“It’s only natural”

This is a work of fiction. Names, characters, businesses, places, events, locales, and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental. This is not intended as a substitute for the medical advice of physicians. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention.

A very handsome, fit and well-dressed young man came in to see me about a nagging, chronic gut problem. This is the sort of thing that medicine doesn’t really have an answer for and the referring family doctor knew this as did the said dashing young man. The reason for her referral was that he had had enough.

I took a very long history filled with exacerbations and remissions going back to when he was a teenager, alleviating and aggravating factors that the tormented young man never really managed to leverage.

All the same, he was ahead of the curve in his career. He travelled extensively, ran a half-marathon and even climbed Kilimanjaro.

We were nearly certain that his condition didn’t have an organic cause we could address, but given the one or two potential pointers for such a cause, the duration and extent of his distress, it was decided that the gentleman should have some specialist investigations. As a sort of an advance measure, we gently suggested that in all likelihood, the tests won’t find anything and if so, there won’t be much we could offer him besides a few tweaks of what has helped him in the past. At this point he covered his face with his hand, then made a tight fist whitening his knuckles, plunging visibly into anger and frustration – not so much at us, it seemed, but at the powerlessness of medicine and his ill fate.

There is no denying that this high-flying man suffered greatly with his imperfect bowel. I was left there wondering two things.

This man is so accomplished, able to climb mountains and run marathons, why does he so firmly believe that his condition is “debilitating”? I can only presume that he has a kind of equation in his head where his potential plus his condition equals his reality. I did wonder if his reality could have been far more impressive had it not been for these bouts of gastrointestinal torture. I have the suspicion that the thought occurred to him. Perhaps it occurred to him many times a day.

Furthermore, if he is determined to eradicate this unidentified fiend sabotaging his gut, why didn’t he do more of what worked and avoid the aggravating factors? It would seem a little maladaptive to refuse to negotiate with the affliction. Or did he write down all his shortfalls to the condition, thus allowing him to sustain a vision of unadulterated, perfect potential trapped by the wretched disease?

I then wondered if that is our perfectionist millennial nature that’s always chasing the latest maximising-optimising lifehack or is that the sort of irreducible self-selection that particular kind of young person to hospital regardless of their generation or culture.

The reason I wonder this is that only last week I was trying to convince a much older man to consider treatment for his chronic pain, but he insisted, “it’s only natural”. Then again, I don’t think it would ever occur to him to climb Kilimanjaro.

If Symptoms Persist by Theodore Dalrymple: my highlights

A retired psychiatrist tells all. Warning: Controversy and cynicism ahead.

“I find my own cynicism witty and sophisticated; but in others I find it callous and brutal.”

[About health promotion]: I am so heartily sick of the tepid existence which we doctors are now peddling as the elixir of life that when one of my patients refuses to take my good advice, I want to jump up on my table and give three cheers.

I know there are medical fascists around –a former President of the Royal College of Physicians is one –who would make such patients pay for the treatment of their ‘self-induced’ diseases, but this seems to me to come perilously close to the Erewhonian nightmare, in which youths who bash old ladies over the head will receive treatment but people with heart attacks will be punished.

It is a well-known fact that one of the best preservatives against ill health is self-employment. The self-employed cannot afford to be ill, while those in the employ of others cannot afford (it often seems) to be entirely well.

I should have bought something for my ward with the £ 5, of course, but the devil entered me and I decided to go through the proper channels. [What follows is his recount of how he spent multiples of the “thank you” from a patient on the bureaucracy of “proper channels”].

‘I’ve realised, doctor,’ she said, ‘that life’s not worth killing yourself for.’

The symptoms of her illness were vague but debilitating: she could no longer summon up the energy to do the thing she did not wish to do, such as vacuum-cleaning and ironing.

[About a patient who didn’t notice at all that she was being seen by a doctor who was standing in for her regular doctor, Dr S, who is a very warm-hearted individual]: I feel rather sad on Dr S-’ s behalf. He thinks his patients value his efforts, but in fact he is valued only for his function, as a vacuum cleaner or washing machine is valued.

