In the early 90s I was following a course in meditation at a Buddhist centre and volunteering at the mental health day centre. One evening, our meditation teacher gave us leaflets for a drop-in class and asked us to distribute them around our places of work. When I told him where I was volunteering he asked me instead to take away any leaflets that might already be there.
The view back then tended to be that meditation classes often attracted people for whom they were unsuitable. It was assumed that mental health issues and mindfulness did not mix. But today the consensus has turned full circle. Around the same time my meditation teacher was trying to discourage people with mental health issues from his classes, Jon Kabat-Zin was writing his now hugely popular books on mindfulness, and developing his course on Mindfulness-Based Stress Reduction (MBSR). And very soon thereafter, based in part on Kabat-Zinn’s work, Zindel Segal and Mark Williams established Mindfulness-Based Cognitive Therapy (MBCT), an evidence-based treatment for the prevention of depression. For certain categories of people with mental health issues, at least, meditation was not only proposed as a suitable aid in treatment, there was now empirical evidence to support its efficacy.
In the UK, 2004, MBCT was recommended by the National Institute for Health and Clinical Excellence (NICE), and five years later awarded ‘key priority’ status. ‘Of the treatments specifically designed to reduce relapse,’ NICE concluded, ‘group-based mindfulness-based cognitive therapy has the strongest evidence base with evidence that it is likely to be effective in people who have experienced three or more depressive episodes’ (NICE, 2010).
This means that MBCT currently has a green light to be rolled out through the UK National Health Service as a treatment for preventing relapses in people who have experienced multiple bouts of depression. In other words, meditation is now regarded by the NHS as a favoured treatment for certain forms of depression.
The number of NHS Trusts actually delivering MBCT programmes is small at present, but this seems set to escalate. One of my local trusts runs MBCT treatment groups and a MBCT training. In the summer I attended one of their public dayschools, to check out what it was all about. MBCT courses are secular in their outlook, although the basic techniques being taught are based on Buddhist teachings. The dayschool was a series of talks by Buddhist scholar John Peacock, exploring the Buddhist roots of MBCT practices through taking a close look at the original meanings of the Sanskrit and Pali terms used in the Buddha’s teachings.
It was great stuff, but I was probably a little more au fait with the Buddhist terminology than the language of MBCT itself, so I made a point of chatting with the other delegates during breaks to find out who they were and what they were doing. The vast majority were MBCT trainees or practitioners, most already employed within the NHS. The MBCT training demands prior qualifications in the mental health field, and that applicants demonstrate a pre-existing client base to whom they can deliver MBCT once qualified. I was also intrigued to learn that the key people training the trainees were drawn from the local Buddhist community rather than the NHS. Among them, the same guy who – back in the 90s – had asked me to remove his leaflets from the day centre.
It began to dawn on me that MBCT is set to take off in the UK due to economic factors alone. Firstly, MBCT is an eight-week self-help programme delivered to groups of patients, which means it is dirt cheap when compared to most other forms of intervention. The NHS will no doubt leap at the chance to implement something that is relatively inexpensive and proven to be effective. Secondly, there is a whole community of people already expert in these techniques – i.e. Western Buddhists – most likely grateful for an opportunity to monetize and develop something they would be doing anyway.
Of course, I am sceptical of MBCT. Two decades ago, when the meditation teacher asked me to remove those leaflets, it was not from any lack of compassion. He knew that meditation increases awareness, and if unpleasant mental processes are taking place in our minds, meditation will only increase awareness of them. This may not always be helpful. And this has certainly been my own experience of meditation.
Reading up in more detail on the theory and structure of the MBCT programme, I confess that I was hoping to find some holes through which I could pick it apart. Instead I discovered what seems to me, as an experienced meditator, a solid and well-designed programme for establishing an effective personal practice: posture, concentration, insight, sitting practice, mindful movement, and techniques for carrying over formal practice into everyday awareness – all of these are covered. The flaw in MBCT, however, seems to be that although it works very well for making our situation better, it may not provide enough support for when ‘better’ is no longer good enough.
