rely on the fundamental essence of cow?

If Mindfulness™dared give up the sacredness of the cow,  it might ask what the key aspects of Dharma are that make for a good teacher. What is it in the Buddhist background that helps teachers understand and explain Mindfulness better? Is it commitment and discipline? Calling to a higher purpose? Is it connection to community? All of these can be explained and understood without reference to Buddhism.

If the Buddhist backdrop needs replacing, perhaps a substitute tapestry could be formed of relevant, secular-described elements from Buddhism. Positive psychology covers that territory and then some. This field is finding ways to observe and measure things--like Mindfulness--that contribute to human happiness and satisfaction with life. It might study faith practices, but it remains secular, scientific, and faith-free.

A Buddhism-free Mindfulness, otherwise identical but explained as an outgrowth of Positive Psychology, might be acceptable to a wider group of people and might avoid attracting destructive prejudice.

And perhaps, down the road, it will be time to build on the idea that many -- if not all -- religions and cultures have goals and practices similar to the Buddhist contributions in Mindfulness. A culturally neutral, basic Mindfulness would be a good common platform on which to build. So, when and where ties to religious and cultural groups are seen as necessary, teachers could "insert distinctive culturally-sensitive items here." Researched, planned carefully, this might extend the applications of Mindfulness without putting the whole endeavor at risk.
A postscript: Today's Amazon ad, bringing me personalized suggestions adapted to my interests, recommended Mindfulness, Plain and Simple. I looked up the author on the internet and found an apparently very laid-back Aussie mindfulness teacher. No religion, no highfalutin New Age Mindfulness™mumbo jumbo... just an ordinary guy telling other people about something that has worked beautifully for him (and some cartoon frogs, his chickens, etc.) He has posted several short videos on his "resources/videos"page, including one about what his Labrador Retriever has taught him about the fun of being present in the moment. At the bottom of the "classes" page is a link to a 20-minute meditation exercise. If I were in Australia, I would definitely drop by for one of his classes! This is the sort of Mindfulness I think lots of people can embrace.