Mindfulness and Mental Health

Therapy, Theory and Science

Chris Mace

• Publisher: Routledge
• Year: 2007
• eBook ISBN: 9781135448080
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Being mindful can help people feel calmer and more fully alive. Mindfulness and Mental Health examines other effects it can also have and presents a significant new model of how mindful awareness may influence different forms of mental suffering.

The book assesses current understandings of what mindfulness is, what it leads to, and how and when it can help. It looks at the roots and significance of mindfulness in Buddhist psychology and at the strengths and limitations of recent scientific investigations. A survey of relationships between mindfulness practice and established forms of psychotherapy introduces evaluations of recent clinical work where mindfulness has been used with a wide range of psychological disorders. As well as considering current 'mindfulness-based' therapies, future directions for the development of new techniques, their selection, how they are used and implications for professional training are discussed. Finally, mindfulness' future contribution to positive mental health is examined with reference to vulnerability to illness, adaptation and the flourishing of hidden capabilities.

As a cogent summary of the field that addresses many key questions, Mindfulness and Mental Health is likely to help therapists from all professional backgrounds in getting to grips with developments that are becoming too significant to ignore.

Chapter 1
Understanding mindfulness: Origins

There is no mental process concerned with knowing and understanding, that is without mindfulness.

Commentary on the Satipatthana Sutta,
cited by Thera (1965: 194)

Defining mindfulness

Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.

(Kabat-Zinn 1994: 4)

(a) Mindfulness reminds us of what we are supposed to be doing; (b) it sees things as they really are; and (c) it sees the true nature of all phenomena.

(Gunaratana 1992: 156)

In mindfulness, the meditator methodically faces the bare facts of his experience, seeing each event as though occurring for the first time.

(Goleman 1988: 20)

[Mindfulness is] keeping one’s consciousness alive to the present reality.

(Hanh 1991: 11)

[Mindfulness is] awareness of present experience with acceptance.

(Germer 2005b: 7)

What is it to be mindful? It is to pay attention in a particular way. Is it possible to say what way that is? It is, and these quotations represent attempts by different authors to do so. Some write from the standpoint of Buddhism and some from that of psychology. There is an emphasis on awareness being alive to what is immediately presented to it, at the expense of other kinds of experience, and on this being accepted without judgement. Beyond these points, there can be subtle but significant differences between one conception of ‘mindfulness’ and the next, with different facets of mindfulness being given more emphasis and priority over others by different commentators.

So what quality might typify mindful awareness? In some definitions it is apparently directed, and focused by deliberate effort. (Jon Kabat-Zinn helpfully uses the word ‘intentionality’ in this context.) At the same time, it has been characterised by others as a broad, inclusive and receptive awareness, in contrast to the restriction of attention that results from concentration (e.g. Speeth 1982; Goleman 1988). Does mindfulness have a particular object? From the above definitions, it would seem not. Yet, awareness of internal processes such as breathing, body sensations, thoughts and feelings has been essential to the various methods of teaching it, along with a varying emphasis on mindfulness of external objects apparent through vision and hearing. Does mindful perception have a particular quality? The qualities of acceptance and non-judgement are prominent in most accounts, as the definitions cited confirm. Is there an emotional tone to mindfulness? To some, it is absolutely neutral, with an experience of equanimity being emphasised: to others (including Thich Nhat Hanh), it is closely interlinked with particular positive emotions of love or kindness.

For some commentators, a further key quality of mindfulness is its wordlessness: the immediacy of mindful awareness is a consequence of its being preconceptual and operating prior to experiences becoming labelled through thinking. This point is less than straightforward. As N. Thera has pointed out (1994: 80-1), there are several examples in the Buddhist instructional texts of the deliberate naming of experience being used as a means of becoming mindful of them. Indeed, these techniques have been copied in some contemporary therapists’ methods for teaching their patients ‘mindfulness skills’ (cf. Chapter 3). Then there is the association of mindfulness with presentness: being mindful is to be alert to what is happening now to the exclusion of the past or the future. While this is seen as a key characteristic in many modern discussions, it has no real equivalent in the canonical Buddhist literature. Instead, the latter sometimes emphasises recollection as a key aspect of mindfulness.

