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Mindfulness, Dharma, Mental Health & Science Part 1 of 2

Welcome to all of you. I am happy to be with you and reflecting on these themes this morning. I have a few slides, though I am not planning to present a lot in that form. You can see the growth of interest in meditation in the scientific literature. Over the last thirty years, searching for the keyword "meditation" went from thirteen in 1991 to almost two thousand last year.

We can go back to William James^[1], who said: "The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgment, character, and will... An education which should improve this faculty would be the education par excellence. But it is easier to define this ideal than to give practical directions for bringing it about." In a way, one set of practical directions for bringing it about is what we do—this attentional training that we do.

But this Asian monastic path is also a mystical path. It is not attentional training for its own purposes, exactly. So again, we have James echoing a certain kind of reverence for this mystical dimension: "Our normal waking consciousness, rational consciousness as we call it, is but one special type of consciousness, whilst all about it, parted from it by the filmiest of screens, there lie potential forms of consciousness entirely different. We may go through life without suspecting their existence; but no account of the universe in its totality can be final which leaves these other forms of consciousness disregarded. How to regard them is the question, for they are so discontinuous with ordinary consciousness. Yet they may determine attitudes though they cannot furnish formulas, and open a region though they fail to give a map. At any rate, they forbid a premature closing of our accounts with reality."

The increase in scientific interest around meditation is evident, reflected in the increase in the practical use of meditation. There is not good data from more recently that I could find easily, but in one of the repeated national surveys from 2012 to 2017, you see the growth in the practice of meditation. This is just based on the question, "Have you practiced meditation at some point in the past twelve months?" You see it is grouped here with yoga and chiropractic, which is kind of interesting and a testament to how these things are grouped together, which is meaningful in itself. Here is data for kids, showing growth over this period of five years, and I imagine there has been a lot of growth since 2017. Anecdotally, when I teach residential retreats, if there are a hundred people in the retreat, there will be a lot of people who are now coming into residential retreat through the route of apps and digital technology.

Let me pause this for a moment. The motivations that people are coming in with to practice meditation: about ten percent were recommended by a physician, maybe twenty percent consulted a teacher or a class, but most people are practicing on their own, actually. The people who did consult with a class or teacher, the median annual spending on meditation was $120. The practice motivations were general wellness or disease prevention in about three-quarters of people, improving energy in sixty percent, and improving memory or concentration in about half of the respondents. I don't know where enlightenment was there, but it is lower down, right?

So, this is the convergence or collision of different traditions. How should we think about the application of an Asian renunciate tradition to the realm of mental health and healing? What exactly is the dharma for, and who gets to decide what it's for? To use medical language, what is the scope of practice of the dharma? What is the scope of practice of a nurse practitioner or physician? What is the scope of practice of the dharma? How is the dharma transformed by its interaction with the realm of mental health and all the different encounters it is having in this culture?

In The New York Times about fifteen years ago, they wrote, "The question is not whether mindfulness meditation will become a sophisticated therapeutic technique or lapse into self-help cliché. The answer to that question is yes to both."

We can think about well-being as a continuum. On one end, we have the most intense, unmitigated suffering, and on the other end, we have profound flourishing. Maybe we call it self-actualization or awakening. At the midpoint, we have what we call "normal." Of course, Abraham Maslow^[2] said, "What we call normal in psychology is really a psychopathology of the average, so undramatic and so widely spread that we don't even notice it ordinarily." It is very harsh language, actually, but what we consider normal—what an "okay" human life is—is actually full of dukkha^[3].

Traditionally, the path of dharma has been largely devoted to the span of well-being from "okay enough" to profound flourishing. It has been about potentiating well-being. It has been about refining out more and more subtle layers of suffering. Importantly, the dharma has relevance for this other half of the spectrum of well-being too. This is where the public health interest really is, because there is much more bang for the buck, actually. Fiddling with the subtle kilesas^[4], the attachment to light and bliss—this is not the priority of public health institutions. It is like, "No, there is so much suffering. How can this path of practice be of use in those ways?"

There are so many different ways I might have gone during this time together and how I structured the different themes. I am no doubt leaving lots of questions unanswered, but hopefully, we have some productive discussions together.