[About a woman who immigrated to the UK and successfully built a life there, only to find her one of her sons deliberately unemployed and one in jail]: How has her dream of thirty years ago been turned into this nightmare? I do not have the whole explanation, but I suspect that those who teach that employment is exploitation, that law is injustice, and that racial prejudice is so ubiquitous and all-pervading as to render personal effort superfluous, have much to answer for.

No matter how deluded and paranoid people are, they are usually able to refrain from attacking several policemen, each of whom is over six feet tall.

Since activity is as good as action, the first thing to do is to form a committee… The purpose of this committee is to assure the Health Authority that it can assure the Ministry that it can assure the Minister that he can assure the Government that it can assure the Opposition that something is indeed being done.

As everyone is aware, alcohol is responsible for accidents, murder, suicide, cirrhosis, cancer, heart disease, stroke, divorce, crime and ruination, as well as 95 per cent of the enjoyment at social occasions and a considerable, if lesser, proportion of government revenue.

[On health education]: Their jobs depend upon a permanent effervescence of publicly-funded panic.

Dealing with people makes you appreciate things.

[To a patient]: ‘What you’re really saying to me is this: when you have found the single piece of buried treasure in my psyche that explains my behaviour, I will automatically stop breaking into people’s houses; but if you don’t find out what it is, which is your job as a doctor, then, when I break into people’s houses and steal their videos, it is really your fault and not mine.’

In the eternal struggle between doctor and patient, I told a medical student last week, the patient always has the upper hand. This is because, while the doctor is constrained by a code of behaviour, the patient is not: he can use any means he likes to bring about his desired end… A doctor has to learn to accept blackmail, I said, with a good grace.

Surely, if passive smoking is bad for one, the passive consumption of junk food must be even worse.

The ward smoke alarm went off in the midst of my reflections. I went to see what was happening: the alarm was being tested. It took three men to test it, one up a ladder, one with a clipboard at the base of the ladder, and one –a Fire Prevention Engineer –to oversee operations. And then, suddenly, the whole meaning of life became clear to me: so to arrange things that we survive until tomorrow.

One of the worst things about being a doctor is that you have to pretend that repulsively bad manners are a sign of suffering.

After all, if you don’t do anything, you can’t be accused of inefficiency.

The gender pay gap 💩

There is a hospital crisis in many places in Europe and it’s quite bad in Ireland. It’s a complicated situation. In the midst of this, one of Dublin’s major hospitals decided they won’t pay interns overtime.

Some background. Interns work anywhere between an average of 45 and 80 hours per week in my experience. I assume the hospital will pay for the on-call time (i.e. scheduled overtime), but not overtime done on regular days.

A lot of people who follow my education platform are interested in medicine. I decided to ask a question:

gender gap medicine ireland

First, it doesn’t help the doctors’ wages that people who want to do medicine are ok with working for free.

More interestingly, I found that there was a big divide between men and women. There is an all out war at the moment on whether this gap is at least in part explained by the choices that women make (e.g. 1 vs 2).

In the sample, there were 241 women and 57 men. The sex of 7 voters was unknown.

Of the men who voted, 82.4% said no. Of the women, 69.7% said no.

Surely this is contributing to the gender pay gap?

Of the yes voters, 12.0% were male. Of the no voters, 21.9% were male.

gender pay gap in irish hospitals
The chi-square statistic is 3.7272. The p-value is .053534. This result is not significant at p < .05.

Why? Some theories. The ones that are highlighted are the ones I feel are more plausible.