Therefore one does not have to go very far or very deep to see that there is much scope for divergence between conceptions of mindfulness. They may be describing different things, in which case a corrective analysis is overdue. Or they may be separately failing to capture something that, like the elephant being felt in different places by six blind men, is simply bigger and more varied than any of them have allowed for. Gunaratana, who provides what is apparently the most complex (and, as will be seen, traditional) of the definitions above, argues that ‘Mindfulness is extremely difficult to define in words – not because it is complex, but because it is too simple and open’ (Gunaratana 1992: 154). He states that in any field, the most basic concepts are the hardest to pin down, precisely because they are the most fundamental, with everything else resting on them. This is why he has felt it better to try to say what mindfulness does rather than what it is, just as we might when trying to explain gravity. Unfortunately, this step does not necessarily resolve anything. Instead, it is likely to open up a related question of whether there is any characteristic understanding or knowledge to which mindfulness leads. The question is important and unavoidable. For instance, in North America, the terms ‘insight meditation’ and ‘mindfulness meditation’ can be used interchangeably, encouraging the presumption that mindfulness does affect understanding as well as perception. Whatever contemporary investigations may have to say about the contribution of mindfulness to insight, the connection is made in early Buddhist philosophy and is critical to an understanding of why the practice of mindfulness was valued. To understand mindfulness more fully, its Buddhist context needs to be acknowledged and, at least in its basics, understood.

Buddhist psychology

Buddhism has given rise to an extraordinarily complex body of teachings as it has diversified over 2500 years. Despite many disagreements over particulars, awareness remains central to all of them. The account that follows will draw primarily on the earliest Buddhist teachings. The works of this Theravadan tradition not only have a clearer linkage to the sayings and practice of Buddhism’s founder, but also have been the most influential in modern adaptations of ‘mindfulness’. The main purpose in looking at the Buddhist context of mindfulness here will be to examine what it was expected to achieve. This is useful in making sense of its methods (as well as the lengths people were prepared to go to in developing it). It is also an important preparation for evaluating the uses to which it is being put now.

Any attempt to discuss this literature needs to be accompanied by a strong health warning concerning the problems of translation. The divisions between units of meaning encoded in the ancient languages Pali or Sanskrit rarely coincide with those found in modern languages. Translation is far more difficult as a result. This is compounded by grammatical incompatibilities in which verbs convey radically different modes of action from their modern counterparts. The need for caution is well illustrated by the history of ‘mindfulness’. ‘Mindfulness’ was introduced a century ago by the translator Rhys David when working on Pali texts for the Buddhist Text Society. He used it to translate the Pali term sati, for which common alternative translations are ‘awareness’ or ‘bare attention’. Sati itself has broader connotations, however. Some of these, such as the capacity to tidy the mind, are generally incorporated in ‘mindfulness’. However, as might be expected from contemporary writers’ stress on the ‘present’, the subsidiary meaning of sati as recollection of the past is usually not subsumed under ‘mindfulness’. At the same time, other Pali terms, such as appamada, meaning ‘ever present watchfulness or heedfulness in avoiding ill or doing good’ (Thera 1974: 180) or ‘non-negligence or absence of madness’ (Gunaratana 1992: 158), can also be translated as ‘mindfulness’ in modern texts. It is, therefore, hard to claim complete authenticity or fidelity to the early texts on behalf of modern uses of ‘mindfulness’. (In the remainder of this book, the term will be used in a way that is broadly equivalent to sati as ‘bare attention’, as many of the writers who have thought about mindfulness in clinical settings use it in this way.)

