In Psychological Inquiry, 2007, 18 (No. 4), pp. 258-264.
Department of Psychology
University of California, Berkeley
The matters discussed in the target article are important. Some of the key ideas in mindfulness based psychotherapy and research are radically different from our cultural (and perhaps human) assumptions. One claim is that lives can be improved by changing the consciousness with which people perceive experiences rather than by changing the contents of the lives and the experiences themselves. A second assertion is that constant monitoring of experience in relation to the ego or self is not only unnecessary but actually detrimental to many dimensions of functioning. Finally, since mindfulness of experience can only occur in the present, our cultural emphasis on maintaining a future time orientation is challenged. These are all contentions that need to be taken seriously.
The authors are to be applauded for taking on this difficult task. They go beyond a focus on clinical outcomes of particular techniques of meditation or therapy to ask questions about the meaning of the techniques and the kind of consciousness that they imply. The paper exhibits sensitivity not only to research requirements but also to some aspects of meditation often missed in meditation research.
However, there is a danger in this field of premature closure. The idea of mindfulness (not necessarily defined as is done in this paper) was originally drawn from Buddhist psychology and meditation techniques where it forms only one strand of an interdependent, complex whole. The “burgeoning” research interest in mindfulness stems from the success of a number of new therapies in which mindfulness practices play an important role but which are also composed of other interrelated aspects. My aim in these comments is to contextualize this work both within Buddhism and within those therapies. From this I will argue that the various scales purporting to operationalize and measure mindfulness actually measure a different factor; such research may be important in its own right in understanding health, but it is tangential to the theoretical claims in the paper. Seeing mindfulness both in the Buddhist context in its relation to Buddhist conceptions of wisdom and in the modern therapeutic context offers the opportunity to expand our understanding and perhaps offer new ideas for both research and therapy.
The Buddhist Context
Technically, in the Buddhist Abhidharma (texts which are often referred to as Buddhist psychology -- see, for example, Buddhaghosa, 1976; Narada, 1975, Vasubandhu, 1990), mindfulness (smrti, literally remembrance) is a simple mental factor that can be present or absent in a moment of consciousness. It means to adhere, in that moment, to the object of consciousness with a clear mental focus. There is no such thing as receptive mindfulness versus non-receptive mindfulness. When the authors talk about receptivity (openness might be the closest Buddhist equivalent), clarity, freshness, pure awareness, lucid awareness, or presence as attributes of a mindful consciousness, they are not, in the Buddhist view, talking about how the world will look in the consciousness of an ordinary troubled person paying attention to a moment of her breath or her thinking but to the way in which (according to the Vajrayana and Dzogchen teachings of Tibetan Buddhism -- Ponlop, 2003; Trungpa, 1991, Tsoknyi,1998) the phenomenal world arises in the enlightened mind (dagnang, literally pure perception). To collapse the two is a confusion of levels (as well as historical periods) of Buddhist teachings, easy to do in the West given the unprecedented, but disorganized, availability of various forms of Buddhism. More important to research and therapy, it is a confusion of the types of experience that a person may be expected to have given mindfulness instructions and an obscuration of the necessary co-factors by which both Buddhism and mindfulness based therapies enable people to have more enlightened and less painful types of experience.
In the Buddhist view, the ordinary person is said to live in the state of consciousness called samsara, cycling endlessly through fantasy words in which his supposed but illusory self strives to obtain objects of desire, to avoid or destroy objects of fear, and to remain ignorant of its true nature and condition. This state of existence is seen as more deep-seated and pervasive than the self-concepts, schemas, narratives, and beliefs talked about in present psychology (and in the Brown, Ryan, & Creswell target article). Body, feelings, perceptions, impulses, habits, concepts, and the life in which a person finds himself enmeshed are understood to all arise co-dependently such that a moment of mindful perception will not be experienced as free, receptive, fresh, or pure but as part of what Zorba the Greek famously called (Kabat-Zinn, 1990) “the whole catastrophe.” To gain any leverage on this, even in early Buddhism, the factor of mindfulness would need to be combined with other simultaneous mental factors such as right intention (as brought about by hearing Buddhist teachings), peace (from prior shamatha meditation), and restraint (through lifestyle and vows). When moments that contain insight begin to occur, it will be insight into the nature of the troubled consciousness in samsara.
