I am grateful to a reader named Aaron Zaz who has drawn my attention to an excellent article by Thanissaro Bhikku, a Thervada monk and scholar whose translations of the Pali Canon and teaching of meditation make him, in my opinion, one of the best teachers of Buddhism today. Although I have never had the privilege of personally hearing Thanissaro Bhikku speak, I highly recommend his dharma talks which can be found on Youtube and elsewhere on-line [see the links below]. As a teacher he has the virtue of bringing his deep understanding of the Buddha's teaching to the immediate experience of meditation. But in this article he turns his attention to contemporary Buddhism and the unexamined assumptions that most Westerners bring to the dharma. He argues that German romanticism has been an important, if forgotten influence in our understanding of what Buddhism is and what issues it addresses. As in ancient China, which used Taoism as an entry point or "dharma gate" for understanding Buddhist teaching, the West has taken romanticism as its doorway into the dharma. While finding such a gate is clearly a benefit, there are also drawbacks associated with the discovery. Romanticism regarded truth of feeling and inter-connectedness with the universe as the highest spiritual truths. Buddhism, at least as the Buddha originally taught it, goes beyond such emotional satisfactions to find a deeper, more lasting and transcendent truth by the realisation of not-self. The romantic attitude not only affects Western Buddhism, but according to Thanissaro Bhikku, it is also a major influence in Western psychology, evidence for which can be found in the thought of William James, Carl Jung and Abraham Maslow, to name only three. While Thanissaro Bhikku concedes that using Buddhism for therapeutic purposes can be healing, Westerners risk losing the possibility of finding a greater realisation and more complete liberation by thinking of it in predominately psychological terms with a decidedly romantic bias.
I agree with this article almost completely, but as a psychotherapist I view the matter from an entirely different, perhaps even opposite perspective. As I have consistently argued in this blog, psychotherapy is not in a position to strive for complete liberation, but must usually settle for the lesser goal of helping people make sense of their lives. Moreover, even though I am not reluctant to call myself a Buddhist therapist, I am obliged to help my clients make sense of their experience in the terms that make sense to them. This means that Buddhism--or, perhaps more to the point, my ideas about Buddhism--must not dictate either the course or the outcome of the therapeutic process. I also have no aversion to drawing on the ideas and practices of other approaches if I believe that they might help a client. But my eclecticism might seem to call into doubt my decision to call myself a Buddhist psychotherapist. For if I am not bound by my loyalty to Buddhist doctrines and feel free to improvise from ideas that aren't remotely Buddhist, can I really call myself a Buddhist psychotherapist? Wouldn't it be more accurate to say that I'm a therapist who happens to be a Buddhist?
Part of the reason that I wear my Buddhist colours so openly is to acknowledge my allegiance to Buddhist psychology, especially its ideas about attachment, impermanence and, above all, not-self. Yet, by definition any psychology must be concerned with the self as its principal interest. But the idea of not-self in Buddhism does not deny the experience of being a person, but instead implies the surrender of any idea of a permanent self to a deeper insight about the pervasive reality of impermanence. Still the delusion that a subject of experience finds permanence by coming to awareness through an interplay of desire and memory arises naturally and irresistibly in the course of living and runs much deeper than any mere concept of it. So while it may be relatively easy to accept some idea of not-self as a philosophical proposition, it is much harder to understand it as a living truth, indeed as a moment to moment phenomenon that mistakes its conditional existence for lasting reality. The elusive perception of not-self is also what makes a teacher such as Thanissaro Bhikku such a helpful guide on the Buddhist path. But it may be more difficult to see how such a deep, counter-intuitive insight that leads to the deconstruction of the self could be of use in psychotherapy whose primary concern is the healing of the self.
In truth, the skilled use of the concept of not-self can greatly facilitate psychotherapy. To put the matter simply, the self subsists on its attachments and by helping the client realise that such attachments are not-self they can be relinquished and a new sense of possibility can emerge. But this simple formula seldom, if ever works so easily in the actual course of therapy. For the idea of not-self is not a magic wand that can be waved over a client's attachments to make them vanish at will. Although attachments may constitute the illusion of self, they usually do so subtly and mysteriously, especially if they lurk in shadows that are never exposed to the light of awareness. And as Buddhism has always maintained, one of the biggest, most stubborn attachments of all is the very idea of self, an idea that is not formed by conceptual reasoning, but is largely composed of unconscious desire, fear and will. It is by seeing that attachments have a functional claim on the self and seem to possess a life force of their own that the difficult work of becoming free of them can begin. While it may not be as final as in spiritual practice, even a partial discovery of the truth of not-self can bring a degree of liberation.
The Buddhist psychotherapist Jack Engler once turned a memorable phrase about how the idea of not-self applies in psychotherapy. "You have to be somebody before you can be nobody," he wrote. What this means is that the client must attain a level of self awareness and responsibility before letting go of his preoccupation with self. But my paraphrase is an abstract way of expressing what psychotherapy is actually about, which is to make sense of experience by exploring it in depth in order to facilitate meaningful change. This requires the client to reflect on his past and on his current relationships, as well as those experiences that marked him and made him unique. But it also means reflecting on the self as it becomes revealed in the course of therapy. A romantic belief in the self is actually a hindrance to the kind of reckoning required here. For it usually has more to do with facing painful, even humiliating truths than with finding any romantic sense of oneness with the universe. Still, it is by facing those truths and bringing them to the light of awareness that the freedom to discover higher truths becomes possible.
Finding the ultimate, ineffable truth of not-self is no easy task and so finding a great teacher like Thanissaro Bhikku would be a great boon for anyone travelling on the Buddhist path. But for those who can't imagine finding any path to reach the dharma gate, they might consider trying a good psychotherapist.
