Mindfulness for mental health

This morning the Guardian – the world’s most read online newspaper – has a front page article on how meditation is being adopted within the English NHS.

4 thoughts on “Mindfulness for mental health

  1. Dear Bhante,

    Do you think it is possible to teach mindfulness separately from “Buddhism”?

    If we are dealing with a person with depression or anxiety, who may be firmly established in another faith, for whom mindfulness is “prescribed” (as the article suggests) – can we ignore the possibility that this person will undergo a radical shift in their spiritual and psychological foundations and that in the short run, such a shift could be further debilitating?

    I propose that introducing mindfulness, if it is taught by one who does not understand the interdependant nature of psychological well-being and spiritual world view/foundations/practice – one who does not skillfully translate the compatibilities betwen “mindfulness” and the existing world view/faith foundation of the patient in terms they can identify with, could be harmful for the patient.

    HHDL says:
    “For those who are seriously thinking of converting to Buddhism, that is, of changing your religion, it is very important to take every precaution. This must not be done lightly. Indeed, if one converts without having thought about it in a mature way, this often creates difficulties and leads to great inner confusion. I would therefore advise all who would like to convert to Buddhism to think carefully before doing so.”
    http://hhdl.dharmakara.net/hhdlquotes111.html

    Thay and HHDL (and Buddhadasa – who also proposed to help people discover the heart of their own religion rather than convert them) have taken great care to make the Buddha’s teachings compatible with Christianity – Thay especially by translating concepts and language around spiritual practice to make the two quite compatible (as far as possible). Example, “the Kingdom of God is available in the here and the now.” (“dwell in the present moment,” in Christian terms)

    It is not that I do not think mindfulness cannot be separated from “Buddhism”, it is perhaps that I have not experienced teachings on mindfulness separated from the teachings of the Buddha, (I confess, I gave away my John Kabat-Zinn collection!) and that I am convinced either way that a radical shift in world view is inevitable. One that some “patients” going throgh more serious depressions and anxieties really have to be ready for.

    At a glance, most of the Maha Satipatthana Sutta does not appear incompatible with other religions…as long as the Four Noble Truths, Dukkha, Anicca and Anatta are limited in their scope to mental “stress” and not broadened to challenge one’s entire world view from the get-go.

    A deeper understanding of this is important to me perhaps because it influences how I share my own understanding of Buddhism with friends of other faiths and family in conversations. How to share that which is compatible, how to translate it into the other person’s language and wold view in a compassionate and practical way.

    A second concern would be this. If mindfulness starts to be taught broadly, who decides how this adaptation takes place and that people teaching it are truly qualified? What is the reference material? Is it going to be Maha Satipatthana (according to Goenka’s understadning, according to the Sutta alone, according to Goldie Hawn? as much as I love her!) and will Maharishi and Sri Sri Ravi Shankar and Father Thomas Keating and who knows who filter into the mix?

    A third concern would be how to avoid transferring the confusion onto that patient that soooo many of us have experienced within the Buddhist traditions! The last thing someone with anxiety or depression needs is more confusion. Would confusion be resolved by limiting the basic material to an abridged modern version of Maha Satipatthana? (and in case they run off to a meditation group, which of course they would – in order to support their new practice! – slip them a copy of Swift Pair of Messengers! to guard against further confusion)

    It is not that I disagree, but that we often say “hey this would be great!” but our discussions around practicalities may be limited – the nuts and bolts of how these things would work in a way that is truly beneficial.

    If you were leading the charge, Dear Bhante, what would the gold standard look like?

    _/\_

    • Dear Bhante

      Lisa has raised a very pertinent point and it is something that psychotherapists may harp on, especially in cases where the pathologies of depression may be based on a poor sense of self-worth that could potentially be damaged further by the deautomatization process in mindfulness practice. I found an old literature survey here –

      http://www.buddhanet.net/medpsych.htm

      Do you think Bogart makes a compelling rebuttal of the objections of the psychoanalysts? It is a rather old article from 1991, and I wonder if there has been more recent evidence that goes either way.