  1. Women are more likely to agree to work for free
  2. Women value altruism more than men do (conflicting evidence on this, e.g. 1 vs 2 vs 3)
  3. Women value prestige more than men do (rebuttal: I think men tend to engage in costly signalling more than women)
  4. Women don’t have the foresight to understand what it is like to not get paid for work (rebuttal: I think this is subsumed by reason 6)
  5. Men perceive that they are valued by society based on their ability to earn, not based on their job title (rebuttal: men chase after medals and value the concept of fighting for their country. There is no major monetary reward for that. Similar to number 3)
  6. Women are more optimistic about being able to enact change should they themselves be in an unfavourable situation
  7. Women don’t intend to stay in medicine for the rest of their lives (rebuttal: that’s not impossible, but it doesn’t explain why they would go into at all)
  8. Women don’t see their job as their only income (similar to the above point)

Problems:

  1. Self-selection: people who follow a service that helps to do especially well in school do not necessarily represent the general population
  2. This is a survey, hence the answers are more about one’s projections than actual behaviour
  3. Internalised gender roles: women are supposed to care more about helping others than money, therefore in a survey, they will answer “yes” (this is somewhat subsumed in reason 2)
  4. The sample in mostly women, so men’s answers have less statistical power
  5. The sample is small
  6. The voters lack context
  7. The way I phrased it may have put people off medicine, or indeed made them more righteous in voting yes.

 

Side effects of meditation: be warned!

In the professional medical world, Medscape is probably the most trusted up to date online resource. I am delighted to see that yesterday they published an article that highlights some of the more challenging and distressing aspects of meditation based on a recent scientific paper in PLOS One.

The reason I am so glad is that it means we’re moving to a different approach to meditation, one with more well-warranted rigour in how people talk about this intervention and away from the perception that this is something without side-effects.

Crux of the study:

  • the challenging aspects of Buddhist-derived meditation practices are well described in Buddhist tradition but are less so in Western scientific literature
  • the researchers interviewed nearly 100 meditators and meditation teachers from each of three main traditions: Theravāda, Zen, and Tibetan.dangers of meditation, side effects of mindfulness
  • the researchers developed a taxonomy of 59 experiences organised into seven domains: cognitive, perceptual, affective (emotions and moods), somatic (relating to the body), conative (motivation or will), sense of self, and social.
  • all meditators reported multiple unexpected experiences across the seven domains of experience. 
  • the duration of the effects people described in their interviews varied widely, ranging from a few days to months to more than a decade, the investigators report.
  • some meditators reported their feelings, even the desirable ones, went too far or lasted too long, or they felt violated, exposed, or disoriented. 
  • meditation experiences that felt positive during retreats sometimes persisted and interfered with their ability to function or work when they left the retreat and returned to normal life.
  • the meditator’s practice intensity, psychiatric history, trauma history and the quality of supervision are important factors that influence the meditators experience, but not for everyone.factors that influence quality of meditation
  • the study highlights that the one size fits all approach isn’t ideal: “The good news is that there are many different programs out there and different practices available, and with a little bit of homework and informed shopping, someone could find a really good match for what they are after,” she said. “But I think often people just sign up for whatever is the most convenient or the best marketed, and it’s not always a good match for their constitution or their goals.”

Dissecting the side effects 

Here are the reported side effects with the percentage of people who reported them in brackets:

side effects of meditation cognitive, perceptual, affective, somatic, sense of self, social

It’s fascinating to note that nearly 50% noted a change in worldview. Open mind, new philosophy – fair enough. I would be on the fence about saying that I have a different world view because of meditation. It’s clearer, it’s calmer, it’s more adaptable, but it’s not really changed. Thus, it is possible that people who try to meditate are often looking for a new worldview or are quite suggestible.

Nearly the same number of people reported delusional, irrational and paranormal beliefs! I guess this is all based on Buddhism and there is a strong religious element to it. However, people were clearly made uncomfortable by it. I certainly experienced this: this is why I tread carefully when I go exploring meditation resources. A huge number of them are zealous, either for reasons of unquestioning devotion, or commercial ones. Snake oil requires faith.

Again, over 40% reported hallucinations. Just as a reminder – delusions and hallucinations are the key ingredients of psychosis and good reason to admit someone to a psychiatric ward. Obviously, these must not be quite as persistent as those associated with psychiatric disease, but if I had seen this table before starting mindfulness, I would have thought much more carefully. In this sample, 32% of people had a prior psychiatric history. This doesn’t explain how common all these DSM-sounding symptoms are among them.

