Book Review: Siddhartha’s Brain by James Kingsland

sid-brainSiddhartha’s Brain, written by science journalist James Kingsland, opens with what would be a somewhat shocking quote from Ajahn Amaro, a Buddhist monastic in the UK.

We are all mentally ill.

While this should not quite raise the eyebrows of mental health professionals, it is a rather bald (apologies to Ajahn Amaro!) statement to make in public. However, it does set the tone of Kingsland’s book which takes, by turns, an unflinching look at the state of the mindfulness industry today and the roots of its conception in Buddhist teachings. Kingsland presents his work imaginatively. Using the development of the Buddha, Siddhartha, from pampered and protected prince to a teacher of the Eightfold Path to liberation from suffering, he weaves what we know of Siddhartha’s quest and practice into what we know of the results of our current pursuit of liberation through mindfulness. And, it begins with acknowledging that we are all mentally ill.

In this insightful book interlacing the current findings of brain function, mental states, and mental health with the teachings of Buddhist psychology, Kingsland is a craftsman in making neuroscience accessible and presenting it through the lens of contemplative practices. Using the story of Siddhartha Gautama’s own journey to enlightenment, he draws a rich landscape of the merging of Eastern contemplative practice, Western psychology, and contemporary mindfulness.

As a device to introduce us to the roots of contemporary mindfulness and place the history and progress of the Western approach to knowing the mind in that historical context, Kingsland has done a much better job than most writers. Siddhartha’s Brain doesn’t fall into a polemic of modern science or a contemplative holier-than-thou pit; that is refreshing. The writing is crisp and clear, quiet and confident. It invites examination of concepts not by attempting to convince but by introducing perspectives that are easily testable by the reader. Of course, that is in essence the basic teaching of the Buddha: ehi passiko – come and see (for yourself).

Kingsland makes the important point – as have many Buddhist teachers – that one does not have to be Buddhist to meditate or benefit from the practice. In fact, one of the enjoyable aspects of Siddhartha’s Brain is a broader bandwidth than just a Buddhist social and political transmission of wisdom. Kingsland draws from evolution science, psychology, anthropology, and philosophy, weaving them together  with ease. Most poignant for me was his examination of the early beginnings of meditation through the stories of Herbert Benson and the Transcendental Meditation practitioners of Indian guru Maharishi Mahesh Yogi. Benson’s downfall in the community of psychology is a sad part of our collective history and Kingsland’s insight into Benson’s work – that the foundation of all meditation is the evocation of the relaxation response – is a validation of Benson’s valuable work.

I particularly recommend Chapters Three and Four for their lucid descriptions of the roots (The Cloud of Unknowing) and rationale (The Second Dart) for meditation and practice (and a more universal presentation than just a Buddhist one). It’s a bit more of a slog in Chapter Five (The Man Who Disappeared) only because the idea of a “self” that is not fixed in any one definition or role is still alien to our Western senses. Even in psychology today the discussion of identity is a confounding mess with terms like self-esteem, self-image, existential self, categorical self – all of which rests on a concept of a separate(d), individuated entity. Chapter Five will challenge your notions of these variegated and rarefied selves but also introduce you to the social neuroscience that actually supports the observation that there is no fixed unity called a “Self”. As Kingsland puts it:

Thus, from moment to moment, each of us is no more than a unique blend of spices, a homemade garam masala. (p. 101)

My favourite part of the book is the running theme of the Default Mode Network (DMN), a concept gaining much traction in the neuroscience of mindfulness to explain the fluid state of connection/disconnection that can lead to rumination as well as creativity. Kingsland’s description of how the DMN plays a role as our “Self app” that “(posts) repetitive messages of a personal nature on the screen” is a brilliant image of what happens when we wander down those “dark neighbourhoods” noted by the writer Anne Lamott as places she “never goes alone”.