Ever since Freud convinced us that it is our sexual urges that drive our emotional lives it seems that Western culture has fallen under the spell of sex. But Freud's vision was much darker and far more nuanced than the common understanding of it, which, in its most grossly simplified and distorted version, holds that it is the repression of our sexual desires that causes the frustrations which give rise to mental illness. In fact, most people know little, if anything about Freud and would be more likely to hoot in disbelief at ideas of his such as the Oedipal complex than admire the depth of insight of his essentially tragic conception of human sexual desire. Still, the idea that sex holds the key to character continues to exert considerable influence on our understanding of the human condition. But it was another figure, who was more of a sociologist than a psychologist, who had perhaps even greater influence than Freud in shaping our understanding of sex. Alfred Kinsey, the founder of modern sexology, used anonymous surveys and statistical analysis to find out what sexual behaviour people actually engaged in, as opposed to what their sexual behaviour was supposed to be. What his research revealed is that people were far more promiscuous and diverse in their sexual habits and tastes than conventional morality supposed. Although recent scholarship has questioned some of Kinsey's methods, his legacy was at least as important as Freud's in contributing to the contemporary understanding of sex. Freud convinced us that our sexual instincts rule our emotional lives; Kinsey revealed the extensive range of our sexual activities, which affected our sexual norms. Their work, though undertaken separately and with quite different aims, led to the widely shared belief that sex indicates the essential truth of self and that the only true way to understand a personality was by knowing the sexual urges that lay hidden beneath its surface. Sex has always demanded secrecy and privacy, as much for its furtive pleasures, as for its potential for shame. But due in large part to the efforts of Freud and Kinsey, discovering those secrets is now widely considered to be the only way to discover the truth of self.
Although Buddhism has always recognised the power of sexual desire in the formation of personality, it certainly does not believe that sex holds our ultimate truth. But as a psychotherapist, I have to face the evidence of my working experience, which often does seem to vindicate both the ideas of Freud and the research of Kinsey. More to the point, many of my clients believe they have unwittingly discovered their personal truths in the pain and humiliation of their sexuality. Not that all of them have miserable sex lives or have suffered painful traumas related to sex. More often, it is simply the absence of love in their sex lives that drives them to question the wholeness of their personalities and the quality of their experiences in general. For that absence seems to betoken a deeper, more unspeakable loss. If sex is supposed to be the royal road to love, it is only natural to suppose that there must be something terribly wrong with a traveller who has little hope of reaching the destination.
The truth is that erotic experience really can be a gateway to surpassing delight bordering on divine bliss, as poets have always recognised. In Love's Labour's Lost, for example, Shakespeare observed the rapturous effect of falling in love when he wrote: "When love speaks, the voice of all the gods makes heaven drowsy with the harmony." Indeed, the ecstatic union of lovers can even rise to spiritual heights when it is made to serve as a spiritual discipline. In both Buddhism and Hinduism, the esoteric practices of Tantra use erotic imagery to express the exquisite sense of union that occurs upon spiritual realisation. And in so called left-handed Tantra, though not used for the purposes of pleasure or procreation, some practices can even involve actual sexual intercourse. Yet, in spite of its potential for touching divine or near divine realms of experience, sex can far more easily descend into a hell in which the shrieking of the furies drowns out the harmonious chorus of the gods. The echo of those screams can often be heard in psychotherapy.
It is not difficult to see why sex can be such an endless source of suffering. Perhaps nothing else illustrates quite so vividly the principle that craving is the cause of suffering, for which reason Buddhism has always warned against the dangers of heedless sexual indulgence and encourages celibacy for those who are most ardently committed to the dharma. But even before we give in or refuse to give in to such craving, sexual desire arises in us as a chthonic power that can feel as irresistible as a force of nature. This is implicit in the expression "falling in love", even though we are more apt to romanticise such a surge of feeling as two lovers surrendering to passion in order to to unite in erotic bliss. But the reality of being possessed by sexual desire is usually far less pretty. It is more often a case of coarse physical craving finding release in loveless erotic pleasure for which the pornography and sex industries readily provide accessories to their immense profit. Moreover, nature is hardly beautiful when it summons the force of desire in defiance of personal identity or moral expectations. For some people sex is saturated in shame precisely because it reveals to them the selves they don't want to be. Erotic bliss, bordering on the divine, can only appear absurd when sex comes wrapped in disgrace. Yet, the desire for intimacy in sex-- two people willingly participating in bodily passion with and for each other--can survive even the worst sexual experiences. It is also why most people will always believe in love and sex as an ideal unity. Acting on our sexual urges in whatever we can may be a biological imperative, as Freud argued and KInsey documented. But trying to find love in the tropism of desire is surely no less human.
RD Laing once observed the distinction between love and lust by a simple shift of prepositions. Lust, he said, is the feeling of and love is the feeling for the person one desires. Another way of putting this is that sexual loving involves a deep recognition of the subjectivity and desires of the other, loving through sex, rather than using the other for sex. Conceived in this way, the expression "making love" would mean a true act of intimacy, rather than stand as a euphemism for engaging in sex. But what about sex as a natural instinct which, if pursued responsibly and with a modicum of respect for one's sexual partner, can be indulged in with no moral or psychological penalty to pay? For some people this appears to be true. Sex can be as casual as going to the cinema on a rainy afternoon. But for others, sex is always haunted by the absence of an intimacy that they can't help but hope for. And though this is often considered a sexual problem, it is more likely to be a problem about loneliness. For if love is knowing and wanting to know the other, sex between partners without interest or concern for each other suggests a deeper deprivation. Although everyone knows that having sex is not the same as making love, if love can't be found in sex, the fear may arise that it can't be found at all.
A brief word on Open Dialogue Therapy which, strangely, is hardly known in spite of its astonishing success. I suspect some readers of this blog will have heard of it, but perhaps more will know nothing about it. I myself have limited acquaintance with Open Dialogue and only learned about it by reading Robert Whitaker's book Anatomy of an Epidemic, which mostly provides a scathing critique of what he considers mainstream psychiatry's scandalous alliance with the pharmaceutical industry. Whitaker argues that because of its increasing reliance on highly profitable drug therapies, psychiatry has made things demonstrably worse for its patients and has caused a veritable epidemic of mental illness. But he noted one remarkable exception to this lamentable trend that has occurred in Western Lapland, a sparsely populated region of Finland which, thirty years ago, had the highest incidence of schizophrenia in Europe. Developed by the Finnish psychologist Jaakko Seikkula, Open Dialogue relies on a a team of two or three therapists treating the client within twenty four hours after a psychotic breakdown. The intervention occurs in the client's home and involves every member of the household in addressing the crisis. Although hospitalisation and anti-psychotic medication can sometimes be used in this approach, the emphasis is on working within the interpersonal context of the client's family. To state the matter simply, Open Dialogue works as an effective form of therapy; so well, in fact, that the incidence of schizophrenia in Western Lapland has now become the lowest in Europe. Some epidemiologists even predict that schizophrenia could soon be eradicated in the region. Other observers, however, say that this impressive result deserves closer scrutiny before any general conclusions are drawn either about the causes or treatment of schizophrenia. Many point out, for instance, what a small statistical sample the region provides. Others question the accuracy of the diagnoses of schizophrenia in some of the clients that Open Dialogue has treated. Yet, in spite of these caveats, what Open Dialogue has achieved would still seem to merit much more interest than it has received. Although it has now spread beyond Finland (there is even an NHS clinic in east London that specialises in the approach), Open Dialogue still remains on the fringe as a treatment for psychosis and schizophrenia. So why?
