Wk2-4 The problem of dis-ease
In our last sessions, we talked a lot about some of the difficulties of conceptualizing and operationalizing mindfulness as a scientific construct. And then we worried quite a lot about how to go about measuring this construct once we'd agreed on what it was. So before moving on from those foundations to discuss some of the mindfulness interventions that have been developed as therapeutic technologies in the next sessions, it might be worth pausing in this one to ask why is it that modern societies find the idea and practice of mindfulness so interesting in the first place? [COUGH] In other words, even if it's the case that enables us to find some kind of ease of being, what is it about modern life that makes this so attractive or important? Are we really so maladjusted to the conditions of life around us? And this is the core concern in our session today. The idea that modern life is characterized by a form of dis-ease, or even that dis-ease is the disease of modernity, dominates the mindfulness literature. Sometimes this notion of dis-ease is represented by the concept of anxiety or stress. Sometimes it is glossed by the more generic term distress, or even simply suffering, where this latter term is often propped up by reference to the Buddhist notion of dukkha, to which we'll return in the next module. Now while most of us will freely accept that we encounter stress and anxiety on a regular basis, it's not always clear to us that such encounters need to be represented as problematic. Indeed, there are plenty of situations in life in which stress is our natural response, and in which it might actually be problematic for us not to have a stress reaction. From the standpoint of evolutionary biology, for instance, it's relatively clear that there's a kind of adaptive stress or anxiety that has evolved to help us cope with various challenges and threats. Stress reactions ready our bodies for fight or flight and they condition our brains towards aversion. We actively seek to avoid activities and situations that we envision as stressful. The adaptive stress that you experience when stumbling across a wild grizzly bear on a hike in Whistler National Park is itself going to be a factor in your attempts to avoid doing this again. In general, the problem of dis-ease that mindfulness seems to confront is actually not this kind of adaptive response, which is really a marker of mental health. Instead, mindfulness interventions tend to be targeted at maladaptive anxiety and stress. That is stress and anxiety responses that are inappropriate, unnecessary, or debilitating and hence, constitute a form of disorder. Some of the markers of this kind of anxiety disorder include hypervigilance for, or perhaps over sensitivity to, signs of threat in our environment, which narrow our attentional resources and our openness to experiences and choices of the world, leaving us entangled and enmeshed in a net of stressful possibilities. We no longer even see the more positive clues present in our environment or in ourselves. Some people refer to this is a kind of vicious cycle. And it's often accompanied by physical symptoms, either chronic or acute, such as constriction, tension, heart palpitations, shortness of breath and so on. Individuals who experience maladaptive stress and anxiety of this kind may find that these are triggered by particular events or encounters or feelings. But for some, these responses feel like general dispositional issues in their daily lives, coloring the quality, tone, and taste of all their experiences. One of the intriguing developments in mindfulness interventions over the last couple of decades has been the blurring of distinctions between the populations for whom such interventions seems to be relevant. In particular, the first and still the standard model of secular mindfulness interventions as developed by Jon Kabat-Zinn as MBSR, focused on its utility for populations with diagnosed clinical needs. That is, these interventions were developed as ways to treat maladaptive responses of various kinds. However, very quickly, the practices associated with MBSR spread into non-clinical, sometimes called healthy populations, where they were often seen as ways to lessen stress and anxiety, per se. That is, rather than being techniques to treat maladaptive stress, mindfulness training became concerned with mitigating the sensations and effects of adaptive stress and anxiety as well. The implications of this, which have been raised by many critics, are that MBSR is being misused. Like a kind of recreational drug constructed by a mad, or perhaps just a capitalist, scientist. It's no longer treating people with disorders but instead allowing them to purchase this kind of practice as a new form of escapism. This brings us back to the question posed at the start of the session, are we, as basically healthy individuals who experience adaptive responses to our environment, really so maladjusted to the conditions of life around us that we require special techniques and technologies to help us cope with them? Do we, as healthy well adjusted individuals, need, or even benefit from mindfulness training? Or is it basically a recreational activity that could risk distracting us from the real demands of