Fear, anxiety, panic or paranoia came up for over 80% of people. I think is more a reflection on the sample than on meditation. Why to people meditate? Often they come upon it as a cure for anxiety. Indeed, in my experience, besides actually getting rid of the anxiogenic stimulus, meditation is a great method to deal with it. Depression was very common too at over 50%. Anhedonia and avolition – being unable to experience pleasure and not having any desire to do anything – are hallmarks of depression and were experienced by 18%. Personally, anxiety has always accompanied meditation in some way or another, but not in a bad way. It’s a little bit like saying that exercise cause shortness of breath. However, panic and paranoia are step to far.

Where there are mood changes, there are autonomic function changes and indeed they seem to have been affected too: level of energy, quality of sleep, appetite, etc. It’s unfortunate to note that many of those changes were negative with common reports of fatigue and pain.

As expected, 75% of meditators had their mind bent by Buddhist approaches to the self. We also know from MRI studies, that the anatomical self, seated in default mode network is modified by meditation, so this is expected.

Clarity, meta-cognition and increased cognitive processing – that’s our thinking clearly box ticked.

What does all of this mean?

To meditate or not? Meditate, but proceed with caution, a healthy balance of open-mindedness and scepticism – and preferably with supervision. In the words of Dr Walsh, it’s important to be challenged, but not overwhelmed.

As for me, I often take breaks from meditation. If it’s not happening, I don’t force myself too much. Thirty seconds of mindfulness is better than ten minutes of desperate striving effort and then feeling exposed, lonely and inadequate. To give it a Buddhist twist, we can think of the experience as if it is the weather. You may have decided that you are jogging today, but if it is stormy outside, it’s better to be a bit more adaptable, stay at home and practice your planks. Same here.

Reference:

Lindahl JR, Fisher NE, Cooper DJ, Rosen RK, Britton WB (2017) The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLoS ONE 12(5): e0176239. https://doi.org/10.1371/journal.pone.0176239

P.S. Have a look at this Christian blogger explaining the emotional conflict she experienced when exploring yoga. It’s not important to be religious to understand that imposing one system of beliefs over another, whatever it may be, can be highly distressing.

negative effects of meditation
Just a picture of Dublin in the sun

 

The darker side of mindfulness: being overwhelmed, side effects and the difficulty of finding a good teacher

It was my pleasure to speak to Dr Chris Walsh, an Australian mindfulness pioneer since the 1980’s and a respected psychiatrist. Dr Walsh has trained with leading Western mindfulness figures such as Jon Kabatt Zinn, Mark Williams, Kristin Neff and Daniel Siegal. Dr Walsh and I spoke about the darker side of mindfulness.

As with any area experiencing such strong growth, mindfulness is surrounded by myths and misconceptions. What is one that you feel particularly strongly about?

It’s used by business to make people work harder. It’s not so much a myth, it’s just the way it is being used.

People think it’s a relaxation technique. This is tricky to address. Mindfulness does help people to relax, but that’s not the main game. It’s about training your awareness.

You cannot count on mindfulness to make you relax.

If occasionally mindfulness doesn’t help you relax, you will feel that it’s not working and are missing out on an opportunity to learn to hold an unpleasant feeling. This can be destructive.

Chris Walsh mindfulness expert tips

Mindfulness can bring out negative emotions, especially during the initial stages. How would you recommend that a person deals with that?

The first thing is to have a good teacher. It’s a delicate balance and it can be hard to know when to lean into the negative emotion and when to stand back from it.

The basic principle is that it is ok to feel challenged, but it’s not okay to feel overwhelmed.

With any kind of learning, including learning to be mindful, it is normal to oscillate between feeling comfortable and feeling challenged. If you’re never challenged, especially with something experiential like mindfulness or a sport, the learning isn’t in its optimal state. Getting overwhelmed in mindfulness is the equivalent of getting injured when training, and this sets back the progress.

