Mindfulness has recently become a popular addition to the range of methods available to counsellors and psychotherapists, especially in the field of stress reduction but is the method being over-sold? This article reviews the origins of mindfulness, attempts a balanced review of what mindfulness is and is not good for, looks at the question of whether the meaning of the term has mutated or suffered dilution as its popularity has grown and considers what that popularity and possible mutation tell us about the current state of thinking in the psychotherapy field. In the process, it puts the usefulness and nature of mindfulness in a new perspective, challenging a number of commonly held contemporary views on the subject.
The term mindfulness has recently come into general circulation in the psychotherapy world. Its origins lie in the interest that psychologically minded people have had in the contribution that can be made to our field by research into Buddhist materials, an interest that sees Buddhist psychology as a discipline in its own right and Buddhist psychotherapy as a natural application thereof (Brazier, 2003; de Silva, 1979; Epstein, 1995; Kaklauskas, Nimanheminda, Hoffman, & Jack, 2008). I have contributed to this process myself in various books and articles (Brazier, 1995, 1997). Mindfulness is one item from this voluminous source that has caught on. The fact that it specifically has done so may tell us something about the contemporary condition of Western thinking and culture, which is increasingly focussed on finding technical solutions to utilitarian problems and also on seeking comfort and stress-reduction, while being less oriented towards questions of wider purpose and meaning.
Mindfulness, as the term is now used, refers to a set of techniques in which one gives deliberate sustained attention to presently occurring ambient, somatic or subjective phenomena. One of the most widely used sub-techniques is the bodyscan (Kabet-Zinn, 1994, 2005). It seems that modern people have commonly lost touch with their bodies and need teaching to pay attention to sensations, thoughts and feelings as they occur and to do so in a less judgemental manner. Have we become over-socialized, enculturated into a mode of relying upon conventional categories to the exclusion of direct observation and awareness?
The Meaning of Mindfulness in Context
The word mindfulness has become the standard translation of the Pali term sati, Sanskrit smriti. In its original English usage, this was a rather good translation. However, a shift of meaning seems since to have occurred as a result of a particular twist that has widely been put upon the general nature and direction of Buddhist philosophy. This twist has come about as a result of an apologetic move, using the term apologetic in its theological sense. Apologetics, in contradistinction to dogmatics, is the art of making a doctrine available to people by presenting it in terms that are already familiar to or popular with the audience. Apologetics generally involves some compromise between the material being presented and the established categories of the culture into which it is being introduced. Thus, Buddhism has made headway in Western society by presenting itself as less antithetic to science than other religions, more compatible with secular categories and amenable to being used as a set of self-help techniques that can be judged on their effectiveness without need for reference to faith commitment. That these claims are controversial has not impeded their popularity (Kirthisinghe, 1984; Lopez, 2008; Wallace, 2003). The idea that Buddhism has much to teach modern psychologists goes back at least as far as James (1912).
Each of these apologetic moves involves some departure from the original form and meaning: ‘adapting new and unfamiliar Buddhist conceptions to more ingrained Western thought-ways, like science, renders Buddhism more popular and less exotic; it also threatens to dilute its impact and distort its content’ (Verhoeven, 2001). Buddhism was not originally conceived with modern ideas about science, secularism, academic sensibilities or popular self-development in mind. Nor was the Buddha much interested in stress reduction. One of his most used words was ‘Strive’. Buddhism is or was fundamentally about waking up to a radically changed perspective on life as a whole rather than the application of limited techniques to the treatment of particular ailments or tension reduction. Mindfulness, in origin, was not a treatment, and it was one dimension of such awakening. It was concerned with fundamentals rather than symptoms. We might well ask ourselves which of these modes characterises psychotherapy today. The Buddha advocated mindfulness as means to learning, not as a treatment. It was supposed to be educational rather than medical. If it had any effect on stress, it was supposed to increase it, leading the practitioner to a direct experiential realisation of impermanence such as would impart a sense of urgency or even crisis to a life and thereby, in the best case, provoke a break-through to a more authentic life.
An effect of the Buddhist apologetic campaign in the West, which one has to allow has been rather successful in terms of generating interest and affiliation, has been that a number of key terms, of which mindfulness is a particularly striking case, have been, as it were, lifted out of their original context and significance and relocated with new associations and even new meaning. Mindfulness was a good translation of smriti because it brings together the elements of awareness and memory in the same way as the original term does. When our parents told us to be mindful of our manners, for instance, they meant to remember and apply them. Mindfulness in its original Buddhist context had much the same import, to remember and apply the teachings, or to hold fast to what one knows, including the fruit of both present and past experience and observe how it works out in practice in one’s direct experience. However, in the dislocation of the term, the element of memory seems largely to have been discarded.