Overall, Buddhist theory has the character of an elaborate and systematic psychology rather than a theology or cosmology. Unlike Western psychologies, its concepts are always intended to support practical teaching, never losing a concern with attainment of liberation from various states of spiritual captivity. It is generally available in two formats. In one, the collections of sutras (Sanskrit) or suttas (Pali), ideas are presented within reports of talks given by the Buddha or a disciple that had his approval. They may be elaborated in dialogue with the monks who are invariably present, their practical importance being underlined by parables and injunctions to act in particular ways. In the other format, that of the systematic psychology known as the Abbidhamma, ideas are systematised using a common vocabulary, and the relations between them coded. The result is a huge reference compendium that also provides a map of the abstract relations underlying the different segments of the system. There are therefore important differences in content and style, with the Abbidhamma also probably post-dating the Theravadan sutta collections by at least two centuries.

Superficially, there are similarities with Greek writing of the time. The Buddha’s contemporary, Socrates, also wrote nothing himself, but it is probable his ideas and teaching style are captured in the earliest of Plato’s dialogues, in which Socrates appears as a character. However, unlike Buddha (and Plato himself), Socrates probably had no theoretical ideas that he felt he needed to impart in order to assist his students’ personal growth (cf. Mace 1999b). When, in the hands of Aristotle, Greek philosophy does become more systematic, it is after much additional theorising. The suttas of the Buddhist canon are always unlike Socratic dialogues in being more clearly didactic and intended for rote learning. While it is relatively easy to trace at what point other minds have contributed to the systematisation of early Greek philosophy, an insistence on attributing all the subsequent ramifications of Buddhist psychology to the Buddha himself has made it extremely hard to attribute ideas to other protagonists in ordinary historical terms.

It is not necessary to examine the treatises providing exhaustive accounts of meditative practice to understand the core of Buddhist psychology. Manuals such as the Visuddhimagga (Buddhaghosa 1999) characteristically discern many potential levels and goals encountered in meditative practice, but do not necessarily explain why the progressions take the form that they do. For this, it is important to appreciate the most basic tenets of Buddhism and the Buddhist view of the mind.

The essence of Buddhist teaching, accepted by all schools whatever their other doctrinal disagreements, is expressed in the Four Noble Truths. These are that life brings suffering, that there are causes of this suffering, that suffering can end, and that there is a path by which it may be ended. It is in the elaboration of the last truth, in descriptions of how liberation might be attained, that mindfulness comes to the fore. The method of attaining liberation is set out in eight linked stages within the Noble Eightfold Path. These concern the attainment of morality (sila), concentration (samadhi) and wisdom (panna). Among the eight, the three factors that make for concentration are ‘right effort’, ‘right awareness’ and ‘right concentration’. Mindfulness is an essential ingredient of ‘right awareness’ (often translated as ‘right mindfulness’) and, as such, the foundation of the mental discipline necessary to achieve concentration and, subseqently, the ‘right understanding’ and ‘right thought’ that make up wisdom.

To appreciate how the Noble Eightfold Path leads to liberation, the ontology that underpins it must also be understood. In Buddhist thought, being has three essential characteristics, usually translated as unsatisfactoriness or suffering (dukka), transcience (anicca) and absence of self (anatta). These qualities are interdependent, such that appreciation of the pervasiveness of one of them enhances appreciation of the others. In moving to the phenomenal world, the Buddha referred to five distinct types of aggregates that comprise our experience of the world and ourselves, namely, material form (rupa), feeling (vedana), perception (sanna), mental proliferations (sankhara) and consciousness (vinaya).

In accounting for the partiality of perception and its relationship to other functions such as thinking, Buddhist psychology intimately supports Buddhist practice. There is a series of stages by which, through the five aggregates, events give rise to knowing. Within early Buddhist literature, principal teachings have been presented for general consumption in the suttas as well as systematically in the Abbidhamma. The former are usually far more accessible, and can be turned to here to illustrate the key ideas.