Brown et al speak of mindfulness as showing “how things really are” and bringing “an accurate view of reality” but do not specify what that accurate view would see. Buddhism does specify. In the earliest form of Buddhism, now represented by the Theravada (Speech of the Elders) schools of Southeast Asia (see Buddhaghosa, 1976; Kornfield, 1977; Nyaponika, 1973; Rahula, 1959), a central set of teachings is the Three Marks of Existence: impermanence (anicca), egolessness (anatta), and suffering (dukkha). Each has a gross (conceptual) form based on general knowledge and a subtle (insightful) form for which moment by moment mindfulness is needed:
Impermanence: Gross impermanence is readily observed: "leaves fall," "maidens wither," "moth and rust," "the times they are a changing," and so on. Buddhism certainly talks about that kind of thing; in fact one traditional exercise was contemplation of corpses. But fundamental impermanence, the appreciation of which can change consciousness, was understood to be the moment-to-moment arising and falling, birth and death of perceptions and thoughts themselves.
Egolessness: Psychology and cognitive science do not posit an actual self but only self schemas, habits, brain states, and the like. But who is it who is comfortably discoursing on self schemas and brain states? The Buddhist close observation of experience says that not only does experience change moment by moment, but there is no actual landing platform for that experience; the I who is experiencing also rises and falls, is born and dies, shifts and changes with the moments of experience. Such an insight can sound romantic (perhaps like a fantasy of being present to watch one’s own funeral), but glimpses of actual egolessness in the Buddhist sense are understood to be insights from which the mind normally flees, opting instead for its usual forms of distraction, however painful.
Suffering: The ills, disappointments, tragedies, and pains of body and mind need no introduction. But what the mindful and insightful mind discovers is that all experiences, all moments of consciousness in samsara, are marked by suffering. Grasping for the permanence of what is impermanent and for a self where there is none lead to suffering. Obtaining something one wants only feeds further desire, and vanquishing an object of hatred fuels further aggression. Ignoring is beset by uneasiness. Even simple pleasures, like eating, can be seen to be a form of grasping at fleeting and not all that satisfying straws in the wind.
What does this show us? People are not mindful for a reason. It’s not just that they habitually spin off into depressive rumination or that it’s never occurred to them to notice how nice it is to closely track their experiences (as some of the descriptions in Brown et al and many versions of New Age mindfulness might lead one to believe), but the down to earth, ordinary fact that, for most people, their moment to moment everyday experience hurts. Therapists and researchers ignore that to their peril. The dignity of being able to admit pain is actually what attracts many people to Buddhism in the first place. Of course, Buddhism, like therapy and probably every other viable tradition, also offers an end to suffering and a path. In early Buddhism that meant progressively extinguishing one’s karma, primarily through mindful wise restraint, so that one could eventually leave samsara and enter the (undescribed) state called nirvana. That changed as Buddhism evolved.
The second major form of Buddhism and the most common type today is the Mahayana (Great Vehicle), which began in India around the first century A.C. E. and spread to East Asia (see Nhat Hanh, 1987; Shantideva, 1995; Sprung, 1979; Suzuki, 1970). Here we do get explicit talk of the kind of knowing (vipashyana, vidya) beyond samsara, an awareness said to include two inseparable components, emptiness (shunyata) and compassion (karuna).
Emptiness: The traditional language of shunyata (phrased in negatives such as that things neither exist nor don’t exist) directs the mind beyond concept (not just beyond particular dysfunctional schemas). In fact it goes beyond dualistic vision altogether; all elements of the phenomenal world are seen as lacking self nature but arising interdependently, including the co-arising, moment by moment, of the subject and object of perception. With nothing behind the phenomenal world, one is free.