I have a few tricks on how to deal with being overwhelmed during mindfulness.

  • The feeling of being overwhelmed is most likely to occur when doing a body scan, especially when focusing on the chest and abdomen as this is where we tend to feel anxiety. I encourage people to find “safe places” where they are less likely to feel this anxiety: such as the resting one’s attention on the sensation of breath in their nose. Even this can be too much for some people.
  • Awareness of sounds can also help, as the attention is then focused on something outside the body.
  • Allowing oneself to move can also help to deal with the sense of being overwhelmed. In the Tibetan mindfulness tradition you can move; in the Zen tradition you are meant to be still no matter how much one’s knees hurt. This stillness doesn’t work for people with a lot of agitation. Doing walking mindfulness or exercising before doing mindfulness can help greatly. Some people think that this is an avoidance behaviour. I believe, it is taking a distance, while still still remaining present to the difficult experience.
  • Sometimes it is okay to let one’s mind wander off. When I run classes with inpatients, I tell them that it’s okay to daydream if it gets too much. The important thing is: come back because this way you can learn what has changed. This is very empowering: we don’t always have to do something to change things. They change by themselves.

These tips work for patients with mental health issues, e.g. PTSD, as well as people with no mental health issues.

the darker side of mindfulness chris walsh

Have you ever had any experiences when mindfulness had side effects? The “decentering” in mindfulness may impact an individual’s concept of the “self”. There are anecdotal reports of some vulnerable individuals developing dissociation and psychosis after reading self-help books or attending seminars – and more recently after practicing mindfulness. Do you see any risks in “trying it at home” when it comes to mindfulness?

It is damaging when people use mindfulness to dissociate or disconnect in some way. Two patients I encountered were attached to ecstatic states.

The first was a man with a background of heroin and alcohol addiction. He was able to stay away from drugs and alcohol for 10 years and then relapsed – which is when he came to me. He told me he was using mindfulness to stay away from his addictions and meditated for 8 hours a day! Just before the relapse he got a job: this stopped him from meditating for 8 hours a day, and so he relapsed.

When I questioned him about his mindfulness practice, he told me that he would just got into a blissful state for 8 hours, never experiencing any negative emotions.

I asked him to deliberately call to mind some unpleasant experiences while practicing mindfulness and pay attention to how it felt in his body rather than holding on to these blissful states. The lesson here is to get comfortable with feeling uncomfortable. In Tibetan Buddhism, they talk about samadhi. It is a blissful state – and sometimes people get addicted to this state. Some people this is enlightenment, but the Buddhist teachers say that that’s a delusion, an unhealthy attachement to something.

The second case that comes to mind was of a man with schizophrenia. Many of my patients with schizophrenia derived a great benefit from mindfulness. This man was having a Kundalini experience, where energy was going up and down his spine. They talk about it in the Hindu tradition. He would go through this experience for many hours a day and it made him more delusional and psychotic. It was very hard to persuade him to do less meditation!

I wouldn’t’ call either of these experiences mindfulness, as they weren’t this open, non-judgemental states. This is why having a teacher is important: so that you can reflect on your experience and receive some guidance.

how to choose mindfulness teacher

How should one go about choosing their mindfulness teacher?

There are no absolute guarantees. I am aware of some highly trained psychiatrists who teach mindfulness, but don’t practice it. They say they do, but by talking to them, you quickly realise they don’t: they have a kind of striving attitude.

For people with psychiatric conditions, it is better to have someone who understands both the Western and the Eastern traditions. If you have a teacher, a psychologist or psychiatrist, who comes from the Western tradition only, it is important that they practice mindfulness themselves. It’s important for a teacher to be able to tune into the problems that arise for people as they go through their mindfulness journey rather than sticking to a rigid program.

does mindfulness have side effects

There is a one size fits all approach to mindfulness among the public at the moment. Do you feel that that it’s appropriate for someone to use an app or should they find a teacher?