For Whitaker, the answer is obvious. Mainstream psychiatry has invested so heavily--and is so handsomely rewarded financially for its investment--in the psychopharmaceutical treatment of schizophrenia that it has no interest in considering the merits of any other approach. No doubt there is some truth to this claim, but I suspect the matter is somewhat more complicated than that. I once spoke to a psychiatrist who is largely sympathetic to alternative approaches, as well as highly critical of institutional psychiatry. But when I told him that Open Dialogue is on the brink of eliminating schizophrenia in Western Lapland his reaction was swift and automatic. "I don't believe it," he said. Perhaps his clinical experience had given him ample reason for doubt, but even those without his experience might find reason to be sceptical. For not only does Open Dialogue seem too good to be true, its apparently gentle methods hardly seem capable of vanquishing the horrifying reality of madness. So how then does Open Dialogue actually work?
Seikkula identifies seven key principles of Open Dialogue: immediate help; social network perspective; flexibility and mobility; responsibility; psychological continuity; tolerance of uncertainty; and, finally, dialogue. Together, these principles stand as a pragmatic manifesto that holds remarkably little theoretical baggage. Even psychopharmaceuticals, though hardly preferred as a treatment, can be used in Open Dialogue, as I noted earlier. Art therapy, group therapy and virtually any type of psychotherapy may also be integrated into the treatment, which typically lasts for two to three years. But it is Family Therapy that has had the greatest influence on Open Dialogue, as Seikkula readily acknowledges. Beyond its practicality and versatility of approach, what stands out in Open Dialogue is its humanity. Indeed, it is the deep engagement of the team with the patient and patient's family that appears to have the most positive effect. But a further word needs to be said about the idea of dialogue which is so central to the approach. Based on the thought of the Russian philosopher Mikhail Bakhtin, dialogue in Open Dialogue means far more than just allowing all participants to have their say. It also involves "polyphany", a form of close listening that allows for a multiplicity of perspectives to be expressed by each participant. The belief here is that a participant's position should not remain rigid or fixed, but should evolve as time goes on. Towards this end, therapists do not try to occupy a position of theoretical omniscience, but are active collaborators in helping patients come to terms with their experiences by encouraging them to look at things from a variety of view points. Seikkula himself demands that therapists who work in Open Dialogue must have flexibility, "a tolerance for uncertainty" and a capacity for being surprised. Far from trying to engineer predictable outcomes, Open Dialogue strives to keep the therapeutic process open ended and alert to the unexpected. Yet it works far better than any other therapeutic approach, including, most notably, psychopharmacology.
In many ways Open Dialogue would seem to be a vindication of RD Laing's views, but I have found no mention of either Laing or anti-psychiatry in any of my reading about it. Yet Laing's views on finding the meaning of a psychotic's experience by placing it within the context of the client's family system would seem to have been important influences in Open Dialogue. But perhaps such influence is less important than a crucial difference. Open Dialogue isn't anti-anything and has no interest in casting either parents or psychiatrists as ogres in the story of the client's breakdown. It attempts to recruit as many participants as possible from the client's interpersonal world in the therapeutic process. Parents, siblings and other relatives, as well as doctors, teachers and any professionals who might have an interest in the client's well being are all invited to participate in an ongoing dialogue that is meant to help the client make sense of his or her experience. And if all this isn't enough to recommend it, Open Dialogue is also a cost effective treatment, as Seikkula discovered when funding cuts in Finland (the same curse that affects the NHS today) led to a reduction in his clinic's budget. Yet even after these cuts, Open Dialogue continues to show the same impressive results in spite of its reduced means.
We come back then to the question of why Open Dialogue hasn't led to a revolution in the treatment of psychotic breakdown. Perhaps a revolution has already begun to happen, though without yet gathering widespread notice. Certainly, the clinic in east London appears to be an encouraging sign and hopefully there will be similar developments elsewhere. But Whitaker's suspicions about the alliance between institutional psychiatry and Big Pharma acting together to block reform of the treatment of severe mental illness should not be lightly dismissed. The case of the late Loren Mosher presents an example of how that alliance can act to thwart innovations that can lead to improved treatment for psychiatric patients. As a young American psychiatrist, Mosher went to stay at Kingsley Hall when Laing was attempting to make it into a true asylum that would allow patients to find their own ways out of madness. Appalled by the chaotic administration and maintenance of the place, Mosher still found much to admire in Laing's ideas. Later he went back to California and started Soteria House, another alternative mental health community, but which was much more orderly and better maintained than Kingsley Hall had been. Soteria also had impressive results until the original house was closed down due to a withdrawal of funding (fortunately, the Soteria movement continues in Europe and there is an attempt to start a Soteria community in Brighton). Moreover, Mosher was not some wild-eyed anti-psychiatrist, but was head of the Center of Studies for Schizophrenia in the National Institute of Health for twelve years until he was dismissed from his position in 1980. In fact, he would become increasingly estranged from psychiatry and finally resigned from the American Psychiatric Association in a memorable letter that claimed that he was "actually resigning from the American Psychpharmocological Association". That this brilliant, committed psychiatrist was marginalised by his own profession for objecting to the use of drugs that clearly did more harm than good suggests the kind of resistance Open Dialogue may encounter from mainstream psychiatry.
It is rumoured that there is a fierce competition going on among genetic scientists to identify the gene that causes schizophrenia. The winner, it is believed, will be awarded the Nobel Prize for Medicine. It doesn't seem to occur to anyone that Seikkula should have already won the prize.