Kingsland continues in Chapter Ten (Wonderful and Marvelous):

The marvel is that we can learn to control at will the signals that determine which track we take at any particular moment. By honing our powers of attention and emotion regulation through mindfulness practice, we can, if we wish, restrict the time we spend in self-focused, narrative mode of thinking that can lead to anxiety and depression. We can choose to take the scenic route, favouring a more experiential mode of being in which we are not held captive by our thoughts but rather treat them as transient mental events. (p. 235)

Now, I do have two quibbles – not with the book itself but the information offered from two sources. First, (p. 249) when inquiring into the frequently made claim that meditation can trigger unstable mind states, researcher Britta Hölzel is quoted as saying (somewhat flat-footedly) that “I (Hölzel) have never seen any major problems like that in our classes.” This is a common statement I hear from researchers and teachers of various mindfulness-based programs, which while true evades the question itself. In fact, we have, at the Ottawa Mindfulness Clinic, had many applicants to our program who want to learn mindfulness and are fearful because previous experiences have resulted in intense mental distress, including dissociation, depersonalization, and profound anxiety. Whereas it is quite likely that in Hölzel’s experience there have not been such occurrences, it does not therefore mean this is not an area to be sensitive about as clinicians and to investigate further as researchers. Ottawa psychologist Nicola Wright and colleagues have written about adapting mindfulness for vulnerable populations and it does behoove us to acknowledge this as a necessary direction for future research and definitely for caution.

Second, Ajhan Amaro, who seems to have been a delightful guide and teacher for Kingsland, wrote an important response to our target article in Mindfulness (journal). He calls for a need to include ethics explicitly as a core component of mindfulness programs. I do respect the stance taken by MBSR developers that the cultivation of ethical action is inherent in its programming (see discussion on p. 269 of Siddhartha’s Brain). However, a statement of presumed fact is not a substantiated fact nor does it address whether the outcome is in the desired direction. Given that no therapeutic intervention is values-neutral, the examination of how mindfulness can become weaponized (see my earlier blog post) is important. After all, we are collectively responsible to examine if mindfulness training does give rise to skillful action and ultimately compassion for ourselves and all others.

Kingsland has done well in this book to translate complex concepts into accessible knowledge and convey ancient wisdom with a gentle, inviting voice. If you are at all fascinated by how and why our brains and being are the way they are, read this book. If you are curious about how meditation and mindfulness practices can help with the everyday struggles of just being human, read this book.

Credible Teachers of Mindfulness: How can you know?

Mindfulness-Based programs have become the go-to treatment around the world and their popularity has made treatment more accessible in many ways. Despite the popularity or maybe because of it, several articles have argued against mindfulness because it  (1) seems to be the fix-it for many ills, (2) doesn’t stay true to its Buddhist roots and (3) understates its “dark side”. There is concern that mindfulness therapies and programs are often sold as much better than the traditional methods of treating depression, anxiety, and other psychological disorders. Such concerns were supported when a recent study showed that statistically mindfulness-based therapies (MBTs) have a moderate effect when studied in comparison with wait-list controls and when participants are compared to their pre-post scores. More than that, MBTs are not better than traditional cognitive behavioural therapy or pharmacological treatments. The deepest concern however relates to the qualifications of those who teach mindfulness as more and more programs are offered by individuals and groups with little or no training in mindfulness concepts and approaches.

Elisha Goldstein, writing for the magazine Mindfulness, re-stated some of these issues that constitute a “mindfulness backlash” in his recent blog post which claimed that there is little evidence for a backlash. What stands out in his discussion about the issues facing programs that offer mindfulness is the emphasis on trusting that “skilled mindfulness teachers” will neither over-sell the treatment scope and that “credible teachers” will walk participants through their misunderstanding of what is mindfulness. Goldstein goes on to say – even more emphatically – that it is important to seek out teachers who are well-trained. He adds a link to finding qualified teachers via the Center for Mindfulness at the University of Massachusetts, the birthplace of Mindfulness-Based Stress Reduction (MBSR).

What is left unsaid however is that the focus of all discussions and debates of mindfulness programs are anchored in the original one, Mindfulness-Based Stress Reduction (MBSR). This particular program was developed by Jon Kabat-Zinn and the acronym has taken on an iconic status much like the terms Xerox or Kleenex. When most professionals discuss mindfulness programs they are typically referring to MBSR unless it is clear from the outset that the topic is related to Mindfulness-Based Cognitive Therapy (MBCT). This assumption leads to confusion because MBSR, while being the original, is not the only mindfulness treatment program.

