Meditation, poverty and mental health; psychology and nonduality

We know that poverty can make poor mental health more likely. But therapeutic interventions rarely consider the root causes of mental illness. Could nondual treatments be a solution?

Poverty is a factor in poor mental health

The BPS’s project to support people move from poverty to flourishing has highlighted several important issues; among the most challenging is the notion that mental health is not a ‘DIY project’.1 The challenge arises because, in psychology, there are technical and conceptual barriers to considering social factors such as community and institutional engagement in clinical intervention. However, the social networks that mediate mental wellbeing are becoming even more critical in the COVID and post-COVID worlds.2 Positive social interaction is foundational to health and wellbeing, but many clinical interventions fail to integrate biopsychosocial models into diagnosis and treatment. And the reductive nature of experimental psychology places barriers to considering the individual and the social concurrently. Understanding the personal cost of poverty requires a wide lens; mental suffering doesn’t exist in isolation to family, community or institutions.3 Integrating and tackling mental health’s inner and outer determinants is central to countering the psychological damage caused by enduring poverty. This article will discuss how compassion mind training (meditation) can address mental suffering while encouraging supportive social networks. I’m also going to argue that to access the full potential of compassion mind training, new psychological approaches to meditation are required.

Although there are challenges to defining compassion, the wish and/or the action to alleviate suffering is an acceptable description for many working in the field. Therefore, it is not controversial to argue that a more compassionate society would reduce suffering. There is also evidence that more compassionate individuals suffer less. Although an oversimplification, it’s worth pausing on the notion that compassion interventions can support individual psychological wellbeing and the social factors able to mediate mental health. The consideration of clinical interventions linked to broader social settings is unusual for many psychologists, certainly those working in experimental settings. But understanding how poverty affects a person within their environment is a priority. Without attention to the root causes of mental suffering, psychological interventions will only have a modest impact. I’m not talking about social policy here (in any direct sense); instead, I’m suggesting that more attention needs to be given to curative approaches that address both the internal (mental) and external (social) causes of suffering. Over the last two decades, the growth in compassion research has emerged from the project to medicalise spiritual meditation. But few of the 7,000 meditation studies published over the previous eight decades address the biopsychosocial potential of meditation. Ironically, this holistic and now neglected aspect of traditional meditation was critical to the initial academic and scientific interest.

The reasons for reluctance to consider social factors, alongside mental health treatment, are typically linked to preserving the integrity of the experimental method. Controlling potential confounding variables has always been a central goal of experimental psychology. But compassion mind training highlights that mental states are influenced by cognitive processes based on our inner and outer worlds. Medicalised meditation is one area of research and practice where therapy considers both the psychological and the social. Over the last twenty years, compassion mind training has been shown to improve, physical and mental health as well as social relationships. In their 2017 meta-review of published compassion studies, James Kirby, Cassandra Tellegen and Stanley Steindl concluded that compassion interventions held ‘promising’ potential to reduce suffering from depression, anxiety, and psychological distress.4 Two of the leading advocates for the use of compassion training are Paul Gilbert and James Doty. Paul Gilbert OBE is the founder of Compassionate Mind Training (CMT) and  Compassion Focussed Therapy (CFT), Dr Doty has been the driving force behind Stanford’s Center for Compassion and Altruism Research and Education (CCARE). Between them, Doty and Gilbert have highlighted how compassion mind training can support individual and collective mental health. Gilbert’s 2019 exploration into the nature and function of compassion sets out current research and practice.5 Particularly relevant here is the notion of compassion as a ‘social mentality’. In this context, social mentality refers to the creation of relationships. Although this concept falls far short of the use of compassion in spiritual meditation, it signposts new opportunities for scientific understanding.