The honeyball sutta

In the so-called honeyball sutta (a honeyball is a kind of sweet cake) (No. 18 of the Majjhima Nikaya or ‘middle-length’ discourses (Nanamoli and Bodhi 1995)), the Buddha is sitting in contemplation when a man approaches him aggressively and asks him what he proclaims. He is told the Buddha proclaims that one does not quarrel with anyone else, nor with the world’s gods or rulers, because perceptions no longer sustain the man who achieves detachment from sensual pleasure. Such a man is free from confusion, worry, or any kind of craving. His questioner frowns, says nothing and departs. The Buddha goes to his disciples and tells them about his encounter. They ask him how it could be that perceptions no longer sustain the man who lives free from sensual pleasure, confusion, worry and craving. The Buddha replies they should look to the source of the perceptions and ideas that are tinged by ‘mental proliferations’. If one no longer finds anything to delight in or cling to there, then all tendencies to craving, aversion, illusion, doubt and other unwholesome states of mind will end completely. Once he has said this, the Buddha leaves.

The monks realise his answer was incomplete and berate themselves for not having pressed the Buddha to explain more fully how this comes about. They go to a saintly man whom the Buddha had entrusted to provide reliable explanations and ask him to help them. The man is astonished at the opportunity the monks have passed up to question the source himself, but eventually he agrees to try to satisfy them. He explains that when forms are present to the eye, eye consciousness arises. When form, eye and eye consciousness meet, contact follows. From contact comes feeling. From feeling, perception. From perception, ideas. Through thinking, ideas lead to mental proliferation. Then he utters a crucial sentence: ‘With what one has mentally proliferated as the source, perceptions and notions tinged by mental proliferation beset a man with respect to past, future, and present forms cognizable through the eye’ (Nanamoli and Bodhi 1995: 203). This same circular sequence is then applied in turn to the ear and sounds, the nose and odours, the tongue and flavours, the body and physical sensations, and the mind and mental objects. Each time, the manifestations of contact, feeling, perception and thinking are acknowledged in turn. Each time, the consequent tainting of perceptions and ideas by mental proliferation is mentioned (even if these proliferations are not manifest in themselves). The saintly man goes on to explain that, when there is no eye, no form and no eye consciousness, there can be no manifestation of contact. If there is no manifestation of contact, there can be no manifestation of feeling. If there is no manifestation of feeling, there can be no manifestation of perception. If there is no manifestation of perception, there can be no manifestation of thinking. If there is no manifestation of thinking, there is no manifestation of being that is beset by perceptions and notions tinged by mental proliferation.

He says this is his understanding of how, if one no longer finds anything to delight in or cling to, then all tendencies to craving, aversion, illusion, doubt and other unwholesome states of mind will end completely. The monks are relieved at what they hear. When they tell the Buddha of this explanation, they are told he would have explained it in the same way, enjoining them to remember what they have now heard. When one monk likens its reviving effect to coming upon a honeyball after being weakened by hunger and exhaustion, the Buddha suggests that they might remember the discourse in future as the honeyball discourse.

Although it has been truncated here, the sutta is full of the rhythm and repetition that was calculated to aid its memorisation. Its simple, five-step exposition of the aggregates is inseparable from the explanation of the benefits of disaggregating them by deliberate mental purification.

In the more systematic writings of the Abbidhamma, a more differentiated account of the same mental levels is presented. Although 17 stages of perception are described there (see Lancaster 2004: 110, for a helpful diagrammatic summary), these reduce in essentials to the stages of the honeyball sutta. In staying with this simple model, in which cognition is related to the five broad aggregates of form, feeling, perception, mental proliferations and consciousness, some important qualifications must be added. One is that none of these translations are truly equivalent to the original terms. Two instances of how this can be practically significant will be mentioned.

The term used for ‘feeling’ (vedana) applies across physical and mental feelin...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Preface
• Acknowledgements
• Introduction
• Chapter 1 Understanding mindfulness: Origins
• Chapter 2 Understanding mindfulness: Science
• Chapter 3 Mindful therapy
• Chapter 4 Mindfulness and mental disorder
• Chapter 5 Harnessing mindfulness
• Chapter 6 Mental health and mindfulness
• Appendix: Mindfulness centres
• References