Compassion: To see the phenomenal world fully from the perspective of both freedom and the lack of separateness between oneself and others is to see it also with an irrationally openhearted warmth, friendliness, and compassion toward all the beings trapped in samsara, including oneself. Here is where one gets the “participatory awareness” spoken of by Brown et al. In the light of such awareness, there is now “not a hair’s breath of difference between samsara and nirvana.”
In practice, e.g. from a path perspective, emptiness and compassion bootstrap each other. Even simple sitting practice is understood as a relaxed, open, panoramic awareness that includes all the senses and an awareness of causality past and future. And compassion is viewed as a necessary underpinning for the whole path, a kind of pilot light for the other virtues (think of “but if you have not love” in the New Testament). Many Buddhist teachers, including Theravada, may start with friendliness or compassion teachings and practices before the introduction of mindfulness or anything else. What is relevant in all this for our concerns with therapy and research is that the kind of gentle, receptive, nonjudgmental, nonconceptual awareness that has the healing and insight producing effects described by Brown et al, is seen as something both more penetrating and more encompassing than the “mindfulness construct.” The next phase of Buddhism adds to this.
The final historical form of Buddhism is the Vajrayana (Diamond Vehicle) which arose in northern India, spread through China to Japan, and then moved north into Tibet (see Freemantle, 2001; Ponlop, 2003; Sogyal, 1992; Trungpa, 1991, Tsoknyi, 1998). It incorporates the teachings of the earlier yanas and adds to them two basic components: primordial wisdom (yeshe) and a mandala (kyilkor) of particular wisdoms.
Primordial wisdom: According to this teaching (shared by three of the four major Tibetan lineages), when a practitioner goes fully into experience with direct nondual awareness (rigpa), he realizes a profound basic ground, timeless, empty yet luminous (osel), the radiance of which is what we experience as the phenomenal world. Known in this way, experience is perfect. This is not mindfulness but an awareness unlike anything in dualistic mind; it knows even in the heart of not knowing, such as in dreamless sleep (and, it is said, in death).
A mandala of wisdoms: Through visualization and other practices, the energies of the phenomenal world can be transformed into (more accurately recognized as) different kinds of wisdom. For example, anger when seen into fully, reverts to its true form of peaceful mirror-like wisdom, and habits become (are already) the wisdom of enlightened, all-accomplishing actions.
It is from the point of view of Vajrayana and Dzogchen (Complete Perfection -- another Tibetan form of these teachings) realization that natural awareness can be described as open, clear, fresh, a presence (a term which does not mean present time but the “fourth moment,” dus bzhi pa, of the timeless ground), pure, lucid, or perfect -- all the terms that Brown et al attribute to basic mindfulness. It is true that Vajrayana and Dzogchen awareness is said to be available each moment, “closer than one’s eyes,” but it is also understood that the mind of samsara, accustomed to its cocoon of ego, flees from it in panic because it is too vast, too groundless, and the energy of the radiance too brilliant. Tibetan teachers may give such teachings in public as a general blessing and to plant seeds of enlightened awareness, but such teachings are understood as self-secret in that minds will only understand as much as they are ready for.
What have we learned about mindfulness from this tour of Buddhism? When Brown et al define mindfulness as a receptive awareness, they have unknowingly opened a pandora’s box. Far from a simple technique or type of consciousness that we might call mindfulness, we are dealing with an entire mode of knowing and of being in the world composed of many interdependent synergistic facets which are simultaneously ways of entering the whole and themselves part of the enlightened awareness itself. These include a relaxation and expansion of awareness, a letting go even into deep states of not knowing, access to wisdom knowing beyond what we think of as consciousness or the mind, and an open hearted inclusive warmth toward all of experience and to the world. It also includes one’s deepest intentions toward oneself, other people and the world, usually formalized by vows. It includes ones actions and ways of living. The teacher, teachings, and community of other practitioners are all part of this tapestry with the direct (mind to mind) transmissions of the teacher (made possible because of interdependence) assuming a central role in the Vajrayana. Any of these aspects can be entry points as well as essentials in the whole, and different traditions specialize in starting students in different ways: calming and relaxation, compassion, devotion, study, cleaning up one’s life, intentions, service, vows, mindfulness practice, body practices, identifying with enlightened energies, creative activities...even up to receiving transmission of the primordial wisdom itself. It is against this background that we can now look at mindfulness based therapies and research.