Towards the end of her schematic definition of MBCT, Rebecca Crane writes:
Teasdale (1999) makes the distinction between metacognitive knowledge (knowing that thoughts are not always accurate) and metacognitive insight (directly experiencing thoughts as events in the field of awareness). The suggestion is that the practice of mindfulness develops metacognitive insight, which has more potency in terms of enabling a skilful disengagement from ruminative thinking patterns and difficult emotional experience. (Crane, 2009: 152)
In other words, MBCT equips us with an ability to identify negative contents of our mind as precisely that – as negative contents. However, by equipping us with the ability to recognise thought itself as a mental event, what if subsequently thought itself (rather than just its contents) begins to appear as negative?
Growing awareness of the form of experience (that which all experiences have in common beyond their contents) can lead to a growing awareness that this ‘form’, too, can be problematic. The way that experience itself – as MBCT teaches us – is transient, devoid of any discernible centre, and unable to satisfy us in itself, can present as a problem. Experience from this perspective can begin to seem meaningless or confusing, or else the mind’s habitual inability to accept the nature of experience can become experienced, in itself, as tiresome and inauthentic. Turning to the form of experience as a means of gaining perspective on these contents will no longer help us, but will merely compound the impression, because the contents of our experience have now become our perception of the form of experience, and so the form of experience is now the source of our problem, no longer offering a handle on our suffering, but only seeming to dig us deeper into a more tormenting awareness of what it means to be human.
This is what non-secular mystics and yogis have described as ‘the Dark Night of the Soul’. There is currently no equivalent term among MBCT practitioners for this, but they may soon need to find one! If and by the time the Dark Night presents itself to an MBCT client, the eight-week course will probably be long over. Because of the way that MBCT is delivered as a classroom programme, anyone who ran into difficulties before the end would likely just cease attendance, or be judged as not having been suitable for the programme in the first place. In either case, someone who is experiencing merely a deepening of the skills they have been taught could be left dangling with no further guidance in a state at least as unpleasant as that in which they started.
Only the most determined practitioners will realise under their own steam that the practice itself has become the source of their current difficulties, and – instead of giving up and perhaps thereby remaining in those difficulties – will figure out that the only way out is through.
The recent research of Willoughby Britton into the negative effects of meditation is salient in this regard. At the Buddhist Geeks Conference in 2011 she commented:
Meditation comes out of contemplative religious contexts where the goal is – however you want to call it – liberation, awakening, enlightenment; some kind of radical transformation of consciousness. So I don’t think that it would be surprising to hypothesize that if you practice meditation, it will actually produce some of the consequences that it was designed to produce: a radical transformation of consciousness. But a lot of people are very surprised when their consciousness starts to change, because that’s not what they signed up for. They signed up for stress reduction. (Cited in Williamson, 2011).
As Britton suggests, the secular emphasis of MBCT may prove ultimately to be its blind spot. Despite the protests of so-called ‘secular’ Buddhists, Buddhism is a religion. What all religions share is a specific view about the way things are. Secularism and science tend to regard these views as ‘assumptions’ and will strive instead to avoid them. But genuine religious traditions – such as Buddhism – will also include practices and techniques for arriving at a direct experience of the truth of their view of the way things are.
Most people troubled by depression are vulnerable to and troubled by quite specific issues that can have proximate and apparent causes. Although meditation will indeed help us approach these issues differently, by giving us a greater insight into the way the mind actually works, this is also providing us with a whole new domain of experience – a new domain that will in turn present its own new set of challenges and issues.
There is no way that MBCT will not continue to grow and spread. It is too effective and too cheap, with too many people able and willing to teach it capably and inspire others to regular practice. My hope is that it helps the vulnerable client group for whom it is currently intended, and that longer-term research will be conducted to ascertain that it does.
On the basis of personal experience, I cannot shake my suspicion that the real value of MBCT is not as a way out from personal depression, but as a way into deep and universal dissatisfaction.
Crane, Rebecca (2009). Mindfulness-Based Cognitive Therapy: Distinctive Features. Hove: Routledge.
NICE (2010). Guideline on the Treatment and Management of Depression in Adults: Guideline 90. Accessed October, 2013.
Williamson, L.J. (2011). Willoughby Britton at the Buddhist Geeks Conference, on the Problem with Meditation. Accessed October, 2013.