The perceived authority of psychotherapists is a curious phenomenon that seems to evoke wonder and dread in many people, especially if they think they might need to go see one. For therapists are often thought of as stern judges whose theories of human psychology are always ready to hand to identify any hidden pathology that could make someone the helpless victim of his own foibles. Moreover, every gesture and vocal hitch, to say nothing of the content of a person's speech, appears liable to become damning evidence for a merciless investigation that will reveal the darkest, most shameful secrets of a subject's personality. No wonder that when I tell people that I am a therapist they often become self conscious and diffident, as if I am in danger of turning my cold analytical gaze into the depths of their being. Perhaps the only reason anybody would ever consider submitting to the humiliation that therapy imposes is an acute need to find freedom or release from a psychological affliction that feels intolerable. The terrifying prestige of the therapist reminds me of the movie The Wizard of Oz, in which the lost and bewildered Dorothy, desperate to find her way home, goes on the Yellow Brick Road to see the Wizard of Oz so that he can help her get back to Kansas. When she is eventually given an audience with the Wizard, she enters a vast hall and finds a terrifying presence whose enormous sun-like head is wreathed in flames as he speaks in thunderous pronouncements. To Dorothy's disappointment, he refuses to help her unless she completes the dangerous, impossible task of stealing the broom off of the terrifying Wicked Witch of the West. As we all know, although she succeeds in her heroic quest, as soon as she tries to cash in her success the Wizard demurs from helping her right away, Fortunately, her dog, Toto, reveals him to be a rather bumbling old fraud who admits that he's not really much of a wizard at all. In fact, he has nothing to do with her getting back to Kansas. But then as the Good Witch Glinda helps Dorothy realise, she never needed his help in the first place.
The idea of a psychotherapist appearing like the Wizard of Oz might seem like a playful caricature, but like all caricatures the picture it presents has enough resemblance to the truth to be immediately recognisable. Many people do regard psychotherapists with suspicion and fear. And some therapists do occupy their positions with a certain stern authority that may seem like an attempt to appear oracular. Certainly, earlier generations of psychotherapists, particularly psychoanalysts, were careful to establish strict boundaries and protocols that were obviously intended to keep clients/patients in their place. Moreover, the assumption of most therapists was that the client couldn't really have a legitimate perspective on his own experience, but could only act out of his psychological condition with scant insight into his true motivations. Some therapists even felt they had the authority to make diagnoses that were more like dreadful prophesies than psychological assessments. Years before he became Baba Ram Dass, for example, Richard Alpert was told by his psychoanalyst that he was "too sick to love". Spoken with all the authority that his psychoanalytic training was supposed to have conferred on him, that analyst must have seemed just as terrifying as the Wizard of Oz appeared to Dorothy. But now that Ram Dass seems like nothing less than an avatar of divine love, it's hard not to regard his analyst as anything but a ridiculous old fraud. We might even hope that he had followed the Wizard's example and admitted the fact.
But there is another aspect to this matter that also deserves attention. The stern authority of the therapist can sometimes be desired by the client, even though experiencing the disapproval of the therapist is something the client typically dreads. Freud himself was wise enough to understand that the patient's desire for the analyst to be authoritative indicated the patient's strong feelings of parental transference. He also saw no hope of disabusing patients of their misplaced feelings and instead made transference into a vital feature of the analytical process. As a gambit this was quite masterful, but as Freud realised, it did bring some attendant dangers. Perhaps foremost among these dangers was that the analyst would reciprocate the patient's feelings of childish dependence by developing a counter-transference and embracing the role of parental authority that was projected on to him. Still, Freud maintained that by successfully negotiating the tricky dynamics of transference and counter-transference a psychoanalyst could help bring about self insight and lasting change in the patient. Nowadays, however, few psychotherapists outside of the psychoanalytic fold would feel comfortable wearing the heavy mantle of authority that Freud believed was essential for therapy. Although most therapists realise that clients will still continue to have transferences for their therapists no matter how much the therapist tries to resist them, they also know that it is when both parties are able to emerge from the duet of transference and counter-transference that real insight can take place in the client. The question then, is how?
This brings us back to Jeff Harrison's necessary question: what is therapeutic? More specifically here, though, what is it that the therapist does that is therapeutic? In fact, this is a question that many, if not most therapists have entertained with considerable anxiety at some point or another in their work. I remember once seeing a client whose problems seemed so overwhelming and so far beyond my ability to deal with them that I nearly blurted out:"You need to see a therapist!" Although I maintained my composure and kept silent, my true, unexpressed response could have been: "You need to go see a wizard". But knowing that I was no wizard, I relied on my training and began to listen attentively and sympathetically to my client without trying to convince either him or myself that I had all the answers. This proved to be the right thing to do as I was able to form a strong alliance with him which enabled us both to deal with his issues constructively. But my listening was the key that enabled him to explore his self experience in depth. Such attentive, sympathetic listening is, I believe, one of the most therapeutic things that a therapist can do. And though it certainly entails the loss of a certain forbidding authority for the therapist, it also earns him respect based in mutual trust.
The authority of the therapist is no illusion then, though it should be based on something other than the projected hopes and fears of the client. It should be an authority that develops from the therapist's demonstrated concern and sound judgement, as well as the client's commitment to psychotherapy. Although it may not be wizardly, it can certainly be effective in helping the client come to terms with his experience.
A friend of mine who has been a Buddhist monk for half of his adult life recently made a decision to leave the monastery in order to become a full time psychotherapist. The decision cannot have been easy for him, not only because the monastery has been his home for so long, but also because the monastic vocation seemed so natural for him. The silence, the spiritual fellowship and the long hours spent in meditation appeared to be quite fulfilling for him, though I am sure that like most monastics he must have also faced times of boredom and self doubt, which are the pitfalls of the monastic life. Still, when we talked about psychotherapy, I noticed how great his interest was. In fact, he had been a psychotherapist before he entered the monastery and even as a monk, he saw clients once a week in a nearby town. What I saw in him, quite apart from his fascination for the human condition (in my opinion, an essential trait for becoming a therapist) was the quality of his concern for people who came to him for help. We traded stories about clients, which might sound like engaging in work related gossip, but was really nothing of the kind. For not only were we careful to observe client confidentiality, we also had no interest in topping each other with therapeutic tales. Our true interest was much more about reaching people within their experiences of psychological suffering, which requires a certain sense of wonder about the varieties of human experience. As a Buddhist monk and a psychotherapist, my friend must have been especially sensitive to the central paradox of Buddhist psychotherapy, which is how to encourage clients towards self awareness within an overarching understanding of not-self. This, of course, has been a recurrent theme of this blog, but my friend's life experience puts him in a unique position to appreciate this paradox. For therapy represents a deep plunge into the self experience of the client with all its potential for conflict. In quite the opposite direction, monasticism represents a decisive turning away from any such potential to find a purity of awareness in which the self is barely allowed to cast its shadow. On the face of it, these would seem to be two radically different paths whose destinations could never be the same. But perhaps by looking at the two paths more closely we might see that they only diverge at the beginning and in some some cases, at least, may actually converge.
