Contemplation: Beyond Mindfulness?

by Denis Larrivee

Germany’s millennial, International Labour Office document, Mental Health in the Workplace, begins with the simple but widely acknowledged personal health reality “Mental health problems are among the most important contributors to the global burden of disease and disability”. The German document goes on to state that the society’s first barrier of defence to mental disease is the family doctor; yet, it also reports that detection rates via this portal are less than 3 in 5 of actual disease instances, with detection rates only rising with the severity and clarity of the symptoms. Depressive symptoms related to ongoing mental stress are, apparently, largely unrecognized by the German medical professional. In Great Britain David Stevenson arrived at a similar conclusion about the demographic impact of mental health for the UK in his report of that same year entitled “Stress - the new British Disease.” Seeking to address this, mostly undiagnosed but broadly evident, health issue some fifteen years later, UK policy makers commissioned its landmark inquiry, “Mindful Nation UK”, into the capacity of mindfulness meditative practice to prevent and/or alleviate stress related factors and offer psychotherapeutic resources for more serious mental health disorders. The inquiry represents the first time that a meditative practice has been considered as a therapeutic measure for national health policy by a modern Western Parliament.

Recourse to meditation to address mental health concerns at this elevated policy level reflects the official acceptance of conclusions drawn from scientific studies, both psychological and neuroscientific, that have been ongoing since the 1970’s, with the onset of extensive social exposure to Eastern religious traditions and their prayer practices. Transcendental meditation, for example, figured prominently as a pacific expression in the 60’s counter culture’s rejection of traditional social mores. Harvard’s Herbert Benson is credited with the first investigation and scientific demonstration in the mid 70’s of the East Asian, meditation induced, relaxation response, an enhanced parasympathetic state that displayed reduced heart rate and a flaccid, bodily tonal condition. Kabat-Zinn’s later, widely cited, 1982, study on the effect of mindfulness practice on chronic pain reduction extended the range of therapeutic applications to include specifically physical ailments, which precipitated the subsequent, extensive exploration of bodily effects, neuroplastic modulation, and underlying causal mechanisms of mindfulness, and which has led, recently, to its consideration for preventative and restorative mental health therapy.

Both Benson’s and Kabat Zinn’s studies were careful to distinguish the physical contribution of mindfulness based events by disentangling the mental practice from its Eastern Buddhist roots. Subsequent studies followed this Westernized and secularized format, defining mindfulness as an open and non-judgmental awareness of self and external events that related the observed phenomenal and physical changes directly to the practice itself. Such neuroscientific studies showed a variety of reproducible brain based, physical alterations that revealed the ability of sustained meditative practice to affect the brain and confirmed the by then generally recognized brain capacity for plastically adapting to the brain’s experiential encounters. Major nerve tracts like the corpus callosum that connects right and left hemispheres of the brain were greatly enlarged as were associative regions like the anterior cingulate cortex. Emotional centres like the amygdala, moreover, showed significantly diminished activity suggesting improved emotional control. Significantly, increased meditative practice was correlated with accentuation of the observed brain changes.

Early scientific speculation that had focused on the brain’s attentional mechanisms as primary mediators of mindfulness induced brain effects has since received considerable confirmatory support. Related to the preceding mindfulness induced changes, for example, were selective increases in the activity of the rostral anterior cingulate cortex and the presence of frontal midline theta rhythms in the electroencephalograms of experienced meditators. Key neural features thus appear to engage executive and integrating brain networks activated by attention.

What all of these studies appear to be showing, and that appears to have garnered the attention for the Parliamentary inquiry, is the innate capacity for brain mediated, and so the largely, self-mediated influence on the health status of the brain itself that is accessed by mindfulness meditation. In line with this type of thinking Harvard researchers Vago and Silversweig have proposed a Self Awareness Relational Transcendence model that is intended to offer a framework for neuroscientific processes that are engaged by mindfulness practice and that structure the physical events behind its phenomenological expression. Given the below the radar screening of stress factors evidenced in the German system, and the live streaming of successive documentary reports since, the promise of mindfulness as a preventative and alleviative therapeutic measure for social stress impact on mental health and flourishing seems to have acquired a well-documented base of evidence.

Indeed, impelled by the results of the mindfulness studies, recent explorations have considered the possibility of its use for therapeutic, or at a minimum preventative, mental health maintenance. A German study by Holzel et al in 2011, for example, concluded that therapeutic possibilities clearly existed for treatment of attentional disorders, and went on to suggest its use for more acute conditions like that of bipolar disorder.