Why might this be? Why are we cultivating such rootlessness? Surely if a client is to get through a present difficulty, one of the things they are going to have to call upon is their past experience. To arrive at this position, there has been a rather selective or incomplete reading of the Buddhist sources. Texts that refer to mindfulness, and notably, the much translated Mahasatipatthana-sutta (Hanh, 1990), often begin with what seem like body-awareness exercises. The Dharma of Buddha, however, can certainly be read not as asserting the nihilistic position that everything is momentary and impermanent, but rather, as becomes very clear in the Udana, (Ireland, 1997) to a heightened sense of what is impermanent and what is not. In Buddhist terms, alertness to the transient brings awareness of the unborn, the deathless, nirvana. Awareness of what does not constitute a reliable refuge adds urgency to the quest for what does.
However, the professional filter through which the material is commonly being read has no place for categories such as the unborn, the deathless or nirvana, but only for the transient phenomena that are thought to be the proper subject matter of science. The prestige of science tends to keep us focussed upon know-how and occludes questions of meaning or teleology to which science can offer no solutions. This lacuna is supposed to be filled for the modern person by a vague faith that science is, nonetheless, always just on the point of finding solutions even to such questions as the meaning of everything, and a faith that one can say without any disparagement of true science and its undoubted benefits is surely ill-founded.
There is a sharp difference of perspective between a modernist philosophy that values this worldly comfort and a former one that sought spiritual liberation no matter the struggle involved. Probably, the most important writer in the Zen tradition in the history of Japan was Eihei Dogen (1200/1253). In his master work, the Shobogenzo he summarizes the Mahasatipatthana Sutta in the following terms: The four abodes of mindfulness: The first is the reflection that the body is not pure. The second is the reflection that feeling is suffering. The third is the reflection that mind is without constancy. The fourth is the reflection that dharmas are without self. For him, mindfulness is a matter of ‘springing forth from self-entanglement’ (Nishijima & Cross, 1999, pp. 1–5).
His interpretation stands in striking contrast to ideas of mindfulness as stress reduction or sensory enhancement.
The Here and Now
Dogen and other classical interpreters notwithstanding, the contemporary approach presents mindfulness as more or less synonymous with present state awareness, or what one might call here-and-now-ism. Philosophically, this is the idea that only what is in present awareness exists, a slogan that one hears increasingly. This idea, while trivially true in one sense, has a number of philosophical disadvantages that we can only hint at here. On the one hand, it carries a serious danger of undermining both forethought and responsibility, factors that both Buddhism and any serious ethics would endorse, while on the other hand, it risks invalidating romantic capacities of the human soul that are essential to its nobility of spirit. Here, we shall be concerned with the matter both philosophically and psychologically as, although the latter is our prime concern, the former can inform us in important ways.
It is, of course, true that a practitioner of Buddhist meditation and a practitioner of psychotherapy share a need to be acutely conscious of detail and process and this includes but is not limited to, attention to what is happening right now. The skilled therapist notices the slightest shift in the client’s voice tone or demeanor. This kind of sharp attention is one of the important skills that a therapist must acquire. It is, however, just as surely, not the only one. It is not sufficient to notice what is happening. It is also necessary to notice it in the context of what has already been revealed and whither all such seems to be tending. In other words, the future and the past are every bit as important as the present, and, if ‘realness’ is to judged by effect, often more real.
In fact, we can go further than this. Strictly speaking, in the very present moment, nothing happens. Nothing can happen in a moment. Happening implies a duration. When we say that we notice what is happening in the present moment, we are using our terms loosely. If something is happening, then that something is a process over a period that is more than the present moment. In fact, we probably have to drop the word moment altogether. The present really means the recent past together with the immediate future and what is noticable and remarkable about it is what changes as that duration unfolds. Nevertheless, even this extended sense of the present is, as already mentioned, often not the most real aspect of lived experience. Causes, origins, purposes and destinations are generally more compelling than the scenery that one passes while travelling. The practice of mindfulness will enable us to notice and appreciate this scenery more, and this will often be a gain and an enrichment and, when the causes, origins, purposes or destinations happen to be oppressive, it may additionally be a relief and a respite, but such here and now awareness, while palliative in the cases suggested, will never be a substitute sufficient to replace the importance of knowing why one is travelling in the first place, where one intends to go and what one should do there.
