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Mindfulness and being useful rather than right

Mindfulness is everywhere. There are guides to mindfulness all over the Internet, mindfulness apps and courses are springing up constantly and the shelves of bookshops groan with books about mindfulness in everyday life.

This is good. Mindfulness is an important psychological technique. It involves cultivating a careful awareness of the present moment and sticking with that. It means shifting focus from the past and the future and remaining rooted in the present.

There are hundreds of different ways to achieve this goal and all are more challenging than they sound on paper. But they are very good exercises: Increasing awareness of how our minds hop about the place constantly, developing skills for focusing on the present moment, and increasing equanimity and cognitive control.

Mindfulness comes originally from Buddhist tradition. To quote Buddha: “There is nothing so disobedient as an undisciplined mind and there is nothing so obedient as a disciplined mind.” Mindfulness helps with this.

But the line between mindfulness and mindlessness is a narrow one and there is a real risk that mindfulness will be over-sold. Mindfulness is just one element of Buddhist meditative tradition and while certain benefits of mindfulness are now clear, greater contextualisation of the practice is needed.

This is one of the many points made in an excellent new book titled Advice Not Given (Hay House, 2018), by Dr Mark Epstein, a New York psychiatrist. Epstein has already written a great deal about Buddhism and psychotherapy in books including Thoughts Without a Thinker: Psychotherapy from a Buddhist Perspective (1995) and, my favourite, Psychotherapy Without the Self: A Buddhist Perspective (2007). The latter is a sensible, bracing collection of essays that includes one on the use of psychiatric medication in conjunction with meditation for some people. Often, a combination of approaches is best: One size does not fit all.

In Advice Not Given, Epstein writes that he watched mindfulness emerge as a valid therapeutic modality in recent years, but stayed on the side-lines, “wary of what has always seemed to me to be people’s exaggerated expectations of this single aspect of Buddhist thought”. Balance, as well as mindfulness, is central to Buddhism.

That is not to say that mindfulness is without value – there are very good reasons why most spiritual traditions include some variation on the theme of mindfulness (repetitive prayer, contemplative devotion, etc). But mindfulness alone is not enough and mindfulness needs to be practised mindfully.

Epstein goes on to explore various other related themes in his new book, which he structures around the “eight-fold path” of Buddhism. To put this in context, Buddhism presents four “noble truths” which are centrally concerned with human suffering (duhkha) and the way to overcome suffering. The first truth is the existence of duhkha, which, in essence, refers to the unsatisfactoriness of much of human experience and behaviour.

The second noble truth is the causes of duhkha, which in Buddhist tradition, are craving (also translated as “grasping” or “attachment”), hatred and false beliefs. These experiences are most often embedded in our responses to sensory phenomena and the world around us. This truth provides much of the basis for Buddhism’s focus on the practice of meditation as a key way to attain calmness, improve insight and move towards enlightenment.

The third noble truth is the cessation of suffering: By facing duhkha and overcoming craving, aversion and false beliefs, we can achieve the cessation of suffering. This is the ultimate aim of Buddhist practice, known as nirvana. Finally, the fourth noble truth is how to overcome duhkha through the “eight-fold path”, based on the key principles of wisdom, moral virtue and meditation. The eight elements of the path are right view, right motivation, right speech, right action, right livelihood, right effort, right mindfulness, and right concentration.

In Advice Not Given, Epstein devotes a chapter to each element of the eight-fold path, illustrating connections with western psychotherapy and placing particular emphasis on the work of Donald Winnicott (1896-1971), an English paediatrician and psychoanalyst.

Epstein has much to say about how eastern and western traditions interact in psychotherapy. He uses autobiographical and clinical anecdotes to excellent effect, commenting, in relation to one patient, that he (Epstein) “made room for her uncomfortable feelings in a way that allowed her to make room for them too”. That idea describes a key purpose of much psychotherapy: Creating a safe, containing space for dialogue, experience, awareness and self-acceptance.

On the subject of psychiatry, Epstein is similarly insightful, writing that “being right is not the point in this profession. Being useful is”. Advice Not Given is very useful indeed, both as a guide to the meeting of eastern and western psychologies, and as an example of thoughtful, measured, compassionate writing about psychiatry.

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