      With metta

    • Hi Lisa and Sylvester,

      Thanks for the comments, and Sylvester, thanks for the article, which I think is an excellent survey, although a little dated.

      To address the concerns that Lisa raised:

      When meditation and/or mindfulness is used in a therapeutic setting, it is typically used in a very mild, closely supervised manner, by a therapist who is specially trained to deal with the specific kind of mental health problem, and to notice adverse symptoms. Like any therapy, it is possible that there might be adverse responses, but I am not aware of any.

      Normally when the kinds of crisis that you are speaking of occurs in meditation, it is for one of two reasons. Either the person is at the stage of their own development when they are ready for some great change, in which case anything could be the trigger and it just happens to be meditation; or they are practicing in a very intense way, for example at a Goenka or Mahasi retreat, and the crisis is suddenly precipitated. In the second kind of case it can be very damaging, as the change is happening too suddenly, without integration in the person’a psyche as a whole. But this is almost impossible in the case of meditation/mindfulness in therapy, as they are far too mild.

      In the first kind of case, when a person has a dramatic existential crisis which emerges out of their own personal development, it would be far better to have this happen when they are in therapy, and they have someone to talk to and understand it, than it would be if they were not. I was just speaking with someone who is going through such a change, and one of their great anxieties was that they had no-one they could talk to in their family about it.

      There is no reason to think that meditation/mindfulness as applied in therapy will be associated with religious conversion. i have never heard of such a thing, but i will keep my eyes out for any studies. Again, conversion typically happens, if it is a true inner conversion, as a result of the development of a person’s whole self. If an encounter with doing a short session of meditation each day, a meditation which itself is doctrinally neutral, is enough to make someone change their religion, that means they must have been looking for something new anyway.

      I don’t agree at all that meditation practice will inevitably result in a shift in world view. Why should it? there are plenty of examples of yogis in history who have practiced various forms of meditation, and I don’t know of any cases of anyone changing their religion solely because of meditation. Typically, meditative experience will tend to deepen a person’s experience of their own faith. If a Christian, for example, practices metta, they will normally be even more convinced of the love of Christ and the truth of the Gospels.

      Mindfulness was not invented by the Buddha. Like so much else, he adopted it from the practices that he learnt before his Awakening. Like it or not, every practitioner is constantly adopting certain things and ignoring others. It’s simply not possible to do everything all the time! The idea that there is a “Buddhist” practice of mindfulness is just another convention. Actually there is just mindfulness that is practiced by someone who considers themselves a Buddhist, who has a certain conception of how that fits in with their path, that’s all.

      As for authorities, one of the positive contributions of the engagement between therapy and mindfulness is the use of careful empirical methods. The effectiveness of different approaches is constantly being assessed, and the application adjusted accordingly. What is taught to someone in therapy should not be the Mahasatipatthana Sutta, or the other authorities you mention, but a simple, practical method that they can apply to ease their suffering. If that works, a therapist’s job is finished. If the individual wants to take things further, that’s up to them, but once they do so they have left the therapeutic context and have embarked on a spiritual journey. That’s when they come and see me! And I’m very happy when I hear that someone has done meditation in a therapeutic setting, as much of the basic groundwork will have been covered, making my job much easier.

    • Dear Ajahn Sujato ,

      Ajahn Sujato wrote: “Mindfulness was not invented by the Buddha. Like so much else, he adopted it from the practices that he learnt before his Awakening. …The idea that there is a “Buddhist” practice of mindfulness is just another convention.”

      According to the Buddha in the Ananus Sutta ( Unheard Before) and the Brahma Sutta , mindfulness of the Body while walking, sitting, reclining, etc.. and the other three focus of Mindfulness in the Sathipathana was not previously heard before. That is not to say the it has never existed in the time of the previous Buddha:

      “At Savathi.