It should be obvious that psychotherapy is not the same as a monastic spiritual practice, as the latter usually, if not always, demands self denial. The Buddhist monastic discipline, for example, is meant to uproot any feeling or sense of self cherishing. By contrast, therapy often tries to promote self esteem in clients who may find nothing to cherish in themselves, at all. A Buddhist spiritual practice, then, seeks to deconstruct the self, while psychotherapy attempts to engage in self healing by encouraging a positive, as well as realistic view of the self in the client. But these are largely differences of aims or ultimate goals and there may be a common understanding of human experience that underlies each approach. As a Buddhist therapist, I often use the ideas of the three poisons of hatred, greed and delusion to help me understand what a client may be experiencing. I imagine monks use these ideas, too, and not simply as handy metaphors for making essentially moral judgements. We both would observe that mental poisons taint the mind much as actual poisons affect the body. And we would agree that just as there are antidotes for physical poisons, there are ways of counteracting hatred, greed and delusion, too. To be sure, a monk would probably apply such remedies to himself more directly than a therapist would able to do in dealing with a client. But when a therapist succeeds in helping a client realise that his attitude or behaviour is what underpins his recurrent suffering, the effect can be similarly liberating. But then who is supposed to be liberated? The monk or the psychotherapy client?
The answer, of course, is both, though liberation has a rather different meaning for psychotherapy than it does for a Buddhist spiritual practice. The monk's attempt to find liberation means nothing less than enlightenment as the complete escape from the round of birth and death. A client, by contrast, would usually settle for the relative release from his problems in living. But what about the psychotherapist whose position can hardly be neutral in the therapeutic relationship? The ideal that the therapist should act with complete impartiality might seem to shift the focus entirely away from any of his personal or spiritual interests. But like most ideals, the perfectly detached therapist is a largely imaginary, if sometimes helpful concept. Although a wise therapist will always try to be alert to his biases in order to be wary of their influence, at the same time he must be cognisant of his affinities, particularly those that deepen his capacity for empathy and increase his understanding of the client. For it is by recognising the humanity that he shares with his client that an empathic bond can be developed which enables the therapist to make insights that he could not otherwise make. But even before that, it is the humanity of the therapist that reaches the humanity of the client.
I spoke earlier about the fascination for the human condition that is so essential for becoming a psychotherapist, but that may sound rather too abstract. In fact, this fascination is really more of a form of identification which is based on the recognition that what others experience could be experienced by oneself, too; but not only by oneself, but also as a self, that is to say as a unique human subject whose complex of desires and needs thrusts him into the stream of life with a sense of bewilderment about how he got there. For a Buddhist, this might be called wandering in samsara, the round of birth and death. But for a psychotherapist who might have become all too familiar with psychological suffering, a client's painful life experiences could seem like just another day in the office. For a Buddhist psychotherapist, however, a day in the office can be taken as a moment in eternity which can uncover some of the essential truths of Buddhism. For suffering is the premier fact of existence, but there is a way out of it, though finding that way is seldom apparent, especially at the beginning of therapy. This does not mean that the therapist should take the client's suffering as an opportunity to proselytise or even push a Buddhist perspective on his client's affairs. But it does mean that what happens in the consulting room can have spiritual implications for both client and therapist.
When I used to visit the monastery my friend used to tease me about becoming a monk and said that I would look good with a shaved head and in robes. Now that he's out of robes himself--and perhaps with a head of hair, too--I am in a position to turn the tables on him and say what a great psychotherapist he'll be. But I wouldn't be teasing.
"Even though I was endowed with such fortune, such total refinement, the thought occurred to me: 'When an untaught, run-of-the-mill person, himself subject to dying, not beyond dying, sees another who is dying, he is horrified, humiliated, & disgusted, oblivious to himself that he too is subject to dying, not beyond dying. If I — who am subject to dying, not beyond dying — were to be horrified, humiliated, & disgusted on seeing another person who is dying, that would not be fitting for me. As I noticed this, the living person's intoxication with life entirely dropped away." The Buddha, Sukhamala Sutta, translation by Thannisaro Bhikku
A recent phone call with my old friend Allan Davies, which left me reflecting on some basic Buddhist principles, prompts this post. Allan told me that he had been visiting a friend of his who is dying of brain cancer in a squalid north Devon nursing home. His friend, who is in his mid-sixties, is alone and destitute and apart from Allan and another friend, appears to have no one who shows any concern for him in his final days. Allan and his other friend provide emotional support to each other as they enter the drab, malodorous premises of the nursing home. For seeing their friend dying in such dismal surroundings leaves them both feeling helpless and dejected, especially as the dying man himself is barely able to acknowledge their presence. The overworked and no doubt underpaid workers in the nursing home barely find the time to feed and medicate their patients and can't begin to attend to the emotional needs of all the dying, feeble people who depend on them. The austerity measures which the government instituted five years ago and look to be increased after the recent election, may be partly to blame for the dreary conditions in which Allan's friend is dying. But though there is no excuse for the heartlessness of the government's policy, the underlying and inescapable certainties of old age, sickness and death, which Buddhism regards as signs of metaphysical significance, are surely the deeper sources of his suffering. Clearly, no one can be blamed for these intractable realities that are imposed on all of us by our conditional existence. Yet, how we act in the face of these conditions determines the moral and spiritual quality of the lives we lead. If we treat them as universals that encourage us to compassion, we benefit others and may also acquire precious wisdom for ourselves by doing so. But if we regard them merely as vague, distant eventualities that we can long postpone while pursuing our more selfish interests, we aggravate the suffering that comes from simply being alive. This may not be apparent to those whose good fortunes appear to grant them temporary immunity from the ravages of old age, sickness and death. But it becomes obvious to anyone who bothers to look. Indeed, bothering to look and learning to see is much of what the Buddhist path is all about and should certainly influence the practice of Buddhist psychotherapy. As always, the Buddha's example is the best place to begin reflecting on these truths.