A multi-directional view of compassion allows a relationship of mutual support between the psychologist and the patient to develop. In this scenario, peers come together to solve problems; hierarchical limitations are less pronounced. Gilbert uses the primary caregiver-child relationship as an example of this reciprocity, but this illustration is most useful as a heuristic to think about compassion in new ways. Rather than the passive recipient of therapy, the patient also becomes a catalyst for compassionate thoughts towards others. Mind training in compassion can be, as Gilbert describes, a dynamic process between patient and clinician, but it is not necessarily limited to that. Compassion can support the mental health of the patient while also developing their compassionate insights towards society more generally, and thus stimulating increased social engagement. The research agenda of CCARE includes investigation of ‘methods for cultivating compassion and promoting altruism within individuals and society-wide’.6 These are the nondual insights that highlight the potential of mind training to support mutually dependent relationships between community and self.

Despite pioneers such as Gilbert and Doty, compassion research appears to be developing the same limitations as other forms of medicalised meditation. Construct validity is still uncertain, and reliable psychometric instruments are a work in progress. And if you follow the literature, you will find frequent overlaps between compassion and concepts such as empathy, altruism and loving-kindness. Attempts to reduce the idea of compassion by establishing the binary constructs of self-compassion and other-compassion have also run into difficulty; in 2017 Christian Kandler and his colleagues demonstrated that self-compassion is a facet of neuroticism.7 From a historical perspective, several common problems are visible in the relocation of meditation to psychology. For example, similar methodological and theoretical limitations exist in the research of mindfulness, compassion and related pro-social behaviours.8 While it might be premature to suggest the scientific study of meditation in its current form (and therefore compassion mind training) has reached an impasse; clearly, there are obstacles to making further progress. The scientific study of meditation technologies is rich with intersections between traditional spiritual practice and psychology. For example, Doty and Gilbert both draw heavily on Tibetan Buddhist influences in their work. But while psychology can safely observe the effects of traditional meditation from a scientific perspective, integrating practices from spiritual traditions with psychology is a risky undertaking. Risky on several levels, but primarily because of the conflict between the world views of Western science and Eastern knowledge systems.

The migration of traditional meditation from the temple to the laboratory followed a long and complicated path. Many of the problems and opportunities for meditation-based mind training come into sharper focus when we consider meditation’s scientific history. From the early engagements, western scholars and scientists have been working on two broad trajectories to medicalise Eastern mind training methods. The paths of integration and appropriation. The integration path can be traced back through the medical counter-culture, Zen psychotherapy and Buddhist reform movements of the late 19th century. Experimental work with electroencephalographic (EEG) technologies from the 1930s laid the foundations of the path of appropriation. The rise of scientist-practitioners since the 1970s, people such as Robert Wallace and Jon Kabat-Zinn, accelerated spiritual and psychological convergence. In both interconnected strands, foundational cognitive elements of traditional meditation, such as ethical judgement and compassion, were uncoupled from modern medicalised methods. These ‘human’ factors give spiritual meditation holistic curative potential through the interconnectivity between self and others. Richard King and Steven Stanley are just two of the academics that highlight the loss of these elements during meditation’s relocation. In scientific investigations of mind training’s operational features, I have found no comparative studies that evaluate traditional meditation methods with reference to their ontological frameworks. This inevitably means that we have uncoupled compassionate mind training practices, by accident or design, from their original conceptual contexts. This same point applies to mindfulness meditation.

There is no question of normativity here or comparative judgement of the psychological methods over spiritual practices (or vice-versa). The issue under discussion is, how can compassion mind training be best used to support people from poverty to flourishing? Despite a lack of replication, the cumulative evidence for the benefits of compassion methods is significant. However, in common with mindfulness, compassion meditation remains a ‘promising’ rather than an effective mental health intervention. We should not underestimate the impressive progress made in this field, particularly since the 1970s. But the challenges presented by increasing levels of poverty require more reliable and flexible meditation-based interventions. In order to harness the full potential of compassion mind training, two questions need to be addressed; what happens to traditional meditation methods translated to psychological interventions, and what is lost or gained in the process?