In my classes, I have a handout that reviews the apps and advises my patients to beware of any apps that tell them what to feel or that they should relax. People can play with apps – it gives them experiential information that allows them to commit to go to a class. Some people learn a lot from the apps. I haven’t seen the good apps causing any harm. Headspace is quite good. Buddhify is great for getting past the idea that mindfulness only happens on a cushion and has lots of shorter meditations that people like. Insight timer has nice mindfulness bells and nice soundtracks. Some are a bit New Age-y, so people need guidance in choosing the right ones. iTunes U UCLA meditations are quite good too. I send people to my website as I have some soundtracks there.

how to deal with feeling overwhelmed during mindfulness

What are your thoughts on transcendental meditation? It became commercialised quite quickly once it reached the West. Do you worry that mindfulness is headed in that same direction?

I did TM for a few years and found it helpful. I studied Buddhist meditation before that and it gave me the impression that the mind has to be completely quiet – which caused a lot of agitation. TM helped me to get past that as it involved returning to the mantra without trying to eliminate thoughts. TM also taught me about preliminary practices such as exercise.

In the East, mindfulness is used to investigate the mind as well as everything else. A lot of the insights of Buddhist psychology are now being confirmed using Western methods, such as fMRI. I believe this aspect of the Eastern tradition doesn’t get enough attention. However, we need to separate the psychology, philosophy and the religion. Those who say that Buddhism isn’t a religion are lying: it is a religion, but as well as that there are psychological and a philosophical components. These can be separated out, just like has happened in the West.

The tradition in the East is 2,500 years old, so we run into a lot of interpretation and translation problems. The Eastern languages have changed in meaning and nuance in that time just as much as Western languages have. Jus think how much trouble we have interpreting Shakespeare and his writing was only 500 years ago. Furthermore, Buddhist psychology is based on  human investigation that has evolved over time, so it’s not like the Bible that has been “handed down” and and passed on as some kind of unchanging truth. The Eastern mindfulness tradition, in fact, has a lot in common with the Western scientific tradition. This tradition has evolved from the Socratic tradition which is based on debate and questioning. rather than prescriptive rote learning. I believe that if we start paying more attention to what is already known in the East our progress in understanding the mind will be accelerated and our meditation practices will become even more effective.

Dr Walsh’s own website contains a lot of case studies and blog articles on mindfulness that I would highly recommend: mindfulness.org.au

Five philosophical myths about mindfulness that are sabotaging your practice

From a useful superstition with medical benefits to a deeply spiritual practice, mindfulness has seen a variety of labels. Together with Nguyên Giác, we put together a list of common misplaced attitudes towards mindfulness, so that you don’t sabotage your practice. [Watch video instead]

Mindfulness has become quite popular and seems to be gaining further momentum. It is set to soon be mainstream.

As is often the case with explosive popularity, there are some misconception and misinterpretations about mindfulness making the rounds among bloggers and on social media. 

1. Mindfulness is a Buddhist concept

It’s not uniquely Buddhist. Mindfulness has roots going back to Christianity. More that that: wherever humans have existed, they have discovered mindfulness. Many traditions poke around the mindfulness bush, some more directly than others. Why? Because mindfulness is healthy. It makes sense, evolutionarily. A mindful population will thrive. A population lacking mindfulness will have a hard time propagating the memes (Richard Dawkin’s meme, not the funny picture, meme.. although they are related) and genes that define its character.

Christianity has elements of mindfulness practice present in ritual and scriptural form (both within and outside of the canon).

There are a number of passages that obviously point to the practice of mindfulness, and there are many others that, when understood in context, point to mindfulness practice.

Whenever you have people that are practicing awareness of what they are doing in that moment, you have mindful people. When people know they are washing dishes, they are mindful dishwashers. Christians who are mindfully carrying candles, passing out bread and wine, and consciously delighting in each other’s company are Buddhist Christians – they are increasing awakeness in the world.

As Thich Nhat Hanh says,

“‘Buddhism is a practice. Like Yoga’. It is not a ‘religion’ in the way that Christianity is a religion. There are no gods. No required beliefs.. Nothing to take ‘on faith’.”