One of the questions is how we situate this Buddhist tradition with science and empiricism. In the academic world, there are buildings that separate different departments: this is biology, this is literature, this is education, this is medicine. There are these siloed academic departments based on particular expertise. But there are also increasingly common interdisciplinary approaches where you bring to bear a range of different forms of expertise. Here, the problem, rather than the discipline, becomes the focal point, and very diverse expertise is relevant. I often say that dukkha is an interdisciplinary problem. It is not the province of just one discourse, be it dharma or science or anything. The fact that the dharma is the only medicine, I would say, for certain species of suffering, doesn't mean it is the medicine for all species of suffering. How we navigate this dialogue happening between disciplines is important, and we want to have it in intelligent ways.

I have very deep devotion to science and the spirit of empiricism, and obviously to the dharma, which I have dedicated my energy and my life to. As I talk, I have my dharma teachers on one shoulder, and my scientific mentors on the other, and I'm trying not to mortify either of them. We will see how I do.

What is the stance of a religious tradition toward other discourses—toward science, medicine, philosophy, history? One possible stance is just to ignore these other disciplines. This would go something like, "Well, dukkha might be an interdisciplinary problem, but the dharma is really sufficient for all that truly matters." Another stance might be competition. This is a very familiar stance of religious traditions toward the secular—a sense that the secular, scientific, or historical is an encroachment on the sacred ground of the dharma that needs to be fought off. You see this acted out historically and at present.

Another way of situating dharma and science is something like "non-overlapping magisteria." There is a famous phrase from Stephen Jay Gould^[5], an evolutionary biologist and science communicator, who was trying to find a way for religion and science to coexist peacefully. Gould said, "Science tries to document the factual character of the natural world, and to develop theories that coordinate and explain these facts. Religion, on the other hand, operates in the equally important, but utterly different, realm of human purposes, meanings, and values—subjects that the factual domain of science might illuminate, but can never resolve." That was his attempt at non-overlapping magisteria, a way of situating religion and science.

There is another way, something like selective appropriation. There is the cultural appropriation on one side, divorcing mindfulness from its rich cultural history. But on the other side, there is a selective appropriation within dharma—highlighting supportive scientific data that confirms our Buddhist presuppositions and trotting out data that amplifies those claims. So much of the way neuroscience is used rhetorically is an attempt to convince us that we should keep practicing, which is okay, but it is selectively cherry-picking certain bits of science as a way of reinforcing Buddhist notions. I just want to say, science doesn't just give; it also takes. If we, as dharma practitioners, get into the business of marshaling scientific evidence for our claims, we want to do this carefully, because science doesn't just give, it will take too.

The last kind of relationship between these different traditions, which is closest to my heart, is a conversation. It is a truly bidirectional flow of information. It is treating dukkha as an interdisciplinary problem, with a degree of reverence for the respective zones of expertise. And it is about accepting influence. In couples therapy, there is a notion of accepting influence: can one partner accept the influence of another? I think we want to be open to accepting influence.

I want to note the problem of scientism in this discussion. Scientism is the sense that science is the ultimate arbiter of all claims and all value, a reductionistic vision of the plurality of knowledge traditions. Karl Popper^[6] said, "Despite my admiration for scientific knowledge, I am not an adherent of scientism. For scientism dogmatically asserts the authority of scientific knowledge, whereas I do not believe in any authority and have always resisted dogmatism." The more you study the philosophy of science, the more humble you are about what science does and does not do. In scientists who are conscious of the epistemological understanding of science, there is a lot of humility.

Empiricism and the scientific method have staggering power, and many of the claims of the dharma are empirical claims. They are empirically testable, falsifiable claims. The nature of unhappiness, of well-being, of flourishing; claims about the value of training our attention in this way; claims about the value of ethics for well-being; claims about how mindfulness alleviates suffering—these are all empirical claims. Science is a powerful way of assessing the validity of empirical claims. Maybe even more fundamentally, science, when done well, is actually a form of intellectual honesty. It's a willingness to be wrong. That willingness to be wrong is obviously profoundly lacking in the world.

The last thing I want to say about this is that the commitment to deep love, to awareness, to a reverential stance in relation to the dharma, is compatible with a scientific sensibility. There is a sense that if we welcome in some empiricism, somehow the sacred will be compromised. I don't think it has to be that way. It might go that way, but I don't think it has to. An openness to the discourse of science does not necessitate a reductionistic vision of the path, of its potency, its beauty, or its depth. Sincere, beautiful integrations of the mindfulness tradition and the dharma tradition are possible.