Whether mindfulness will prove therapeutically useful to the extent hoped for in a more extended range of clinical application, however, remains to be seen; that is, despite its successful and well-argued advertising, there appears to be a caveat in the midst of its prognostications. Over the past 25 years there has also been a growing, and by now substantial, body of neuroscientific studies on the neural contribution to human social behaviours, from parental bonding to monogamous relations, to empathic concerns, and more, such as how humans work together as social groups, now classed together under the theory of mind model. In the context of mental health, significantly, a majority of clinical psychiatric manifestations are linked to social aberrations, particularly in the context of social interaction. John Cacioppo, who has been investigating social neuroscience since the field’s inception, links these to disruptions in the brain’s capacity for social behaviour. Axis I and II disorders, for example, are characterized by a range of cognitive deficits that negatively impact social interactions or social cognition. Stresses introduced by social deficiencies, seem, thereby, beyond the reach of self transformative therapies of the sort that mindfulness appeals to; that is, mindfulness seems to offer only limited or indirect therapeutic resources to psychiatric manifestations that are socially implicated.

Yet, more extended prospects for meditative therapy may not be wholly foreclosed, although they may not involve mindfulness per se. Western Christian meditation, notably, has historically practiced, and evolved its distinctive formulations within an expressed, socially interactive format. Bernhard Haring, a prominent Christian theologian, characterizes Christian meditation this way “the dialogical character in prayer is most fully realized in the so called passive or mystical prayer, in which the divine motion is in the foreground of consciousness, and divine love stirs the heart…” That is, Christian meditation is uniquely dialogical, and while it shares with Eastern religious practice positive dispositional attitudes of good will, it is intended primarily to forge personal bonds that Teresa of Avila has likened to deep and intimate friendships. Does this mean that Christian meditation is uniquely different from mindfulness in the sorts of neural phenomena that are occasioned by its practice? The answer to this question seems to be no and yes.

No, in that Christian meditative practice bears similar regimes and shares similar phenomenological features to mindfulness meditation, as pointed out in a recent article by Larrivee and Echarte in the Journal of Religious Health. Evidence for such similarities has been accumulating in the guise of historical studies of the cognitive exercises performed by ancient Greek philosophers. Pierre Hadot’s extensive study of their training formats, that he has termed spiritual exercises for their expressed intention of inculcating mental discipline and virtuous living, reveal a program for self-transformation that bears much in common with mindfulness. Significantly, Christian meditation seems to have later appropriated these exercise formats through Augustine of Hippo, who used them to facilitate discipline in contemplative prayer. His exercises then greatly influenced the contemplative prayer of succeeding centuries.

Yes, on the other hand, in that Christian meditation additionally evokes a phenomenal and neural repertoire that elicits a 1st and 2nd person dyadic polarity, that is, an intersubjective dimension of encounter. Danish researcher Schoejte shows, for example, that specifically social regions of the brain are activated during personal prayer. Engagement of such dialogical and intersubjective exchange initiates activation of dynamical brain activity related to a distinct awareness of the presence of the other and the initiation of the synchronization of activity loops that are tuned to the intersubjective encounter.

What seems significant for mental health is a neural and phenomenal exteriorization of relations that are both self-formative and outwardly directed. Contemplative prayer, for example, assisted Augustine in his reversion from a narcissistic and hedonistic lifestyle. Significantly both Lacan and Piaget model psychological maturation according to a process of self formation that is elicited and sustained through dyadic and dialogical exchange, that resembles the sort of self-enscription of the Christ Image and self-transformation that Teresa of Avila makes reference to about contemplative prayer.

So where do these sorts of observations place Christian contemplation vis-a-vis mindfulness and psychotherapy in a conflicted and stress filled era? Adrian van Kaam, a war camp survivor, psychiatrist, Catholic priest, and author of more than 600 psychiatric, medical articles in the 60s to the 90s was careful to emphasize in his own psychological models the multiplicity of needs of the human psychiatric spectrum. Van Kaam’s complex but integrated model layered the individual according to an experiential and interactive hierarchy that extended from the biological to the self-engaged, to social, and ultimately, to the existential and divine. Mindfulness, in this framework, seems to fit with the personal need for self-integrative control involved in personal orientation, but does not appear to be engaged in the additional, relational, levels of his model. Intriguingly, Van Kaam’s hierarchy place at its apex the intersubjective dimension needed for existential meaning, specifically invoking God as a source of existential satisfaction, a proposal which seems confirmed in Peterson and Seligman’s observations on the cultural distribution of the character trait of transcendence. The growing quest for personal meaning and the modern evolution of existential psychotherapy suggest that his model was well in tune with human needs and where these were likely to express themselves, now seen in the current spate of existential neuroses. Given the amenability of British health policy makers to meditation inquiry, perhaps next on the docket ought to be Christian contemplative prayer and its address to the multi ordered dimensionality that is the human being.