Does it matter? Absolutely. While most programs have a similar format (8-10 weeks, groups, meditation and yoga, etc.), significant aspects of the program will differ. Even more than that, the type of training and confirmation of skills of the teacher will differ considerably. And since Goldstein makes a very good point that we need to find credible teachers, it is important to note that not all qualified mindfulness teachers will have been trained in MBSR itself.

Recently, the Center for Mindfulness at the University of Massachusetts (CFM-UMass; the home base for MBSR and training of MBSR teachers) announced a format of teacher training that includes training those who will train teachers. While it’s perfectly understandable that CFM-UMass has taken a firm stand in cultivating MBSR teachers, this move is not without its detractors. However, it will filter those who have been teaching without full training at CFM-UMass and passing their programs off as MBSR. Nevertheless, this raises a difficult issue for those who have been trained in approaches that are not MBSR but which are legitimate approaches; the cachet of the term MBSR now takes on a more serious tone because many identify it as THE treatment program and may be confused by others.

That being the case, it is important to know that there are a number of other training centres that train teachers for mindfulness programs.

The M4 Program, Ottawa Mindfulness Clinic. The M4 (includes Mindfulness-Based Symptom Management; MBSM) training is in-depth and takes as long as a year. It requires applicants to have a clear rationale for wanting the training and expects a high level of participation. They attend the 8-week program as participants and do twice the expected formal and informal practices. They must attend a silent retreat in the year of their training. Current research and topics in mindfulness treatments are researched especially in their area of interest of specialization. They attend a training in the specifics of the delivering the program and in cultivating teacher qualities. Before teaching the M4 potential teachers must teach under supervision (qualification level) and then teach for 3 sessions with senior teachers in the clinic for Certification.

MBSR, University of Massachusetts, Center for Mindfulness. This is the original MBSR program and the training is extensive.

MBCT, The Centre for Mindfulness Studies. The training in MBCT is offered through various forms of study and teacher development. This program is supported by the Factor-Inwentash Faculty of Social Work (University of Toronto) which offers a certificate in MBCT.

MiCBT, Mindfulness integrated Cognitive Behaviour Therapy. An approach to mindfulness that weaves together Western psychology with Eastern principles of mindfulness. Training is comprehensive and a graduate diploma is offered for teachers.

Applied Mindfulness Meditation, Faculty of Social Work, University of Toronto. This program offers what is likely one of the most extensive trainings in mindfulness, meditation, and all its attendant components.

Training in the UK. This website lists various programs that train mindfulness teachers, including MBCT teachers. Rebecca Crane and her colleagues at Bangor University have also developed a teaching assessment protocol for the cultivation of mindfulness teachers which is a gold standard for any teacher who is dedicated to cultivating their skills.

Mindful Self-Compassion, Center for Mindful Self-Compassion. Developed by Christopher Germer and Kristin Neff, Mindful Self-Compassion (MSC) has developed a following in the last year as the teacher training becomes more available globally.

UCSD Mindfulness-Based Professional Training Institute. For training in various mindfulness-based programs such as Mindfulness-Based Relapse Prevention, Mindful Eating, etc.

Institute for Meditation and Psychotherapy offers a certificate program in mindfulness and psychotherapy. The founding practitioners include Paul Fulton, Christopher Germer, Ronald Siegel, Trudy Goodman – all well-regarded in the field of meditation and clinical psychology.

If you intend to take a mindfulness program, ask the sticky questions. It’s your health and your wellbeing. Be informed. The program may not be MBSR. And it may be something valid and well-supported in its own right.

 

Is Mindfulness the same as Buddhism?

