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.