Everyone knows the story of the Buddha's enlightenment which begins with his auspicious birth as the crown prince of a royal family and his coddled upbringing in palatial luxury. Lacking for nothing, Prince Siddhartha nevertheless intuited the inevitability of old age, sickness and death when, on successive journeys into a nearby city, he noticed an old man, a sick man and a dead man. Deeply shaken by what he had seen, it was upon later seeing a wandering holy man, the last of the Four Sights, which led him to begin his spiritual quest. In spite of its profundity, the story of the Buddha's awakening has the reassuring tone of a fairy tale that we know will end happily. A dose of realism is required for us to appreciate that these momentous encounters are actually common, everyday occurrences. Even so, they were momentous enough to stimulate his unusually deep and sensitive nature and move him to begin his spiritual quest. In fact, what he later realised upon becoming the Buddha was that old age, sickness and death stood on the ontological fault lines of suffering which affected every phenomenon that came into existence. As the Buddha, he developed these insights into principles that became known as the Three Marks of Existence--impermanence, not-self and suffering [anicca, anatman and dukha]--and became foundational to his teaching. But even if we accept that these truths are undeniable, most of us can't prevent ourselves from trying to evade them. And that is the point: accepting the Three Marks merely as metaphysical propositions does not really count for very much. It is only by seeing the pervasiveness and inevitability of suffering that we can reach a deeper understanding of the nature of reality and our precarious place within it.
The suffering in the world is in fact limitless as most people recognise, at least intuitively. But rather than try to alleviate suffering when we see it in others, we may be more inclined to turn away from it, knowing that in the long run of things there is nothing we can really do. Small wonder then that many of us cling to our more selfish desires in the hope that by pursuing them we can at least find some satisfaction for ourselves. But an unfortunate illusion may occur if we commit ourselves to such a way of being. We see the world as the domain of our desires and interests and imagine that it exists in order to sustain us; sustain others, too, perhaps, but sustain us first. This is the logic of self interest that governs the world and we would be unwise to disregard it or discount its benefits, especially if it helps to make us more responsible for our actions. But when we are restricted by such logic, compassion comes as an afterthought, if it comes at all. Even so, most of us dread the possibility that we might not find compassion when we most desperately need it. For it is bad enough to die old and sick. How much worse will our suffering be if we have to die alone, as well? Unlike Prince Siddhartha, many of us prefer to ignore to this troubling question. But ignoring it does not make it go away.
Neither Allan nor his friend is a Buddhist, but then compassion isn't the sole property of Buddhism, either. Evolutionary psychologists assure us that a tendency towards compassion is part of our genetic inheritance, which may come as something of a consolation given our more selfish and violent tendencies. But I would argue that something deeper and more subtle is in action whenever people act with compassionate motives towards the suffering of others. Although compassion may well derive from an evolutionary development that values self sacrifice in the interest of group cooperation, its more immediate, personal benefit comes from widening our understanding of what it is to be human. It also counters the tendency to see our good fortune as destiny and the suffering of others as mere background noise to the music of the spheres. As Siddhartha realised, we too will be subject to much the same suffering that we are horrified to witness in others. Compassion, then, not only recognises the inescapable truth of suffering, it also puts us in a position to learn from it. But what we learn cannot be grasped by any abstract formula. We must learn it from the depths of our being, which is as much a matter of feeling as it is of thinking.
There is, however, an unfortunate and mistaken idea that compassion is merely a sentimental virtue which takes flight on the wistful hope that all the suffering of the world can be washed away by a wave of human kindness. But as the First Noble Truth tells us, suffering is the most fundamental and obdurate fact of existence. It is both a proximate cause of compassion, as well as the abiding reality that will survive it. Allan's friend, for example, will not be recovering from cancer nor is he likely to die in more congenial surroundings. Whatever consolations he receives will come from his few remaining friends or others in the nursing home who may not know him at all. Though Buddhism tells us that compassion can be the gateway to higher wisdom, we may not always be able to see this. But we should all be able see that compassion evokes a sense of shared humanity when people need it most. That may not make us bodhisattvas, but it does make us better human beings.
A friend of mine recently passed along an article from The Spectator which reports the dramatic decline of psychoanalysis in New York . New York has long been the thriving hub of psychoanalytic culture so to discover that psychoanalysis is now something that very few New Yorkers do comes as something of a shock. The article, which unfortunately fails to distinguish psychoanalysis from other forms of psychotherapy, reports that a recent survey reveals that the average number of clients that a therapist sees is a mere 2.75 (per day? per week? per year?--the article didn't say) . So what has happened? According to this article, prospective patients now turn to other forms of treatment to deal with their psychological complaints.. CBT, anti-depressants, meditation and yoga were all mentioned as preferred alternatives., even though the last one can hardly begin to address the problems that psychotherapy typically deals with. But the tone of the article was one of faint mockery and referred to Woody Allen and his famous neurosis as if that sort of case were typical for therapy. The survey on which the article was based seems somewhat questionable, as well. Just who were queried? The New York Times runs an excellent series of articles about psychotherapy called "Couch", the regular appearance of which suggests that psychotherapy still has an important place for its readers. So is it possible that the survey was restricted to classical or orthodox Freudian analysts and neglected to canvass the far more numerous psychodynamic practitioners who draw heavily on psychoanalytic theory without adhering to Freudian practices? Even so, it would still seem that Freudian psychoanalysis, which once predominated in psychotherapy and is the progenitor of virtually every form psychotherapy, may now be in terminal decline. And though the reasons for that are not hard to guess, there is a larger question beyond the fate of psychoanalysis. Is the future for every form of psychotherapy as dim as it appears to be for psychoanalysis?
Recent readings of mine about two men who were subjected to judicial violence prompt this post, but the character of the two figures in question couldn't be more different. The first is the late Dr Tenzin Choedrak who was the Dalai Lama's personal physician both before and after he spent seventeen years imprisoned by the Chinese government. The other is Thomas Silverstein, a member of a white racist prison gang in America called the Aryan Brotherhood (his surprising Jewish surname came from his stepfather, which perhaps explains why he was admitted into a criminal organization of White Supremacists), who is now kept in solitary confinement in the ADX Florence penitentiary, the so called "Supermax" prison that holds the most notorious prisoners in the US penal system. There is no question that Choedrak was entirely innocent of any crimes and under the most extreme duress displayed the qualities of the bodhisattva that he undoubtedly was. In contrast, Silverstein is a convicted murderer who gained a reputation for fearsome violence in some of the worst prisons in America. From these bare facts we might be led to conclude that Choedrak was an undeserving victim of injustice, whereas Silverstein deserves the severe punishment that he will continue to suffer until he dies. But my interest here is not so much about the guilt or innocence of either man, but concerns how violence and the threat of it conditions our understanding of justice and even of morality. Although most us claim to deplore violence, fearing the violence of which others are capable leads us to countenance institutions in which violence is dispensed as a supposedly fair expression of justice. Perhaps this is necessary, at least in some cases, but we err grievously if we suppose that the right by which society claims to exercise such violence is tantamount to justice itself. But let's first consider the stories of the two men in question.