DSC_0049There’s been a lot of chatter on the internet these days about Mindfulness and Buddhism. In a nutshell, practitioners, writers, and philosophers of Buddhism have expressed concern about the potential misuse of Buddhist beliefs and concepts by mindfulness-based interventions or programs. There is much merit to these concerns although the discussions tend to become bogged down with a lot of arguments that missed the central point. There are important issues about Mindfulness and Buddhism as well as Mindfulness itself that anyone considering a program should take the time to investigate. Below are some of these issues that may be helpful to consider.

Are Mindfulness-Based Programs and Interventions the same as Buddhism?

The answer will vary depending on the framework we use to address it. At one level, mindfulness is a Buddhism-based concept so it is unavoidable that the core principles guiding any Mindfulness-Based Intervention or Program will reach into a Buddhist conceptualization of its meaning and practice. However, mindfulness has moved far enough away from Buddhist philosophy and has begun to draw from various fields of psychology such as Cognitive Theory, Positive Psychology, Motivational approaches, Organizational Psychology, that it can be said to be a new “wave” in the genre of psychological and organizational approaches.

If you are considering a mindfulness program, there are some underlying concepts and frameworks you may wish to know that will inform your decisions. In our course intakes, we are often asked if the program is Buddhist. We are also asked if there are aspects of the program that would interfere with the person’s religious views or practices. People also want to be assured that the program won’t impose values and beliefs on them that may not fit with their own values and beliefs. These are important questions and need to be addressed openly and all the more important with the debates going around on the Buddhist nature of mindfulness and the potential dangers of teaching it as a secular or psychological modality.

Is Mindfulness the same as Buddhism?

Not completely. We can organize mindfulness programs into two categories: Mindfulness-Informed (MI) and Mindfulness-Based (MB) approaches (edit: See Shapiro & Carlson’s book The Art and Science of Mindfulness). Mindfulness-Informed approaches will draw from Buddhist philosophy using concepts of impermanence, adaptive self (non self), and the reality of suffering. They can also introduce concepts of lovingkindness and compassion. MI approaches may not use meditation practices specifically. Typically, the professional is trained in Buddhist theory and/or practice and therefore understands how our attitude and interpretations of our difficulties leads to our sorrow and suffering. Mindfulness-Based approaches draw from Buddhist practices such as sitting and walking meditation, breath awareness, etc. and build from this a state of steadiness so that the issues that plague us can be faced in a skillful manner. (edit) Additionally, Mindfulness-Based approaches draw from current understanding of stress theory and other psychotherapeutic models. (edit end) The final intention of both MI and MB approaches is the same – the reduction of suffering. Neither approach requires nor relies on a belief in Buddhist religious concepts.

Are all Mindfulness Programs the same?

No. For clarity, I refer to interventions separately from programs. A Program is offered over a time period, typically 8-weeks and may or may have a psychological intent; it may be conducted individually or in a group. “Programs” may be offered for stress management, lifestyle changes, spiritual growth, personal wellness or development. An Intervention refers to the medical- or psychological-based intent of the approach; this may be delivered as a time-framed process in a group or individually. “Interventions” may be offered to deal with physical or psychological issues such as depression, anxiety, chronic pain, physical pain or injuries, etc. These typically require a registered health care professional to supervise or conduct the intervention. Research articles on mindfulness will refer to Mindfulness-Based Interventions (MBIs) or their specific label such as Mindfulness-Based Cognitive Therapy.

There are many, many MBIs! Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Mindful Self-Compassion, Mindfulness-Based Relapse Prevention (for addictions), Mindfulness-Based Mind Fitness Training, Mindfulness-Based Eating Awareness Training, and so on. And of course, just to add to the confusion, each of these will be taught under different “company” names. The M4 Program we offer at the OMC is a psychologically-based MBI and designed as an intervention for psychological issues such as depression, anxiety, chronic illness etc.

Are Mindfulness Instructors or Teachers accredited, certified or trained professionally?