As an example, Marsha Linehan^[7] developed Dialectical Behavior Therapy (DBT), which is used initially around borderline personality disorder, but generally for emotion dysregulation and self-harming behaviors. Mindfulness is not just one of the modules; it is the backbone of that treatment approach. About ten years ago, Linehan revealed the origins of the treatment she's largely responsible for developing. This is from The New York Times:

"Are you one of us?" the patient wanted to know. And her therapist, Marsha M. Linehan of the University of Washington, creator of a treatment used worldwide for severely suicidal people, had a ready answer. It was the one she always used to cut the question short, whether a patient asked it hopefully, accusingly, or knowingly, having glimpsed the macramé of faded burns, cuts, and welts on Dr. Linehan’s arms. "You mean, have I suffered?" "No, Marsha," the patient replied in an encounter last spring. "I mean one of us. Like us. Because if you were, it would give all of us so much hope." "That did it," said Dr. Linehan, 68, who told her story in public for the first time last week before an audience of friends, family, and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17. "So many people begged me to come forward, and I just thought—well, I have to do this. I owe it to them. I cannot die a coward."

She disclosed her own history of mental illness and failed treatment, the depth of hopelessness, and the necessity of figuring out: "Okay, we can do better. How do we treat people like me?"

Some years later, I saw her dedication in one of the DBT skills workbooks—developing skills of emotion regulation. She wrote:

"When I am on retreats, each afternoon I walk and wring my hands, saying to all the mental health patients of the world: 'You don't have to wring your hands today. I'm doing it for you.' Often, when I dance in the hallway of my house or with groups, I invite all the mental health patients of the world to come dance with me. This book is dedicated to all the patients of the world that think no one is thinking of them. I considered telling you that I would practice skills for you, so you don't have to practice them, but then I realized that if I did, you would not learn how to be skillful yourself. So instead, I wish you skillful means. And I wish that you find these skills useful."

I find that touching. You can't write a dedication like that unless your heart has been pierced in some way by the path of practice. I have some trust that when one has a deep encounter with the path of practice, the modifications, distillations, and articulations of this path—no matter what they look like—will have integrity if they come out of an understanding of the depth of what's possible.

You can hear many of the themes I've been articulating in this last piece I'll share, from leaders in the movement around mindfulness-based programs. This is Jon Kabat-Zinn^[8], Christina Feldman^[9], and Judson Brewer^[10]. They asked in a 2016 paper, "What is the warp and the weft of mindfulness-based programs?" The warp on a rug is the backbone, and the weft is the design. So, what is the warp and weft of mindfulness-based programs? I'll read the five essential qualities of mindfulness-based programs. You will hear innovations and also familiar echoes of the dharma path. Mindfulness-based programs are:

1. Informed by theories and practices that draw from a confluence of contemplative traditions, science, and the disciplines of medicine, psychology, and education.
2. Underpinned by a model of human experience which addresses the causes of human distress and the pathways to relieving it.
3. Develops a new relationship with experience characterized by present moment focus, decentering, and an approach orientation.
4. Supports the development of greater attentional, emotional, and behavioral self-regulation, as well as positive qualities such as compassion, wisdom, and equanimity.
5. Engages the participant in a sustained, intensive training in mindfulness meditation practice, in an experiential inquiry-based learning process, and in exercises to develop insight and understanding.

I'm curious how that reads and lands for you. You can certainly hear echoes of the dharma path, but also this interdisciplinary approach, highlighting particular aspects of the dharma path to the exclusion of others. This whole conversation is happening in the context of Jon Kabat-Zinn's work. In 2011, he said of Mindfulness-Based Stress Reduction (MBSR):

"MBSR was developed as one of a possibly infinite number of skillful means for bringing the dharma into mainstream settings. It has never been about MBSR for its own sake; it has always been about the 'M,' and the 'M' is a very big 'M.' We use the word 'mindfulness' intentionally as an umbrella term to describe our work and to link it explicitly with whatever I have always considered to be a universal dharma that is co-extensive, if not identical, with the teachings of the Buddha."

I don't know where that leaves us, what we are to think of all of this, and I don't want to fight about it either. But I do want to pause and open it up for questions and initial responses to me laying it out in this way. If you want to ask a question, raise your electronic hand and I'll unmute you.