Even a preliminary investigation of Buddhist (Mahayana) ‘science and philosophy’ reveals foundational concepts underpinning meditation methods such as ‘relative compassion’, ‘nonduality’ and ’emptiness’. But acknowledgement of these elements in traditional meditation is almost totally absent from the psychological literature. It is problematic to relocate human technologies to new knowledge systems without understanding the original cognitive components. This is an approach that risks creating interpretive forms that lack essential elements. The uncoupling of meditation from its full potential during the migratory process probably explains the perennial ‘promising’ tag that has followed the clinical use of meditation for fifty years. New translated forms of mind training could develop into effective Westernised psychological interventions in their own right. But taking the historical perspective, I’d ask how long will it take and how useful will they be? The pressing challenge of tackling the suffering linked to poverty requires new approaches to develop our current knowledge.

Perhaps the most significant limitation in the project to medicalise meditation is the failure to find a common language for psychology to engage with the traditional forms of meditation. There is a need for a lingua franca, a conceptual rosetta stone that will allow psychologists to access the curative potential of compassion long observed in Buddhist meditation. Doty, Gilbert and others frequently hint at this potential but generally retreat into positivist terminology to investigate and describe it. The role of meditation in supporting mental health and social networks remains largely theoretical or anecdotal to psychology. The shortfall between what medicalised meditation is and what it could become appears to be brought about by inflexible approaches to non-Western knowledge systems; a tendency to translate human technologies ahead of the full documentation of psychological benefits. The scientific history of meditation indicates that psychology requires more sophisticated ways of understanding the world if it wishes to unlock mind training’s full potential. While positivism is a powerful investigative tool, its current form appears unable to penetrate aspects of traditional (non-positivist/nondual) knowledge systems. Given the growing role of meditation technologies in society, the creation of a new discipline to access traditional knowledge is long overdue. The development of nondual psychology would create an approach able to consider the curative potential of traditional compassion meditation (and its operational cognitive components) free of the distortions of cultural and ontological translation.

Notes


1 ‘From Poverty to Flourishing: Towards 2021 | The Psychologist’ https://thepsychologist.bps.org.uk/volume-33/october-2020/poverty-flourishing-towards-2021.

2 Ichiro Kawachi and Lisa F Berkman, Social Ties and Mental Health, Journal of Urban Health: Bulletin of the New York Academy of Medicine, 2001, lxxviii.

3 ‘WHO | Social Determinants of Mental Health’, WHO, 2019 http://www.who.int/mental_health/publications/gulbenkian_paper_social_determinants_of_mental_health/en/ [accessed 4 January 2021].

4 James N Kirby, Cassandra L Tellegen, and Stanley R Steindl, A Meta-Analysis of Compassion-Based Interventions: Current State of Knowledge and Future Directions, 2017 <www.elsevier.com/locate/bt>.

5 Paul Gilbert, ‘Explorations into the Nature and Function of Compassion’, Current Opinion in Psychology (Elsevier B.V., 2019), 108–14 https://doi.org/10.1016/j.copsyc.2018.12.002.

6 Mission & Vision – The Center for Compassion and Altruism Research and Education’ http://ccare.stanford.edu/about/mission-vision [accessed 4 January 2021].

7 Christian Kandler and others, ‘Old Wine in New Bottles? The Case of Self–Compassion and Neuroticism’, European Journal of Personality, 31.2 (2017), 160–69 https://doi.org/10.1002/per.2097.

[8] Nicholas T. Van Dam and others, ‘Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation’, Perspectives on Psychological Science, 13.1 (2018), 36–61 https://doi.org/10.1177/1745691617709589.

If mindfulness works, we have to be able to produce the evidence

The longer the science of mindfulness resists reforms, the greater the risks to the technology.