Not all are. Most professionals will have taken at the very least a 5-day intensive training in the specific area of interest. Some will have continued from this to take on-going training with specialists in their field. (edit) All MBI teachers are expected to have a personal meditative/contemplative practice to support their teaching skills and personal development. (edit end) Health Care Professionals who work in the Mindfulness-Informed approaches will likely have trained in their specific treatment modality (CBT, EFT, etc.) and also continued with a Buddhist or other contemplative practice tradition. Others will have obtained accreditation from specific organizations.  The Center for Mindfulness at the University of Massachusetts offers a teacher certification program for Mindfulness-Based Stress Reduction Programs. Mindfulness-Based Cognitive Therapy accreditation is available from the Factor-Inwentash Faculty of Social Work, University of Toronto. The Center for Mindful Self-Compassion offers teacher training in Mindful Self-Compassion. The University of California at San Diego is developing a Professional Training Institute that will allow teacher-development programs in several streams of Mindfulness-Based Interventions.

One aspect of the training/accreditation question is to consider whether the facilitator or instructor is accredited in their own field of expertise. All health care professionals have a regulatory organization which certifies their training; mindfulness can be viewed as a therapeutic intervention that they provide as a trained health care professional. Other professionals such as educators, coaches, and spiritual care professionals,  will have professional organization that verify their credentials as a trained professional.

Do all Mindfulness-Based Programs have the same positive effect?

It depends. Research shows that MBIs have a positive impact for many issues. Whether an individual experiences the expected positive change depends on the “good fit” between the individual and the program. If the issue is depression, then a “stress” program may not do the job. If there are issues of anxiety that are not disclosed at the intake (yes, there should be an intake!), then this can have an impact on their experience of the program. What can increase the probability of a “good fit” is asking lots of questions at the information session or the intake appointment. The most frequent issues that derail the program for participants are as follows:

  • Realizing that there is a certain amount of sharing that happens in the course
  • Finding out it is not like a school course where we get all the answers from the teachers
  • Not realizing how much time the practices take
  • Wanting a “quick fix”
  • Needing certainty that the practices will work
  • Wanting to “get rid” of the problem

These are all important questions to consider and to ask if you are thinking of taking a Mindfulness-Based Program. It is about your health and well-being. Be proactive. Understand the scope and limits of MBIs. Most of all, know the people offering the programs.

A Celebration of 10-years and a new site!

The OMC began in 2003 with a class of 10 people drawn from our private practice.  We met in a conference room at the Riverside Hospital that barely fit 12 of us and a three-section oak conference table.  Each evening that table had to be stacked in the corner so we could do the Body Scan lying down.  The intercom would blare and the code alarms would sound.  Somehow we managed.

Now, ten years later, we practice in a lovely meditation room set next to our offices available for daily meditations, classes, and the Alumni sessions.  On this 10th series of sessions, we are offering four classes of MBSR and look forward to this ever-increasing spiral outward into society.  We continue with our professional training in Foundational Mindfulness-Based Interventions, a course we have conducted continuously since 2005.

In celebration, we have just published our new website and will move our blog there.  Please join us.  There are still a few tweaks on the blog page that need to be done and we hope that will be completed shortly.

The inaugural post will be a review of Mark Williams’ terrific book, Mindfulness: An eight-week plan for finding peace in a frantic world.

Thank you to all our participants whose enthusiasm and dedication made all this possible!  May your days be light and joyful.  May your practice bring you peace and love.

Online introduction to MBSR with Steve Flowers

Thanks to UCSD Center for Mindfulness and Mindful Coaching for the link.

New courses at the OMC

We are thrilled to announce three new courses scheduled on the OMC roster.

Managing Chronic Illness

Discovering our lives may be limited because of a chronic illness can be difficult to accept.  Emotionally and psychologically, this is a challenge in a world that values productivity and performance.  Often, we spend time trying to push past the symptoms and only make things worse for ourselves.  Sometimes, the symptoms don’t make sense because we think we’re taking good care of ourselves and yet it seems not to make any difference.  You may be trying to manage the symptoms and pushing yourself to the edge which can drain your already limited resources.  Self-care is not a bad word.  Self-care is an important skill to develop if we are to meet our symptoms in a way that does not make the experience escalate.  Understanding limits, how to set them, and why this is a form of generosity can increase our health and well-being.