Again, we can ask ourselves whether psychotherapy is primarily about such palliative care – alleviation without cure – or whether it has a more ambitious goal. Certainly, if we go back to the Buddhist source materials, the concern is not with defining a present moment, real or otherwise, but with a deeper awareness of the consequentiality of living one way rather than another. The Buddha’s constant concern is with the developing continuum of life and how an understanding of consequentiality under-pins both wisdom and compassion. We may say that far from reducing our attention to the here and now, Buddha’s agenda was to show people how their follies result from being taken in by superficial appearance and short-term thinking. What we were supposed to glean from mindfulness was a sense of continuity and greater wisdom concerning the results of intentional action rather than relief from having to think about such things. Wisdom and compassion are certainly of immediate concern to the therapist. The therapist’s task is nothing if not applied compassion, and this is practical wisdom. Those of us who are interested in what Buddhism can contribute are interested to know whether the wisdom that Buddhism suggests is indeed the one necessary to bring healing and wholeness to our clients or not. The idea that that wisdom consists in an exclusive emphasis upon the here and now, however, would be, I suggest, a mistake.
What then of the evident successes of the application of mindfulness in its reformed meaning? Attention to the present does have a calming effect upon the frenzied mind and modern life may be said to induce a degree of frenzy even in people generally considered to be of sound mind and good health. The welladjusted modern person handles a welter of information and responsibilities and certainly benefits from periodic opportunities to put this burden down and let the mind rest. If the object upon which it rests is an item of nature or beauty so much the better.
Let us consider another instance. A time when one does have acute here and now awareness is when one is in pain. On such occasions time seems to slow down drastically and in serious cases one wonders how one will get through the next few moments. Of course, at the very extreme, one might indeed lose consciousness and one might consider this a blessed relief. Now, if Nature’s remedy is to have us lose consciousness, we might do well to ask why we think that consciousness should always be the right remedy. It evidently is not. There is a place for unconsciousness.
The Value of Unconsciousness
At least since the Delphic slogan ‘Know thyself’ and certainly since Freud’s ‘Where id was there shall ego be’, there has been a tendency in Western psychology to assume that consciousness is all good. Many psychotherapy practitioners tend to assume that their job is to bring things to consciousness that were formerly out of awareness. However, there are probably just as many instances in which consciousness impedes as those in which it helps. Self-consciousness can certainly be a terrible blight, adversely affecting performance in a wide range of situations. This could, in fact, be one of the reasons why research has so conspicuously failed to find a positive relationship between experience of being in therapy oneself and ability to perform as a therapist. Being in therapy probably, in general, has the effect of increasing self-consciousness, and this factor may be quite sufficient to wipe out any gains accruing as a result of resolving particular personal issues. Consciousness is not the all-good that it is widely assumed to be and there is often a case to be made for keeping some things out of consciousness as much as possible. One can be sure, I suggest, that if Nature provided something there was a reason for it and we are amply provided with unconsciousness, both of the kind that occurs when we are not awake and of the kind when we are awake but unaware. Most of our vital processes take place out of consciousness. For the most part, I am quite happy to let my body get on with the business of secreting and distributing whatever hormones and digestive juices it thinks appropriate and it only needs to let me know when something goes seriously wrong. That is surely as it should be. Similarly, in our social life, we do not need to know everything. In many, many such cases, there is no reason to think that we could do better than natural process. Awareness would lead us to try to manipulate what we would do better to leave well alone.
Nor is the value of unconsciousness purely negative. If our minds did not fall into reverie, we would probably be a good deal less ingenious or creative. Now a certain kind of mindfulness can play an important part here garnering the results of intuitive processes. The method known as Focusing (Gendlin, 1978/2007) developed by Eugene Gendlin capitalises on this and Focusing can be regarded as an early valuable application of mindfulness in Western psychology, though it probably developed more or less independently of Buddhist influence. Like the Buddhist method, Focusing is primarily aimed at deriving meaning from direct awareness. It implies a co-operation between the conscious and unconscious in which the rational is, as Albert Einstein put it, the servant of the intuitive. To live constructively and creatively, many different kinds and modes of consciousness, including those that, since Freud, we have learnt to call the unconscious, must co-operate. Immediate here and now awareness is only one and it has its place and where there is a deficiency of it there is a value in its cultivation, but it is only one dimension of human functioning among many and the others are just as significant.
