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.
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.
 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.