The Therapeutic Context
A New Yorker cartoon pictures Pandora walking demurely through airline luggage screening as the screeners stare bug-eyed in amazement at the images in her dainty suitcase. Thus might we marvel at the way numerous elements, just described as aspects of Buddhist enlightened awareness, are incorporated into practices in the four therapeutic systems that include mindfulness training as a component. These systems are: Mindfulness Based Stress Reduction (MBSR; Kabat-Zinn, 1990), Mindfulness Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002; Teasdale & Barnard, 1993), Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b), and Acceptance and Commitment Therapy (ACT; Hays, Strosahl, & Wilson, 1999). (See also Baer, 2006; and Hayes, Jacobson, Follette, & Dougher, 1994.) Patients are never just given minimalist mindfulness instructions (such as “Pay bare attention to what comes into your mind”) and then left to themselves – for good reason. I know of no cases where anyone has developed a meditation, or even relaxation, practice without considerable input. Let’s look at a few of the most salient of the elements:
All of the mindfulness therapies include a facilitator or therapist, a person in authority to whom patients are looking for help. Nothing stretches one’s understanding of “mindfulness” beyond simple definitions as much as being in that authoritative role; it calls forth all the therapist’s or facilitator’s resources and wisdom. MBSR and MBCT incorporate actual meditation sessions as part of the practice. People’s first reaction to mindfulness meditation per se is usually to feel that they cannot do it because their mind wanders or because they get bored. Particularly with patient populations, the teacher is called upon to convey an attitude of non-judgment, inclusiveness (that it is all part of the practice), and of caring compassion along with whatever depths and flavors of wisdom he or she may have developed. Facilitators in MBSR and MBCT are required to have had mindfulness meditation experience in formal settings for good reason; early MBSR groups led by individuals who lacked personal experience tended to be ineffective. MBCT, DBT, and ACT are actual therapies. A teacher’s or therapist’s understanding and wisdom may be conveyed in ways that we don’t yet understand. It is not just high Tibetan lamas who transmit states of mind; so do ordinary people -- a phenomenon recognized in research as the experimenter bias effect and in medicine as part of the placebo effect. Interestingly, just as audio-tapes by meditation group founders are a staple in such groups, so too guided meditations by Jon Kabat-Zinn, the founder of MBSR, have become a staple of therapeutic mindfulness training. Perhaps one take-away lesson from all this is the important role of the personal development of therapists, something little noted in most clinical psychology programs.
People have a need to understand what they’re doing. In all of the mindfulness related therapies there are theories, handouts, and books by the founders (just as there are texts and commentaries in all traditions). Teachers and therapists expound and explain (and read appropriate poetry of their choosing), all part of the transmission process. Note that this same kind of transmission process occurs when instructions are given in mindfulness experiments.
Intentions are considered the foundation of everything else in Buddhism, and the binding (samaya) to enlightened awareness that comes with commitments and vows plays a major role. ACT may be the first system of therapy to explicitly incorporate the power of this aspect of change. Patients are guided toward finding their deepest intentions, and they then formally commit to them. Other therapies, take notice!