Our 8-week Mindful Skills for Chronic Illness course (2012 May on Tuesdays; 10-11:30AM) can help you learn how to live well in the life you now have.

Managing Caregiver Stress

It’s not unusual that caregivers put the needs of loved ones who are ill or disabled first.  That means there is not enough self-care being practiced to stay healthy and present for the ongoing demands of being a caregiver. You may be running on empty and feel anxious that it means you don’t care.  Caring for someone means being generous with your time and resources; it is a commitment to being present to their life as it is right now.  But, generosity is only effective and sustainable if you take time to replenish yourself.

Our 6-week Mindful Skills in Caregiving course (2012 November 12 – Dec 17 Mondays; 4-6 PM) can help you learn how to balance the needs of those you care about and your own need to stay healthy and steady in the face of uncertainty.

Mindfulness for Health Care Professionals

This course will be offered in Fall 2012 as a dedicated 8-week training for Health Care Professionals who are interested in developing mindfulness-based intervention skills or consolidating mindfulness skills they learned in a short workshop or course.  The course is composed of the foundations of mindfulness, meditation and experiential practices, inquiry training, and has written requirements for completion.

Please check our Calendar for dates and times or contact the OMC Registrar for more information.

The critical role of ethics as process in an MB program – a gentle critique of Grabovac, Lau and Willet’s article

A recent article, Mechanisms of Mindfulness: a Buddhist Psychological Model by Grabovac, Lau and Willett in Mindfulness attempted to re-insert Buddhist Psychology into the foundations of Mindfulness-Based Stress Reduction. Grabovac and her colleagues did a good job of putting the Three Dharma Seals (impermanence, suffering and nonself) into the service of explaining the mechanisms involved in mindfulness-based interventions. Drawing partially from the Abdhidhamma (the texts that form the basis of Buddhist Psychology), they worked out a pretty good set of visuals that lead us through sense perceptions, attachment/aversion, and the generation of suffering and nonself. I found their explanations of the concept of nonself narrow, but that’s not as critical as what comes next.

About halfway through the article, they address the role of Ethics (sila) in the cultivation of mindfulness. After listing the Five Precepts (not killing, stealing, engaging in sexual misconduct, lying, or using intoxicants), Grabovac and colleagues make what is likely one of most faulty statements of the intent of a practice founded on sila.

(O)ne of the major purposes of the ethical guideline is to reduce the baseline amount of mental proliferation, thus aiding both concentration and mindfulness practices… Leading an ethical life, in the context of the (Buddhist Psychological Model),implies that the meditator experiences less guilt, doubts, worries, etc. that can often be a source of mental proliferation.

I don’t think one can get more off-track than this. In effect, Buddhist Ethics are reduced to a utilitarian process of feeling good. In terms of Kohlberg’s moral development that makes Buddhist and Mindfulness-Based Stress Reduction practitioners capable of not much more than the second level in which we choose the “right” thing to do because it gets us something in return. What Grabovac and friends have missed is that sila plays an equal role (if not more so) to Wisdom and Concentration in the triumvariate model of practice. (The Buddhist practice model is formulated by the Eightfold Path which is categorized into Wisdom, Ethics, and Concentration.)  It is more than just doing something to get something in return. And perhaps, this is where I find the teaching of Mindfulness-Based courses to be inherently limited if we stop, as most courses do, at symptom relief -and that includes “feeling good.”

The ethics of a Buddhist Psychological or Applied Model requires opening to our interconnectedness (non-self is the start point). The practice of the Five Precepts (or Five Mindfulness Trainings of Thich Nhat Hanh) is more than about avoiding a poor rebirth or ensuring some Thing for ourselves. To miss this, places their translation of Dharma into Psychology on very shaky ground. In fact, I think it just collapses.

It’s disappointing that researchers who put so much into developing a bridge between the two worlds would have missed something so critical and obvious. And in a journal of some repute, it concerns me that readers not well-versed in Buddhist thought will take the diminishing of Buddhist Ethics to a utilitarian role as a fact. I haven’t seen an open challenges to this part of the article. Perhaps it will come soon.