It is an open-handed teaching, hiding nothing, encouraging actual practice, letting you realise things without forcing it. The labels of “Buddhist” and “Christian” can be hindrances. It is nice to respect our spiritual ancestors, but it is foolish to isolate ourselves within the confines of some set of teachings. Old “maps” may not accurately represent the present territory.

Some people make the claim that there is an actual historical link between Jesus and Buddha. Indeed, there were Mahayana Monks in Egypt during Jesus’ lifetime. But, with or without the causal connection, Buddha/Gnosis is one – the message is the same. People can happen across the same spiritual truths in totally separate cultural contexts. The historical connection would be interesting and exciting, but it is not necessary.

So, in conclusion, there are some big chasms to cross as one journeys between world views, but if we look within we will find one human experience– we are unique, but we share common ground. It is beautiful. If we can learn to gently share our ideas with respect and give credit where credit is due, this era of history can be an amazing one.

Naturally, mindfulness occurs in religions other than Christianity and Buddhism, we shall try to address that another time.

myths and misconceptions about mindfulness
Sure, who wants an article on mindfulness without a picture of a woman meditating?

2. Mindfulness is about detachment and emptiness

Buddhist terminology also presents some problems for the Western Mind.

The translators of yore did not have the proper conceptual tools to work with the subtle ideas generated by Buddhist genius. And, still, people are hung up on ideas of “nonself”, “emptiness”, “detachment”, etc.

The Christian West has to do some serious psychic judo to make sense of these things without experiencing intense fear and trembling.

There are many potential points of conflict, but, let’s focus on non-self. Anatman. Anatta. No atman. This seems to have been one of the Buddha’s big ideas. There is no independently existing ego, or self-sustaining identity, anywhere in existence. All is dependent on all. Every square inch, square centimetre, every atom is as significant as the largest star. Look at “Indra’s Net”. It’s a nice way to visualise emptiness, or non-self: emptiness and non-self are the same idea. Interdependence is a better word. So when you read, “non-self”, “emptiness”, “voidness”, etc… just remember interdependence.

In the West, largely populated with traditional Christians, many have trouble with all this. There is this idea of “something out of nothing” that the Christian must accept in order to fall in line with dogma. It is totally illogical. Therefore, the Christian declares that faith is necessary. The question, “what was before the beginning?” will never be answered. Those who try to convince you that they have answered that question are liars or fools. Asserting that “God did it” is dangerous, the priests who make such assertions are “like dogs in the cattle manger, they can’t eat and they won’t let the cattle eat”. And, this is what Jesus is implying in the Gospel of Thomas when he encourages us to ignore those who claim to know “the way to heaven”.

On a more comforting note, the Jesus of the Gospel of Thomas also recognises this truth of non-self, which is very closely related to the truth of impermanence, another central Buddhist idea.

He also declares that all things that come together will fall apart. Everything will change.

Gospel of Thomas, 11:

Yeshua said / This heaven will pass away / and the one above it will pass away. / The dead are not alive / and the living will not die. / During the days when you ate what is dead / you made it alive. / When you are in the light, what will you do? / On the day when you were one / you became two. / But when you become two, what will you do?

Some people want to hide in their meditation halls, with their tibetan loving-kindness mantras – that’s fine… However, the Bodhisattva (the being tending toward awakening) engages the world and meets people where they are at. By helping others in real life, the Bodhisattva also develops her own Buddha Nature.

what we get wrong about mindfulness meditation

3. Mindfulness is part of the positive thinking / law of attraction world view

Many have come to view mindfulness as a close cousin of positive thinking. This is a misconception.

Mindfulness cultivates non-judgement – which the exact polar opposite of insisting on only ever dignifying positive thoughts with our attention.

A concept seemingly resonant with positive thinking/ law of attraction appears in the Dhammapada, one of the primary collections of teachings attributed to Siddhartha Gautama:

Mind precedes all mental states. Mind is their chief; they are all mind-wrought. If with an impure mind a person speaks or acts suffering follows him like the wheel that follows the foot of the ox.”