When one is in pain, distraction may be a greater mercy than awareness. When we marvel at operations being performed under the influence of hypnosis the hypnotic effect that we are marvelling at is essentially distraction. Certainly, the thing that is most useful in such cases is a form of non-consciousness, and if we cannot do it by hypnosis, then we are quite happy to rely on chemicals to achieve a similar effect.
Again, when we talk of distraction we are referring to the fact that the mind can only be fully conscious of one thing at the expense of other things. Mindfulness certainly cannot mean to be aware of everything all the time as this is beyond human capacity. Freud, indeed, suggested that one of the functions of the senses is to filter what would otherwise be an overwhelming cascade of sensory input. If mindfulness is a matter of fixing attention upon something, be it the muscle tone in your left arm, the tree in the garden or the deep meaning of the Buddha’s doctrine, then it must, of necessity, also be a matter of withdrawing attention from other things. We could, therefore, say that mindfulness is a restriction of consciousness or that it is an exclusion of some areas of awareness with as much justice as we can call it consciousness, awareness or concentration.
Once we start to consider mindfulness in this way the question ‘Mindful of what?’ becomes salient. The sudden rise of a wide variety of ‘mindfulness-based …’ therapies gives evidence to the fact that mindfulness can mean quite different things in different contexts. No doubt a soldier is taught to be mindful of not getting his rifle wet while crossing a river just as much as a nurse is mindful of the comfort of her patient, but here, of course, we have slipped away from the contemporary redefinition of the term back into the traditional usage, a usage that used to be as much Western as Eastern.
However, I think we have already here had enough small forays into the implications to see that mindfulness redefined as a state of active, open attention to what is concretely present has its uses, but is probably currently being oversold. It is sometimes useful to observe your thoughts and feelings as if from a distance and it is sometimes useful to temporarily suspend judgement about them in various ways that might be habitual. It is sometimes useful to pay attention to the state of one’s physical organism, its muscle tone, its involuntary processes. It is sometimes useful and can be pleasant, to look out of the window and regard the sky or, while on a country walk to pay attention to the air, the trees, the wind and flowers, or, even, while walking in somewhere that is not normally considered attractive, to notice small details in new ways so that a freshness of perception shifts one out of old ruts and makes a poem even of a heap of dirt, a dustbin, or a broken domestic appliance.
All of these things, any of which might in different contexts fall within the rubric of mindfulness in its modern usage, can be useful, pleasant, relaxing or healthy sometimes and, in the interests of therapy, one could prescribe them. However, none of them are panaceas and one can easily imagine situations where prescribing the opposite might be more appropriate or productive and one knows that Buddha often did. The cancer patient suffering from a tumour does not need more awareness, and they need more opiate. The artist needs to be sharply aware at least some of the time, but the poet also needs to dream. While driving one’s car, it may sometimes be charming to use the attention that is superfluous to the needs of controlling the vehicle to observe the roadside scenery, but there may be other times when the same surplus may be more profitably deployed in being engrossed in conversation with the person sitting next to you. There are times when it benefits us to be in control or to be distant from our process, but ecstacy comes when we lose it and submerge and the benefits of being completely lost in the flow are well attested (Csikszentmihalyi, 1990).
There is then the consideration whether the 'flow experience' is mindfulness or not. I might be considered to have been unmindful, on one definition, to have forgotten my girlfriend’s birthday, or, on another, to have not noticed that she was wearing a new dress, but in either case, it was probably because I was in the flow of some other consideration. It might be considered mindful to be in the flow of a tennis match but not of a dream, though, of course, while the tennis might yield an ephemeral satisfaction, the dream just might change the whole course of one’s life. Here, again, we are back to the question of immediate relief vs. long-term authenticity.
The Therapeutic Use of Awareness
So what is this reformed mindfulness good for? Primarily, it is claimed as an antidote to stress and stress-related illness (Kabet-Zin op.cit.), and, to some extent, as useful in cases of chronic pain. Chronic pain will tend to lead to muscle tension and spasm so anything that is effective in reducing stress should be beneficial in pain cases too. So this means that the primary claim is for stress reduction. There can be little doubt now that there is some validity in this claim. Bringing awareness back to things that compel attention by being immediately present does take the mind away from the factors that give rise to stress and thereby allows a very useful degree of relaxation to occur. Other areas where results are claimed is in the treatment of obsessive-compulsive disorders, in the management of anxiety (Orsillo & Roemer, 2005), and as an aid to the prevention of relapse in patients recovering from a variety of conditions including addiction and depression (Segal, Williams, & Teasdale, 2002; Williams, Teasdale, Segal, & Kabat-Zinn, 2007).