Buddhism and mindfulness
Making sense of mindfulness research

Leading UK economist Richard Layard has drawn further attention to the growing controversy surrounding mindfulness meditation. In his recent book Can we be happier?, Layard sends a number of uncertain messages about the role and benefits of mindfulness. The central premise contained in the Introduction is that by increasing levels of altruism, a new age of increased happiness can be established. Throughout the book, mindfulness and meditation are used as examples of technologies able to support the ‘happiness revolution’. But confusingly, Layard highlights concerns that the altruism present in traditional meditation methods, has been erased from secular forms of mindfulness. According to Layard’s hypothesis, if mindfulness decreases altruism it might reduce happiness. The same problem may be present with any self-focused form of mind training, self-compassion or CBT for example.

man wearing black crew neck top

Can we be happier? also misses the opportunity to discuss the lack of replicated data in mindfulness research. Several scientific reviews have argued that revisions to the methodologies used to study meditation are required.1 Given the status of Layard as a leading authority in the science of happiness, his failure to mention this growing problem is surprising. Leaving the book open to accusations of a lack of scientific objectivity.2 A tendency to ignore critical reviews from academics and scientists is causing increasing damage to the reputation of the contemplative sciences. If action isn’t taken by the scientific and clinical communities, there is a danger that the progress of mindfulness will be stalled further. There are three pressing issues that need to be addressed by professionals working in this field.

  • The body of research needs to be reviewed and a distinction made between reliable (fully replicated studies) and unreplicated (unreplicable) work.
  • Any systemic problems must be acknowledged and a plan of action to eliminate them agreed.
  • Robust theoretical frameworks need to be established.

“Those of us with a long experience of meditation, know how valuable a technology it is. But if we wish that meditation and mindfulness are treated as scientifically reliable, we must meet the required standards of evidence. Including a need for extensive replication.”

Stephen Gene Morris

Notes:

1 Nicholas T. Van Dam and others, ‘Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation’, Perspectives on Psychological Science, 13.1 (2018), 36–61.

2 https://www.theguardian.com/books/2020/jan/23/can-we-be-happier-richard-layard-review

Science demonstrates the benefits of altruism

Initial findings suggest that our own suffering can be reduced through altruistic acts.

A community support projects
Helping others may be the way to our own fulfilment

Authors: Wang, Y., Ge, J., Zhang, H., Wang, H., & Xie, X.

Year: 2019

Title: Altruistic behaviours relieve physical pain

Summary: There has been a trickle of studies investigating the health benefits of prosocial behaviour in recent years. And research into altruism has remained at the periphery of psychological enquiry. A search of academic databases reveals greater scientific interest in ‘self-compassion’ than ‘compassion for others’ in recent years. The paper by Wang et al. poses some problems for current thinking in psychology. That selfless acts may hold the key to reducing the experience of pain. But, in common with all experiments involving complex human behaviours, the findings of this paper need validating through replication.

As a starting point, this study built on the foundations of two pilot investigations. Its cognitive insights are underpinned by the results of brain imaging technology (fMRI). The researchers found that altruism relieved pain in both experimental and clinical settings. The clinical participants were cancer patients suffering from chronic pain. The goal of the experiment was to test the hypothesis that altruism could reduce physical suffering. In this regard, the results were significant. People undertaking altruistic acts did experience less pain than participants in control groups. More experienced experimental psychologists might like to comment on the methods, but they appear to be robust. We should treat such radical findings with caution of course, but also bear in mind this is not a new idea. Compassion and altruism exist in every culture; they are universal human traits.

Successful repetition of these experiments would open up new areas of research into pain management. While also signposting new understandings of the mind. For example, a link between pro-social behaviour and mental and physical wellbeing more generally. This latest study should encourage scientists and clinicians working with compassion meditation.

“If found to be reliable, these findings may put behavioural sciences on a new trajectory.”

Stephen Gene Morris

Link: www.pnas.org

Better mental health through meditation?

adult air beautiful beauty
Photo by Oleksandr Pidvalnyi on Pexels.com

Authors: Kieran C.R. Fox, R. Nathan Spreng, Melissa Ellamil, Jessica R. Andrews-Hanna, Kalina Christoff

Year: 2015

Title: The wandering brain: Meta-analysis of functional neuroimaging studies
of mind-wandering and related spontaneous thought processes

Summary: Thinking about the most common effects on the brain from meditation will lead you into an area that psychologists call spontaneous thoughts. These are defined as thoughts and ideas that seem to come out of nowhere and don’t necessarily have any obvious relationship to a specific task you may be undertaking. Meditation scientists have long considered that the most popular forms of secular meditation lower activity in regions of the brain known as the Default Mode Network (DMN). The DMN is strongly connected with, self-reflection, thoughts about relationships with others, memories of the past and our ability to project into the future. It is also the home to our mind wandering or drifting.