Relaxation, letting go, surrender
Ego based habits cannot relax and let go any more than a panicked insomniac can will himself to fall asleep. (Or a depressive can neurologically let go even in sleep, see Rock, 2004.) Religious traditions all know this and incorporate it in various ways into their theologies. In later Buddhism, the practitioner seeks to find the relaxed wisdom mind (or no-mind) in which experience is already let go (Tib. rangtrol, literally self liberated). In all of the mindfulness incorporating therapies, both protocols and case studies show recognition of the necessity of letting go. There may be body relaxation practices such as yoga, letting-go-encouraging ways in which teachers answer questions, and, of course, the acceptance part of ACT, basically a surrender to one’s experience.
It is in the life outside of meditation, training, or therapy that the fuller interdependent aspects of a more enlightened awareness have a chance to be tested, honed, and to manifest. All therapies deal with outside behavior which is then talked about (or otherwise worked with) in the therapy, but particularly interesting are case studies in DBT in which patients in crisis call the therapist and are guided through the situation as it unfolds -- examples also of the many dimensional nature of these therapies.
Not knowing and the wisdom mind.
Openness to one’s experience is predicated on openness to non-experience. The element of mystery is what is most in danger from an over specification in mindfulness research. DBT is the therapy that most explicitly posits a wisdom mind beyond reason or emotion. The theory is that such a mind is a dialectical combination of rational and emotional mind, but in practice the patient is guided into an unknown source of wisdom -- much as people in twelve-step programs turn to a “higher power”. We tend to forget the role played in the founding of psychotherapy by Freud’s discovery of the power of gaps in the conscious mind; it was when patients ran out of associations and went blank that subsequent healing discoveries could be made. Let’s not kill the goose that lays the golden egg.
In summary these therapies could as much be called wisdom-based as mindfulness-based. Mindfulness would seem to play two roles: as a part of the therapy itself and as an umbrella justification (“empirical”) for the inclusion of other aspects of wisdom that may be beyond our present cultural assumptions. Where in this is mindfulness in its original sense of the mind adhering to an object of consciousness with a clear mental focus? From a Buddhist path perspective, we are talking about the grounding of a nascent enlightened awareness to specific manifestations of body and mind such that the energy of being alive and aware does not send the mind spinning off into fantasy worlds. Tibetans speak of this as the joining of heaven and earth (Trungpa, 1984) and see it as essential. My basic point is that all the aspects of it are essential.
Measurement of Mindfulness: The Mindfulness Scales
Five scales for measuring mindfulness have been developed: the Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003), the Freiburg Mindfulness Inventory (FMI; Buchheld, Grossman, & Walach, 2001), the Kentucky Inventory of Mindfulness Skills (KIMS; Baer, Smith, & Allen, 2004), the Cognitive and Affective Mindfulness Scale (CAMS; Hayes & Feldman, 2004), and the Mindfulness Questionnaire (MQ; see Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006). Brown et al see the “mindfulness construct” as a unipolar dimension, but recently Baer and her collaborators (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006), in a comprehensive factor analytic study of the properties of these scales, has convincingly demonstrated them to be measuring five separate facets of the construct rather than a unipolar factor. Since Baer is a contributor to this volume, I will leave further description of this excellent work to her. My additional concern is with what the scales are actually measuring. We tend to get so caught up in the psychometric properties of measurement instruments that we may lose sight of the actual items, and thus the face validity, of scales.
By now it should be clear to anyone acquainted with the scales that none of them are measuring either mindfulness in the narrow Buddhist sense or enlightened awareness in its broader sense. Only one of the factors identified by Baer et al (2006), a factor consisting entirely of items taken from the FMI and KIMS, dealt with close observation of experience, and it failed to correlate highly with the other factors for non-meditators. The other four factors seem to be measuring a construct of more versus less pathology. One factor, which loads almost entirely on items from Brown and Ryan’s MAAS, appears to measure being seriously “spaced out;” e.g., a high endorser admits to behaviors such as driving places on automatic pilot and then wondering why he went there and snacking without being aware he’s eating. Another factor appears to measure strong self-criticism; a high endorser says that she makes judgments about whether her thoughts are good or bad and gets angry at herself for having distressing thoughts or images. A third factor measures moderation in emotion, e.g., an ability to modulate affective states and not get carried away by thoughts; it correlates negatively with the first two factors. The fourth factor is an ability to label and describe with words; it correlates negatively with the two negative scales and positively with the positive one, particularly unsurprising in the college student population on which the work was done. It is useful to know that the spaced-out dimension is part of this package, but there is no evidence that this is the primary or originating factor.