      1. ” The contemplation of the body in and of itself’- thus, bhikkhus, in regard to things not previously heard before, there arose in me vision, knowledge, wisdom, true knowledge, and light.

      ” That contemplation of the body in and of itself is to be developed’..’ That contemplation of the body in and of itself has been developed’- thus, bhikkhus, in regard to things not previously heard before, there arose in me vision, knowledge, wisdom, true knowledge, and light.

      2. ” This contemplation of feelings in and of itself’….

      3. ” This contemplation of mind in and of itself’…

      4. ” This contemplation of phenomena in and of itself’- thus, bhikkhus, in regard to things not previously heard before, there arose in me vision, knowledge, wisdom, true knowledge, and light.

      ” That contemplation of phenomena in and of itself is to be developed’…That contemplation of phenomena in and of itself has been developed’- thus, bhikkhus, in regard to things not previously heard before, there arose in me vision, knowledge, wisdom, true knowledge, and light.”- Ananus Sutta ( Unheard Before)

      According to the Brahma Sutta (SN 47.18) the Knowledge of the Four Satipatthana as a Way to Nibbana arose in his mind shortly after awakening:

      On one occasion the Blessed One was staying at Uruvela, on the bank of the river Neranjara beneath the Goatherd’s Banyan Tree, just after Awakening. Then, while the Blessed One was alone in seclusion, there udapadi (originated, arose) in his mind the following parivitakko (reflection, consideration) :

      ” This is the ekayana magga (straight path, path with only one possible destination, one-way path ) for the purification of beings, to overcome of sorrow and misery, the ending of pain and displeasure, for the achievement of the method, for the realization of Nibbana, that is the four establishments of mindfulness (satipaṭṭhānā ) .

      “What four? Here a bhikkhu dwells contemplating the body in and of itself, strenuous , clearly conscious , mindful, having removed covetousness ( abhijjha, craving, grasping) and displeasure related to the world. He dwells contemplating feelings in and of itself… mind in and of itself… phenomena (dhammanupassi, anupassi: one who contemplates, dhamma: truth) in and of itself, strenuous, clearly conscious, mindful, having removed craving / grasping (abhijjha, covetousness) and displeasure ( domanassa, displeased, disfavor, dejection) related to the world. This is the Ekayana Magga (straight path, one-way path, path with only one possible destination) for the purification of beings…that is, the four establishments of mindfulness (satipaṭṭhānā) .”

      Then Brahma Sahampati, having known with his own mind the reflection in the Blessed one’s mind, disappeared from the brahma world and reappeared before the Blessed One, just as quickly as a strong man might extend his drawn-in arm or dwarf in his extended arm. He arranged his upper robe over one shoulder, raised his joined hands in reverential salutation towards the Blessed one, and said to him:

      ” So it is , Blessed One! So it is, Fortunate One! Venerable sir, This is the ekayana magga (straight path, path with only one possible destination, one-way path ) for the purification of beings, to overcome of sorrow and misery, the ending of pain and displeasure, for the achievement of the method, for the realization of Nibbana, that is the four establishments of mindfulness (satipaṭṭhānā) . ”

      That is what Brahma Sahampati said. Having said this , he further said this:

      “The one-way path he knows, the Compassionate One,

      He who has seen the end of births:

      By which in the past ( such as during the time of previous Buddha) they crossed the flood,

      By which they will cross and cross over now.”

      Among other concepts that occurred to him beneath a tree shortly after awakening includes, Dependent Origination, Transcendental Dependent Origination, and The Five Indriyas, etc. The Brahma Sutta ( S.v.232f) mentioned that as the Buddha was reflecting on the Five Indriyas (saddhā, sati, etc.), as a way to Nibbāna, Sahampati appeared and agreed with him. He related to the Buddha how, when he was a monk named Sahaka, in the time of Kassapa Buddha, he practiced the Five Indriyas and became an Anāgāmī ( third level of Awakening) born in the Suddhavasa world as Sahampati.

      With Metta,

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