Mind wandering can increase under certain conditions and has been linked to a number of long term mental health problems including anxiety and depression. Many forms of meditation reduce activity in the parts of the DMN known to support spontaneous thoughts and mind wandering. This can be a great help to people that have problems concentrating or are troubled by negative or challenging thoughts. The research by Fox and colleagues undertook a review of 24 functional neuroimaging studies looking into mind wandering/spontaneous thought. Results confirmed that well-established centres in the DMN (medial prefrontal cortex, posterior cingulate cortex, medial temporal lobe, and bilateral inferior parietal lobule) were associated with mind wandering. However, it was evident that a number of other brain regions were also engaged. The significance of the study was that spontaneous thought cannot be regarded as universally linked to a limited number of centres in the DMN. A range of regions in different networks appears to be instrumental to spontaneous thought and mind wandering.

The implication for meditation practitioners and researchers is that the apparent act of suppression or restriction of activity in the DMN cannot be seen in a narrow context and may have a broader implication for a number of interrelated processes.

Link: https://www.sciencedirect.com

Deepening crisis in meditation research

Is contemporary mindfulness a meditation practice or something different?

pexels-photo-203553.jpeg

Two leading researchers from contemplative science respond to a critical study of meditation and mindfulness research.

Authors: Richard J. Davidson and Cortland J. Dahl

Year: 2018

Title: Outstanding Challenges in Scientific Research on Mindfulness and Meditation

Summary: The article begins by applauding the critique of Van Dam et al. This is only to be expected, published meditation and mindfulness research often falls short of the methodological standards normally required of journal articles in cognitive psychology and neuroscience. The authors address the five points raised by the original paper in a very linear fashion, not appearing to engage with the underlying issues. The same issues that have dogged meditation research since the launch of MBSR. However to summarize the five rebuttals contained in the paper:

1 – The criticisms of meditation research reflect weakness in psychological research more generally.

2 – Contemplative practices are varied and scientific enquiry is only able to understand a few limited forms.

3 – Mindfulness and contemplative practices were not originally therapeutic in nature

4 – Research has failed to understand meditation in a relevant context.

5 – Mobile technology may be able to resolve some of the methodological issues.

Link: http://journals.sagepub.com

Author’s Critique: It is important to note that Davidson and Dahl are leaders in this field, but if they permit I offer some observation as an experienced meditator and trained neuroscientist and cognitive psychologist.

Psychology does not appear to understand meditation in the broadest sense, the (mis)appropriation of the term mindfulness has led contemporary meditation research into a limited field of investigation without clear definitions. For example, the reduction of meditation (or mindfulness) to method alone, existing in isolation to wider cognitive processes is hard to understand in the context of traditional meditation. And it must be acknowledged that the MBSR/MBI movement uses methods ‘congruent’ with traditional meditation.

If we strip the motivation of the meditator from the meditation rationale we change the entire cognitive setting. To use a rough analogy, I can train people to kick a football but if participant A is training just for a course credit and participant B is training to play in the World Cup final we can expect the effect of the training to be different. This doesn’t just mean that comparing traditional and contemporary meditation practices is fraught with difficulty but that the current understanding of how we research meditation needs to be refined. Traditional meditation literature spanning hundreds of years indicates that two people undertaking the same practice may not experience the same effects. Their individual motivation, their capacity to meditate, external conditions such as the availability of a reliable teacher and methods can all play a part. Psychology has the instruments to consider and account for many of the factors presumed to impact on the effect of meditation, but generally, the method alone dominates the thinking of meditation scientists.

