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West Meets East - Page 3

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Several years ago, David Barlow, the prominent anxiety researcher, was talking at a conference about tension that had arisen between two groups involved in developing the DSM-5: the splitters and the lumpers. The splitters felt that the problem with the DSM-IV was that it didn’t have sufficiently refined categories. Further subdivisions of diagnoses were needed to avoid mixing apples with oranges. The lumpers felt this approach was wrongheaded, missing the forest for the trees. Our separate diagnoses obscure the commonalities among different forms of psychopathology, they argued.

The splitters challenged them: “What commonalities?” they asked. “We don’t see any.” The lumpers replied: “experiential avoidance.” All psychological distress, they said, involves trying to avoid unpleasant experiences, or trying to hold on to pleasant ones. Whether it’s the drug addict numbing his sadness with a fix, the phobic person warding off anxiety by taking the train instead of the plane, the depressed individual sidestepping anger through emotional deadening, or even the psychotic patient becoming delusional rather than feeling the heartbreak of a loss, most emotional disorders involve trying to feel better by avoiding something unpleasant. So here again, an adaptation that’s well-suited to survival contributes to our suffering.

It gets worse. As if all of these propensities weren’t enough, we seem to be hardwired to try to enhance our self-esteem. Robert Sapolsky, a neuroscientist at Stanford, spent the last couple of decades hiding behind blinds of vegetation in Africa, watching baboon troops. He and his colleagues would wait for a particularly dramatic interaction among the baboons and then anesthetize the group, draw blood, and study their stress hormones. When he was being interviewed on the NPR program Fresh Air, Terry Gross asked him, “What did you learn?” Sapolsky wavered, emphasizing how much more complex stress responses are than we used to think. Wanting a memorable interview, Gross pushed him harder. “Well, we did discover one thing repeatedly,” he said. “It’s particularly bad for your health to be a low-ranking male in a baboon troop.”

Now we, as the smart monkeys, may feel that this doesn’t apply to us. But it’s no accident that kids in middle school refer to their insults as “ranking” on one another. As adults, we constantly fill our minds with comparisons to others: who has the better body, mind, house, car, spouse, therapy practice, or children. Indeed, it makes sense that our minds are wired this way—only high-ranking hominids got to mate, so those who weren’t concerned about rank didn’t get to pass their genes on.

Unfortunately, this, too, makes us pretty unhappy, because none of us—except a select few, with really bad character disorders—always wins in these mental comparisons. Compounding this litany of ways we make ourselves feel bad is our terrible prognosis: we’re all going to get sick and die, and on the way, we’re likely to decline. No wonder we’re so often upset.

Mindfulness as the Universal Elixir

Proponents claim that mindfulness practices actually address all of these evolutionary difficulties. First, they mitigate our propensity to dwell in painful thoughts by redirecting attention out of the thought stream toward awareness of sensory experience. Most practices begin by developing concentration: we direct our attention to the breath, the feeling of the soles of the feet contacting the ground, the sound of a bell, or some other set of sensations. Each time we notice that the mind has left its focus and been hijacked by a train of thought, we congratulate ourselves for noticing, and gently bring our attention back to the moment-to-moment sensory experience. We then repeat this about a billion times.

The result is that we begin to see thoughts as secretions of the mind, arising and passing like clouds moving across a vast sky. We stop believing in them as we once did. That, in turn, lessens their grip and reduces our emotional reactivity to them.

This is a significant departure from traditional CBT, which encourages clients to notice thoughts, and properly label them, but then try to replace irrational, maladaptive thoughts with more adaptive ones. Mindfulness practice is like CBT on steroids: we regard all thoughts as untrustworthy—a passing show, rather than representations of reality.

Mindfulness practices also take a different approach to unpleasant experiences in the body, such as physical pain and negative emotions. Rather than seeking ways to lessen these, or distract ourselves from them, we practice bringing open, curious, loving attention to the experiences—a sense of “what might this be?” We then allow them to stay as long as they like, trusting that painful feelings, like everything else, will eventually change.

This is why mindfulness practice is often described as the “third wave” of behavioral treatments, following behavior therapy proper and CBT. Instead of trying to control experience, it helps us learn how to be with experience and accept it. This can address our other evolutionary problems. Acceptance modulates our stress response. As we come to see our thoughts about everything that has and might go wrong as passing objects in the mind, they create less distress. Our system is quite good at returning to baseline when it isn’t rearoused by thoughts of impending disaster. Most of us also have a robust tendency to become stressed out about our stress responses: “Oh my God, I’ll never be able to give the speech. I already feel so nervous.” By practicing acceptance of changing body sensations during meditation, we learn to ride the waves of unpleasant emotional responses during the rest of our day.

Thus, mindfulness is the opposite of experiential avoidance, the mechanism that the lumpers say accounts for most psychological disorders. It allows us to feel the urge to have an alcohol drink arise and pass rather than heading to the bottle, to get on the airplane and feel the fear rather than stay grounded, to be with the tight muscles and violent imagery of anger rather than shut down in depression, and to feel hurt rather than escape into delusion.

Finally, mindfulness practices can help us loosen our preoccupation with ourselves. Concerns about our rank, health, mortality, and all the rest are tempered as we see that there’s ultimately no “me” there, but just the unfolding of neurology, moment by moment.

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