life? To paraphrase Marx, is mindfulness a new opiate of the people? We'll return to this important social and political question in the final module of this course. Meanwhile, mindfulness scientists have made various responses to this potentially devastating question. The first is to take the familiar and contested step back into Buddhism and to argue that it's a basic characteristic of human life that everyone experiences suffering. Hence, the techniques of mindfulness are not only relevant to people with diagnosed clinical disorders, but are also relevant to everyone else as well. The difference between these populations is not one of kind, but simply of degree. In the end, clinical and non-clinical populations all participate in the basic problems of humanity to different degrees. The important thing is to realize that nothing can rid human beings of all suffering, since suffering is essential to the human condition. That is, the end of suffering is simultaneously the end of our humanity. So on the face of it, this Buddhist inspired defense actually seems to reinforce the notion that mindfulness interventions should be envisioned as treatments for maladaptive responses, rather than opiates to blunt normal adaptive responses. That is, the Buddha doesn't claim to be able to inoculate all people against all suffering, only to help them alleviate unnecessary suffering by changing the quality of the attention that they bring to it. As a kind of zero level of suffering with which everyone must deal, even the healthy. Indeed, any technique or technology that could eradicate suffering all together would simultaneously end or perhaps transcend the human condition itself. For the Buddhists this is the territory of awakening, enlightenment, Nirvana, and so on. What this helps us to understand, however, is something that any teacher of non-clinical MBSR will have encountered in nearly every class they've taught. And that is that the distinction between populations with diagnosed clinical needs and populations without diagnosed clinical needs. It's not necessarily determined by those needs, but by the diagnosis. That is, in practice it's simply not the case that so-called healthy populations have no maladaptive responses or are free from such suffering. These maladaptive responses are simply insufficiently intense to be diagnosed, or even more simply, they're just not diagnosed. The conceptual difference between clinical and non-clinical groups is the difference between ideal types. In practice, everyone, all of us, reside along a spectrum of maladaptation to our environment. We all have dis-ease that we could do without, and that's where mindfulness training is useful. In fact, the scientific response to this challenge is even more persuasive than, and perhaps complementary with, this Buddhist oriented response. From the standpoint of evolutionary biology, for instance, it's relatively clear that the distinction between adaptive and maladaptive responses is not clear cut. In particular, with specific regard to anxiety and stress responses, it seems clear that the human body evolved its reactions to threatening and stressful situations at a time when such threats were more than likely physical and violent in nature. In modern societies, which are defined by the legitimate appropriation of violence by the nation-state, we're much less likely to encounter such threats. Hence, there's a powerful sense in which even our biologically adaptive responses are actually maladapted to contemporary life. The stress we feel about a job interview, about public speaking or an unpleasant email is real, but our body's subsequent need to run away or fight is not helpful. We have no where to go and nothing to fight. Indeed, sometimes the adaptive stress response is itself a cause of stress. Since we know that our natural tendency towards tension, shallow breathing, lashing out is not only unhelpful but actually counterproductive in many circumstances today. Instead of fighting or fleeing, our energy, effort, and attention are all devoted to cognitive planning, scheming, and rumination. So finally, while studying and testing the therapeutic value of MBSR, scientists have uncovered a range of non-therapeutic effects, somewhat in the manner of stumbling across unexpectedly beneficial side effects in a drug trial. As a result, the MBSR program in healthy populations is now also associated with training enhanced positive functions, much like other forms of meditation. Rather than healthy individuals using it to medicate against the trials of everyday life, research now shows that mindfulness training is associated with enriched quality of life, an enhanced sense of well being, higher energy levels, more creativity, more reliable decision making, more fulfilling interpersonal relationships, and so on. In other words, we don't have to go as far as Marx in one direction or Buddha in the other to make the case for potential utility of mindfulness interventions. Even for healthy populations, as well as clinical populations in today's societies. In our next sessions then, we'll take a close look at the most widely practiced and studied interventions today. First, mindfulness based stress reduction, or MBSR. And then mindfulness based cognitive therapy, or MBCT.