In his affecting memoir, The Rainbow Palace, Choedrak recalls the rather idyllic country that Tibet had been before the Communists conquered it. Yet, he himself did not enjoy a happy childhood as he lost his mother when he was a small child and was raised by a stepmother who showed him little affection and occasionally mistreated him, as well. While still a boy, he was sent to a monastery to become a monk, where he adapted to the rigours of monastic life and eventually found his calling as a doctor. By his own account, Choedrak was not a particularly gifted student, but his sense of vocation was strong and through diligence he managed to excel in his studies. Because of his accomplishments he was made the personal physician to Tenzin Gyatso, the recently installed Dalai Lama and became close to both the young monarch and his family. All of that changed drastically, however, once the Chinese Army took over Tibet, eventually forcing the Dalai Lama to flee to India, leaving Tibetans to suffer the tyrannical rule that continues oppress the country to the present day. Choedrak himself was arrested and imprisoned for being a member of "the Dalai clique" and refusing to denounce the spiritual and temporal leader that the Chinese still call "the wolf in sheep's clothing." Accused of spying, Choedrak was sentenced to fifteen years in prison, but in the event he actually spent seventeen years in confinement where he routinely suffered torture, beatings and starvation, all for refusing to denounce his patron and admitting to crimes that his persecutors knew that he didn't commit. Many others who suffered the same conditions broke under the regimen of cruel punishments, either perishing from torture, malnutrition or suicide or surrendering their wills to their sadistic captors. Choedrak himself managed to survive by using his medical knowledge to treat himself for the various injuries and illnesses that were inflicted on him, but there were times when he would have preferred to die. More remarkably, he also refused to hate his tormentors and demonstrated heroic spiritual resolve in extending compassion to those who appeared to relish inflicting such cruel punishments on him. Later, the Chinese sought his medical skills for their own benefit which led to his improved treatment and eventually, his release from prison. Once freed, Choedrak was able to rejoin the Dalai Lama in India where he resumed his role as his personal physician and oversaw the development of a Tibetan medical institute that preserves traditional medical practices. We may hope that his story will prove representative of the Tibetan people in general so that they too will emerge from the horror of Chinese rule with their spiritual values and way of life strengthened by their ordeal.
If Choedrak offers an inspiring example of compassion and forgiveness, Silverstein presents an altogether different case. For such a hardened criminal his background is somewhat unusual in that he was not materially deprived while growing up in suburban southern California and at first displayed none of the violent tendencies that would later mark his character so fatally. But no more than Choedrak's, Silverstein's childhood can't be described as happy, either. Seen as weak and passive as a boy, he became the victim of relentless bullying. But no bully among his peers proved as damaging as his own mother who, when he returned home crying after suffering physical abuse, told him that he would be beaten even more severely by her for coming back home in tears. "That's how my Mom was," he recalls. "She stood her mud. If someone came at you with a bat, you got your bat and you both went at it." By the time he was in his early teens, he lost any trace of submissiveness and began to exhibit the dangerous aggressiveness that would make him one of the most feared prisoners in the US penal system. He faced his first term of confinement in a reformatory at fourteen, beginning a life of imprisonment that he resumed in early adulthood and has continued without interruption ever since. It was in prison that he committed three murders, including one of a prison guard for which he was given a life sentence without parole. Even worse, perhaps, was a previous murder of the leader of a rival Black gang after which he and his accomplice triumphantly dragged the dead body of their victim in front of the cells of other inmates. Now in his mid-sixties, Silverstein's life seems little more than an unending story of pain and rage.
There appears to be an obvious moral that can be drawn from the stories of both men, but perhaps we should be circumspect and cautious about reaching it. Still, it is clear that Choedrak was able to emerge from his ordeal in part because of his compassion and ability to forgive his enemies. By contrast, Silverstein seemed to have sunk progressively deeper into the hell of his imprisonment because of his compulsively violent and retaliatory nature. Choedrak managed to survive in the harsher prison environment and found moral strength as he attempted to help his fellow prisoners in whatever way he could. As a leading member of the Aryan Brotherhood, Silverstein terrorised, exploited and killed his fellow inmates in order to reign supreme among the wretched. In the moral universe they each inhabited, Choedrak seems an angel of mercy and Silverstein a demon of despair. But their moral universe is the same one we all occupy and the punishment that each suffered tells us something important about how societies use institutions like prisons to crush those who threaten society. While the Chinese prisons in which Choedrak suffered incarceration were certainly worse than any American prisons, we need to consider just what a place like a Supermax prison is meant to do the people who are imprisoned there.
I came across Silverstein's story from an article in the New York Times about the ADX penitentiary which reported the astronomically high incidence of mental illness among its prisoners. The fact that inmates are kept in solitary confinement twenty-three hours a day does much to explain this statistic, as do the bleak, antiseptic conditions in which they are confined. Florence, Colorado happens to be located in a remote area of the Rocky Mountains, but from the tiny windows of their cells, prisoners are not given much of a view of their magnificent surroundings. Everyone, however, is provided with a small television set. The prison population is fairly small, but is composed of some of the most notorious, high-profile convicts in America: infamous gangsters, terrorists, and serial killers, including Theodor Kaczynski, the obviously mentally ill Unabomber, are all confined within its unbreachable walls. Most are certain to die there, as well. Prison officials insist that for these irredeemable criminals nothing less than the Supermax prison will do. But what is such a prison actually supposed to do? Protect the public? Keep the inmate population from killing each other? Or does the grey horror of the Supermax express a cruel desire to avenge those that the American justice system deems hopelessly evil? Although the punishments in Chinese prisons are far more brutal and often fatal, the deprivation of human contact and the endless boredom of the Supermax constitute forms of torture in themselves, as prison authorities are surely aware. The high incidence of mental illness in the Supermax can hardly be a surprise to anyone, then. Indeed, it is the intended effect.