Q&A

Question: The self-description sounded incredibly idealistic, particularly about the sustained serious practice. The few people I've known who are not Buddhists who have done some sort of mindfulness thing, it was pretty short and not sustained or deep. One friend of mine came away not really understanding what it was or what the point was, and she's very intelligent—she has a PhD in psychology. That's anecdotal, but... And the other question I had was about the fifth description point, that the mindfulness movement is "approach-oriented," and I didn't know what that meant.

Matthew Brensilver: I think one of the things you're pointing to is the question of attrition. What are the attrition rates in the dharma realm? It's high. I don't know exactly what it is. The dropout rates for an eight-week mindfulness class are actually quite low, probably similar to cognitive behavioral therapy (CBT). But is eight weeks a sufficient dose in the course of a dharma life? It's amazing to me that there are treatment effects after eight weeks, because when I think about my mind on day one and day fifty-six, it was a circus gone wrong on day one, and the same at day fifty-six! The benefits in those early phases of treatment are probably mostly cognitive reframing and reappraisal, not attentional benefits.

So, are we giving the equivalent of half a milligram of Prozac rather than the twenty which is standard? How do we understand attrition in different spheres? Maybe this group right here, we're the super-responders that are highly unrepresentative of the initial sample. We're the weirdos, actually, and we somehow stayed. Understanding the moderators of treatment responsiveness—the variables that predict a stronger response to the meditation treatment—is important.

Regarding the "approach orientation," I will talk more about that later. It's alluding to the fact that much of our distress, especially anxiety but other things too, is sustained by rigid, habituated forms of avoidance. Mindfulness is an approach orientation in its basis. All the instructions you hear in guided meditations are ones of approach. I think one way of thinking about the dharma is as an exposure therapy, which is an approach orientation to all phenomena. The deepest kind of approach is love. It's love and samadhi^[11]. That's the deepest contact we can make with phenomena, and in this way, the potential extinction learning is most profound when we approach that deeply.

Question: That figure about three-quarters of them starting because of health issues is probably the way Jon Kabat-Zinn started it. But that sort of explains to me how much I need sangha^[12], and how judgmental I get against all of us who are suffering versus those who manage to get by. I just came off my first two-month retreat. It was great, and it was not the miracle I wanted. This is darn hard and I'm running out of time. I just feel envious of those people who manage to get by better, because why not make hay while the sun is shining? I don't know where my question is, but I'm sure I said enough for you to react to.

Matthew Brensilver: Some of the language around dharma is that it's measureless, meaning we're actually invited to step out of the realm of the comparing mind. I know you're going to say, "I know, I know, Matthew," but we're really being invited out of that realm, because it is symptomatic of the dukkha itself. This is not the view from which to understand suffering; it is suffering itself. Trying to figure out "greater than, less than, equal to"—we are being invited out of that realm.

It's one of the most painful mind states. It's just gruesome. An essayist once said something like, "Of the seven deadly sins, only envy is no fun at all." Lust and gluttony might have their moments, but envy is no fun at all. It is another expression of sakkāya-diṭṭhi^[13], and this needs to be loved to death. Just be careful how the defective dharma self congeals around it.

Question: First of all, honestly, I saw your name, I registered, then I read the topic. Every one of your courses has impacted me. I've been practicing eight years, I'm really disciplined, I do two and a half hours of meditation every day, and I did ten weeks of retreat last year (unfortunately all on Zoom). I come from a STEM background, but I have this deep desire to know topics like the science of mindfulness, though I don't have academic credentials behind it. I'm wondering why I'm interested in this topic? I enjoy the practice very much, I'm a chaplain, I serve in the prison. I've read books on the science of mindfulness and the Dalai Lama's compilations. I'm starting to wonder if it's not helping my practice as much with this approach to knowledge. Should I just break away from this and enjoy and experience the practice?

Matthew Brensilver: I think it's totally legitimate to put all of this down and just practice sincerely. I do not feel like it's necessary for many people to study this. For a long time, the meditation research was primitive and reductionistic; they were just demonstration projects saying, "This is not a cult, there's actually something here." It dignified it as a topic for empirically responsive people, but it did not add much to the practice itself.

Just recently, we're starting to get to the point where people who have a long history of dharma practice are collaborating in interdisciplinary teams, or they are the scientists themselves. It's starting to change how I think about practice, and some of the science is actually feeding back into the dharma. But I wouldn't feel obligated to look to the emerging science around mindfulness to support your path of practice.