However, mindfulness emphasises the value of accepting things as they come.

Yes, we “create our own reality”, but we certainly don’t do it alone.

Reality is seen from a fundamentally different viewpoint in the philosophy underpinning mindfulness. The Bodhisattva does not proclaim that things are either positive, negative or neutral– Buddha abides “beyond good an evil” – beyond positive and negative and neutral.

In many Buddhist schools, there is this idea of the Five Skandhas. The Five Heaps. The Five Collections or Aggregates. Instead of a self-sustaining ego, Buddha spoke of these components – the Five Skandhas – that make up a personality.

The sensory experience, contact with sense objects through one of the sense doors (light / eye, sound / ear, chemical / taste and smell, pressure and heat / touch, thought / mind), is either positive, negative or neutral.

There is an event, and there is a knee-jerk reaction to it that is either good, bad, or not good or bad.

The Five Skandhas are empty”. They are interdependent. Sensation is just one of these heaps. Sensation depends on form, perception, mental formations, and consciousness. And – positive, negative and neutral are also empty!

There is no positive without negative or neutral, and the same is true for negative and neutral.

Our strength is not found in forcing reality to remain “positive”. We are considered accomplished because of the strength we have to endure the snaky shifting of Samsara. We endure the ups and downs, we remain in this mind system with these sentient beings, unperturbed by the positives and negatives and neutrals. We are beacons of peace and stability in this chaotic ocean.

4. Mindfulness is a natural remedy for anxiety

People want to talk about mindfulness like it’s some miracle pill. Despite what we so often hear, this practice of mindfulness is not always roses and cotton-candy. The practice of mindfulness may reveal things one has been been avoiding. This can be painful. This is the real work though! Learning to see clearly requires deep compassion for oneself and for all sentient beings. Gentleness can smooth over those scratchy rough spots.

Mindfulness meditation is work, but it is healthy, soothing work.

New things will be noticed. New things can cause fear. If new things aren’t being noticed, if fear isn’t arising, it is probably a good idea to refocus the practice. But how?

The goal is not to be rid of negative emotions.

Mindfulness meditation teaches us to put harsh feelings into context and not become totally overwhelmed by their presence. The goal is not to become a tranquil yuppy – it is to become present, aware and in touch with actual bold faced reality.

Yes, there are benefits. Mental and physical health benefits.

Breathing meditation can bring calm. “Negative” feelings can also arise – they are as real as “positive” feelings.

During practice, all of these arising positive and negative thoughts are gently touched – and like the fragile bubbles they are, they pop. It is not difficult. There is no strain. However, it is work. Perfectly paradoxical.

You may also like: Mindfulness is pointless – and that’s the point

what we misunderstand about mindfulness

5. Mindfulness is a medical treatment

Here in the West, the main drive for the explosion of mindfulness practice seems to be coming from the medical community. This is awesome. As always, medicalising normal processes is dangerous. It is especially common these days when people look to science for answers – rather than to religion. However, difficulty arises when science, which is much more about questions than it is about answers, becomes scientism, or high priests with Ph.D.’s handing out evidence-based dogma.

There is a lot of cultural appropriation going on around here. Doctors are not far off taking credit for practices that have already been employed for thousands of years. On the surface, this is all fine and dandy, but looking deeper we can see that it’s part of a larger pattern. We Westerners have not been so kind to our friends around the world. We take and take and take. The practice of mindfulness cannot be “owned”, but it seems to me that we should be giving more credit to it’s Eastern roots. Indeed, those roots extend beyond the Buddhist tradition. There are things to be learned from the cultures that have grown up with these practices.

Instead, it looks to me like as Westerners, we are trying to distill the “useful” practices from what we consider to be “superstition”.

Our sciences are constantly revealing a stranger and stranger reality. We would do well to hold our verdicts on what is and is not superstition.

philosophical misconceptions about meditation mindfulness