These scales might perhaps best be described as measures of Practicality or Relative Sanity or Reasonableness. A reasonable man who gets along reasonably well in his society is one who is not too spaced out or emotional or self-critical and has reasonable descriptive facility with language. Such a construct may bear the same relationship to mindfulness or enlightened awareness that the general “gross” forms of impermanence, egolessness, and suffering bear to the fundamental forms. Buddhism distinguishes the small “d” dharmas of knowing how things work in the world (fire burns and so on) from the Dharma of wisdom insight into the world. Both are considered necessary; the problem arises when one thinks one of them can substitute for the other. The trait of Reasonableness might be found to correlate with mindful insight in meditators (e.g., the reasonable man of practical wisdom would probably have an easier time with mindfulness training, as he would with anything else, than would his more insane counterpart) but that doesn’t mean they are the same thing. The distinction between relative sanity and wisdom insight is important. It may be better to live an ordinary life of quiet desperation than one of noisy desperation, but Buddhist practice and mindfulness therapies, like contemplative spiritual paths the world over, offer the possibility of cutting the roots of desperation altogether.
Let’s now look at the culture defying claims of the target article with which we began and see how they have fared:
1) The first claim was that lives can be improved by changing the consciousness with which experience is perceived rather than the content of the experience. There is a resounding “yes” to this from both Buddhism and modern mindfulness based therapies, but the properties that Brown et al wisely attribute to that transformative consciousness are, as I have tried to show, considerably beyond those of simple mindfulness. (One can, of course, redefine the word “mindfulness” – see the September 2006 and January 2007 issues of the Shambhala Sun for a debate about this -- but then one has to make the relevant distinctions in some other way.)
2) The second claim was that constant ego monitoring is not necessary and actually harmful. The Buddhist view points to the fact that ego is far deeper and also more genuinely nonexistent than is recognized by self schemas, ego monitoring and the rest of our concepts about ego. Psychologists might question not only ego monitoring but also their own constant monitoring of the ever-growing cornucopia of ego theories and might turn instead to the phenomena, both those that do and that don’t exist.
3) The third cultural challenge has to do with time. Mindfulness makes clear that consciousness occurs only in present time, but an expanded awareness includes the further transformative experience of timelessness.
4) There are some additional lessons that the Buddhist and therapeutic understanding might have to offer. Most obvious is that interdependence could be taken more seriously (Rosch, 2007). To try to isolate and manipulate single factors that actually operate only systemically is like killing a rabbit and dissecting it to look for its aliveness. This is more than an issue of developing better multivariate statistics; it is a question of the kind of mind with which one perceives the world, whether in life or in science.
5) It is important to respect not-knowing, mystery, gap. There is a legendary book review that begins, “This book fills a much needed gap;” don’t do that -- or as a Tibetan teacher yelled at a student who had been asking compulsive questions, “Leave your gap alone!” Opening to the wisdom in not knowing may be even more important than opening to experiences within knowing. Acknowledging not knowing is what evokes the genuine humbleness prized by every contemplative and healing tradition. It is also the basis of science.
Bottom line: There may be levels (or modes of functioning) of the mind below the surface level of reason, emotion, and ego which are not approachable through the assumptions and logic of our present research -- just as movements of the “heart” like forgiveness may make no sense to the ego (Rosch, in press). What we need at this point is not conceptual closure about mindfulness but openness, wisdom, and creative ferment. Pull on the tiger’s tail of mindfulness and out leaps the tiger of wisdom awareness that may consume assumptions about ourselves and our science. At this point -- as in lucid dreams -- maybe we should just let the tiger eat us.