Sometimes we get a little academic and soak that up, but then we need to dry the ground out with more practice. You're doing a lot of practice, so that's great. It's not going to necessarily help you overcome hindrances in some unique way.

Question: Thank you for doing this. About four or five years ago, I went to a retreat where they played a section of talks by Pema Chödrön^[14] on this topic. She went through what we know about the brain and what we know about the dharma, and she was talking about the paramitas^[15]. Do you happen to know what it is? It was really meaty stuff and I haven't been able to find it again. My other question is, do you know Sam Harris's^[16] work? Could you talk at all about his approach to neuroscience and dharma and how that aligns with yours?

Matthew Brensilver: I don't know the Pema Chödrön talk, but it's out there. As for Sam Harris, I don't know it well enough to speak to it. I know he is blending a little bit of the Vipassana approach with some of the Dzogchen^[17] approach in non-dual-ish ways, without smuggling in as much metaphysics. I really don't know the approach well enough, but I see that his app is a common one for people coming into retreats.

Question: I'm currently enrolled in a science-based mindfulness training program, but I feel a sense of betrayal toward the dharma—to eliminate it completely from the conversation. I'm a lover of the dharma, and now I have the dukkha of that love. I'm trying to find a way where I can hold both and not see it as an either/or. I was wondering if you could shine some light on a path that might help me receive what I signed up for with noble motivation, and not reject it?

Matthew Brensilver: I think a lot of it is how it's done. Is it done with integrity, with heart, and with a kind of reverence for the sacred? Or is it highly selectively extracting practices in reductionistic ways, which can feel really yucky? I think it depends a lot on the wholesomeness of the intentions of the people designing the intervention.

For me, I teach mostly in Buddhist settings, but some in very secular settings, primarily UCLA. The dividing line is not Buddhist versus secular; the dividing line is reverence for the sacred versus the commodification of attentional practice. I think there are ways of sharing the practice in secular contexts that really have heart. But it can get tricky, especially when it gets pressurized by symptom orientation, where the practice has to deliver on outcomes in a short-term window. The practice itself becomes cramped. The delight of investigation is not there, and the pressure of bhava-taṇhā^[18] (craving for becoming) is so strong.

Thanissaro Bhikkhu^[19] was asked about this. He was hesitant in his own ways, but he said something like, "Any way that Buddhism makes its way into culture is a good thing." That was meaningful to me. Even in its reductionistic forms, any way that wisdom and compassion make their way in is a good thing. I try to keep that in my heart.

What Buddhists often accuse the secular folks of leaving out is sila^[20] (ethics). That has not generally been my experience; the ethical roots are well represented in a lot of secular mindfulness. What is actually left out in the secular articulations is the renunciation, the surrender. Renunciation is at the heart of this path; mindfulness is not something for nothing. When you enter a dharma hall, the teacher basically asks you for your life. That is not a reasonable starting point in therapy or an educational setting, so the renunciation is titrated. They start with a small ask: "Just take a look at your mind." Whereas we begin with, "Take refuge, down on your knees"—that depth and breadth of practice.

Question: I just wanted to add a perspective that reinforces what you were saying. I was in an MBSR class in a medical setting at the same time I was exploring the dharma. It was very synergistic. The woman who taught it was a practitioner, but she was really walking a tightrope between the secular and the spiritual. Most people in the class were there because of physical problems, commonly chronic pain. She wanted to reach everybody on whatever level they could relate. Some people weren't Buddhist, some weren't religious, or were practitioners of other religions who wouldn't relate if she spoke in dharma terms. I don't think she was diluting what she was presenting; she was doing it in a way to reach the most people. The class had limited application to me, but I was able to use what I could from it.

Matthew Brensilver: Thanks for the testimonial. In a way, I feel very deeply connected to the Buddhist tradition. At the same time, if I can't articulate this in a different language—if I need to legitimate this practice by referencing the suttas—is that maybe a problem? I think we can talk about the depths of practice in ways that are amenable to scientifically-minded folks without citing the authority of the texts. It's not legitimate to just say, "Well, Buddhism isn't a religion, it's a philosophy, it's just self-evident." All religions think they're not religions! They say, "We study the word of God, that's not a religion, that's just the truth." It's the same thing with the dharma. But I don't want to wander into philosophical territory I'm not qualified to speak on, so we will take a break precisely now.