Don’t misunderstand me, the study of MBSR and related families of mindfulness are legitimate objects of clinical enquiry and experimental study. They have however unconfirmed connections with mindfulness in its many forms as practised in spiritual traditions. Buddhism is not one unified tradition, there are different approaches to what one might call mindfulness, these extend from ‘bare attention’ through to ‘shine’ as practised in Tibetan traditions. Often shine is only engaged with after many years of stable foundational practice and if approached from the Vajrayana perspective would be embedded in a context of a nondual appreciation of human consciousness.

The ability of the meditation teacher and the degree of challenge to dualistic thinking are just two factors able to meditate the impact of a meditation method. But these and other components are generally ignored by scientific studies, even strategic reviews and meta-studies. In a traditional context, a meditation master may undertake decades of practice and study to understand meditation on theoretical and experiential levels. Therefore the capacity of the meditation teacher is an established factor in the progress of traditional meditation students but this is rarely discussed in the scientific literature. The point is that the assumption that the teaching of the meditation method is not a potential variable in any experiment is probably unscientific. The Van Dam et al. study is one of the first to suggest the role of the teacher can influence the effect of meditation training on participants.

Leaving aside traditional mindfulness methods, the reliability of the term mindfulness in relation to MBSR and other contemporary practices needs some further work. Several recent studies have highlighted a lack of consistency in the way mindfulness is understood and thus operationalised. Perhaps this is the single biggest challenge meditation research faces today. If there is a weakness in the reliability over what mindfulness is, how it is understood, applied and taught, it makes experimental replication difficult. Without methodologically sound replication the building blocks to advance meditation research can’t be put in place. This I think is the main message from the Van Dam et al. review. Consider that the scientific investigation of meditation in the west is at least 45 years old, an estimated 15,000 meditation studies have been published in that time and yet experimental work is still often described as ‘preliminary’. What is the strategy to elevate meditation research to a more reliable footing?

Conceptual and Methodological Challenges in Mindfulness and Meditation Research

How to think about the research of contemplative science

pexels-photo.jpg

Title: Conceptual and methodological issues in research on mindfulness and meditation.

Authors: Davidson, Richard J.; Kaszniak, Alfred W.

Year: 2015

Summary: Notwithstanding over 45 years of research into meditation there are growing concerns about conceptual and methodological challenges in this field. There are both similar and different issues facing meditation and mindfulness but three particular questions this paper discusses are:

  • How can the first person experience be understood and studied in contemplative science?
  • Is there a reliable and consistent understanding of terms within meditation and mindfulness research?
  • What tools can be used to overcome conceptual and methodological challenges to gathering and interpreting data?

Perspective: Cognitive psychology, social psychology

Link: http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/a0039512

Loving-kindness Meditation for Posttraumatic Stress Disorder: A Pilot Study

What is the effect of loving kindness meditation for post traumatic stress disorder

pexels-photo-48566.jpeg

Authors: Kearney DJ, Malte CA, McManus C, Martinez ME, Felleman B, Simpson TL.

Year: 2013

Title: Loving-kindness Meditation for Posttraumatic Stress Disorder: A Pilot Study

Summary: A trial of loving kindness meditation was undertaken with veterans suffering from posttraumatic stress disorder (PTSD). Participants were given 12 weeks training in loving-kindness meditation and measured for PTSD, depression, self-compassion, and mindfulness at different stages. The effects of this pilot demonstrated a range of benefits for participants from the meditation and concluded that the practice was both “safe” and “acceptable”. A pilot study but really strong participant attendance (74% involved in 9 to 12 classes) and fascinating results:

  • self-compassion increased with large effect
  • mindfulness increased with medium to large effect
  • PSTD symptoms subject to a large effect at 3-month follow-up (d = -0.89)
  • depression  subject to a medium effect at 3 months

Perspective: Health psychology, positive psychology, clinical psychology

Link: http://www.ncbi.nlm.nih.gov/pubmed/23893519