There is no reason to doubt on fundamentalist grounds that at least some of these claims are valid. The point that I want to make is not to deny that many people may have been helped by changing their patterns of attention, simply that we should be careful what conclusions we draw from this. Without intending to be facetious, would these people have been less helped by taking up jogging, could they have been induced to do so? Or having sex more frequently? Or gardening? There are any number of things that do one good, and it is certainly the case that most of us respond positively to the attention of professionals who are enthusiastic and seem to know what they are doing. What I do doubt is that we have here a method for inducing greater psychological maturity, which I am inclined to think was the aim of the original Buddhist notion of smriti when taken in the context of the other enlightening factors of which it is one element.
Should Psychotherapy be Mindfulness-based?
To my way of thinking, psychotherapy is not simply or even primarily concerned with stress reduction, but with the condition of the whole person and the living of an authentic life which means one grounded in truths derived from long-term experience so I think there is serious reason to question whether any real or complete psychotherapy can be ‘mindfulness based’ in the modern usage of the term.
A patient comes to me and tells me that she has a persistent delusion of having killed a baby and this delusion is disrupting her life inasmuch as she cannot leave a building without searching it first to make sure that she did not unwittingly hide the body somewhere. Obviously, I am going to pay attention to the client and her condition and one might say that therein I am being mindful. Again, it might form part of the therapy to ask the client to observe some aspects of her feelings and behaviour in certain situations. These are probably elements that would form some part of the work of any therapist dealing with such a case. Clearly, however, none of this warrants us calling the work mindfulness-based.
To be mindfulness-based, we would surely have to think that the curative factor is going to be this patient’s development of here and now awareness. However, the client is generally already overly aware due to her deluded terror of being found out as a murderess.
Another client tells me about the troubles in his marriage, his wife’s infidelity, his own temptation to follow suit, the wreckage of his former dream of domestic harmony. Or, another wants to be free from a recurrent tendency to self-defeating patterns of behaviour at work. Another is suffering from a depression triggered by a trivial loss of status, the condition being wholly out of proportion to the precipitating event. None of these are particularly unusual cases. Each will require care, listening, thought, reflection, warm-heartedness and intelligence. The therapist will do well to have a wide experience of life and a sympathetic understanding of humanity’s polymorphous perversity. Along the way both therapist and client may be sometimes engaged in sharp attention to the present moment, sometimes in allowing their minds to wander in free-floating semi-consciousness, sometimes attentive to phenomena arising in the body, sometimes to purely intellectual considerations, sometimes to the present moment, more often to the past. Is there really a reason to privilege one of these modes over the others? I do not think that there is. Nor do I think that doing so would actually be in line with what was intended by the Buddhist term in its original context, a context in which stress-reduction was not a primary consideration. In that context mindfulness meant to be aware of what one knew and it went with investigation that was the finding out of what one does not yet know. Smriti is to not let oneself be distracted from what one knows. This, of course, is distinctly different from the contemporary usage.
The Nature of Psychotherapy
The Buddha lists seven factors of enlightenment. In addition to mindfulness and investigation, there are enthusiasm, rapture, poise, samadhi and equanimity. Samadhi is often translated as concentration, but it contains the implication of concentration on a greater vision of things. If a person can be true to what they already know while being open to new discovery, can be enthusiastic in their search and go into raptures over what they find, yet have poise, faith in a greater vision and the equanimity to handle setbacks, then they will surely make progress in spiritual and psychological maturity. As therapists we might well find ourselves supporting the growth of all or any of these factors in our client and the ways that we find to do so will be as diverse as the clients who bring their life dilemmas to us.
Psychotherapy is an all-encompassing art, not the application of a few simplistic techniques in a one-size fits all philosophy. Although this is not the meaning that is currently attached to the term mindfulness, it is one that makes good sense. Here and there, awareness is one element in the complex business of life, and we can all benefit from improvement in this as in many other areas. To give it exclusive or excessive weight in our philosophy of what we think we are doing in the therapeutic art would be like thinking that because blue is useful when painting sea or sky that all painting should be blue-based. This would be getting the matter out of proportion.
Mindfulness in its traditional meaning is certainly a wholesome factor both for therapist and for client. Mindfulness in its modern usage has some limited applications. Buddha’s teaching was concerned with helping people to find deeper meaning in their lives through reliance upon what they know from long experience and can find out by investigation. Psychotherapy has a similar purpose. Mindfulness in both its modern and original senses can play some part in that, but the original sense is broader than the modern one.
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