Although I have discussed violence mainly in prisons in this post, my title refers to violence as a more general phenomenon. In truth, the violence that society imposes on a dangerously violent criminal such as Silverstein emerges out of a cultural context in which violent resolution is regarded as somehow natural. Perhaps we are reluctant to see our attitude towards violence in this way, but evidence for it is everywhere. The unconscious impulse to violence lies buried on the surface, as it were. I hardly ever go to movies or watch television any more, but I am still struck by the ubiquity of violence that I see in advertisements. Like sex, which is even more on public display, violence is fodder for popular entertainment, especially the sort of violence that is meted out as revenge to some antagonist whose own violence makes him (seldom her) the deserving recipient of it. The righteous passion for revenge against a manifest evil doer provides the licence for retributive violence which influences public attitudes towards legal punishment. Silverstein and all the other members of the Rogue's Gallery who are locked up in the Supermax have earned their place there not just for the magnitude of their crimes or their unredeemable characters, but also--and perhaps more importantly-- for fulfilling the role of villain to such perfection.
Perhaps the last word on this matter should go to Dr Choedrak. I suspect that his moral example would win almost unanimous approval, even though we would all dread to be in a position of having to follow it. But in fact, we don't have to be thrown into such a hell in order to begin practising the compassion that he was able to show towards his persecutors. A more modest expression of compassion would be to treat someone such as Silverstein as a person who deserves decent treatment in spite of his terrible crimes. One day we might even go further and begin to acknowledge that the cultural climate that we have created contributed to the conditions that made him into the criminal that he is.
There was an article in the Guardian this week which reports that mindfulness based CBT [MBCBT] performs as well as (in fact, slightly better than) medication in the treatment of depression. This would seem to be very good news, except for the fact that neither treatment appears particularly effective. Nearly half of the patients in this study who underwent either form of treatment suffered relapses, which raises important questions about why both treatments failed to help the unfortunate half of patients who were unsuccessfully treated. Nevertheless, these results are hardly negligible, especially when we consider that unlike drugs, MBCBT has no side effects and is probably the cheaper form of treatment, as well. And taking up mindfulness for whatever purpose, even the treatment of depression, presents the possibility that it may lead someone to embrace spirituality and find a more meaningful life. Moreover, Buddhism has always dealt with the matter of suffering as its principle concern, so in some way it seems quite natural that mindfulness should be used for treating depression, even in clinical contexts. Still, reservations are in order, not least because clinical science must forbid itself from seeing what Buddhism expressly claims to know. So what does Buddhism know that about mindfulness that might tells us something about the pitfalls of the practice?
Buddhism affirms that one of the factors that makes mindfulness effective is its linkage to wisdom and morality, the two other key principles in its trio of essential spiritual values. But wisdom for Buddhism has specific connotations which distinguish it from other types of wisdom, especially the sort of worldly wisdom which all too readily serves in mundane affairs. In Buddhism, wisdom arises from selfless intentions and the desire to understand the Buddha's teaching, but it may actually be detrimental to worldly success. Similarly, Buddhist morality is not so much a matter of obeying rules passed down from on high as it is about ridding the mind of its defilements and freeing it of any tendencies that produce craving. But this may all seem a matter of religious practice, far removed from the practical concerns of the everyday world. Moreover, at least in regard to the use of mindfulness for psychotherapy, Buddhism's emphasis on morality and wisdom may actually impede its therapeutic utility. As every therapist knows, many clients' primary understanding of morality comes from their experience of it as the rod with which they have always been beaten. And as for cultivating wisdom, most clients hardly have a clue as to where to begin. So in treating something like depression then, it is only right that mindfulness should be assessed in terms of its therapeutic utility and not its adherence to Buddhist doctrine.
Still, there is another aspect to the practical wisdom that Buddhism possesses about mindfulness which seems to feature less importantly in its application as a therapeutic practice. This has to do with addressing what makes mindfulness so difficult, frustrating and unrewarding, even to those who are dedicated to it. Buddhism identifies five hindrances to meditation: sense desire, ill will, torpor and sloth, restlessness and worry, and sceptical doubt. Knowing about these hindrances and learning how to negotiate them is a sound way of strengthening meditation, as well as overcoming the obstacles themselves. Even so, many dedicated practitioners can still find themselves stuck in the doldrums in which nothing seems to happen. This is a mental state that strongly resembles depression and is characterised by lethargy, chronic doubt and sometimes, pervasive anxiety. It can also provoke depression outside of meditation, which is why some people feel compelled to abandon the practice. It should not be assumed that depression occurs only to weak practitioners, either. The great Zen master and founder of Soto Zen, Dogen experienced depression, as did the Rinzai Zen master Hakuin (whose graceful, haunting ink painting "Two Blind Men Crossing a Log Bridge" serves as the logo for this website) when he suffered "Zen sickness", an enervating condition that was brought on by his intense efforts to reach enlightenment. In fact, encountering depression in a rigorous spiritual practice is not uncommon at all, as such expressions as "the Dark Night of the Soul" and "a Spiritual Desert" suggest. But what Buddhism and other spiritual traditions have all developed are ways of dealing with these problems when they arise. So what resources does therapeutic mindfulness draw on when mindfulness no longer seems effective and may even be making matters worse?
I ask this question out of genuine curiosity, for I am sure that strategies for intervening when therapeutic mindfulness goes wrong must have been developed. Moreover, my acquaintance with MBCBT therapists who are also Buddhists reassures me about their intentions as therapists. More teachers than technicians, these therapists mostly want to help their clients manage their lives without the anxiety and stress that drive people to therapy. And when they succeed, MBCBT therapists are certainly entitled to take satisfaction in work well done. Still, as with all therapy, questions must remain whenever it doesn't work, especially as MBCBT seems to place such emphasis on its therapeutic protocols. We might ask, for instance, if MBCBT's results could be improved if it refined its protocols, making its applications more targeted and exact. Perhaps. But I suspect that the secret ingredient in all therapy is the trust that develops between client and therapist in the course of the therapeutic encounter. This does not mean that other factors are unimportant or negligible for the success of therapy. The techniques that MBCBT imparts to its clients really do matter for is success. But those techniques, which can be learned by reading a book or watching a video on-line, are usually imparted so much better by a therapist who cares about the quality of the transmission.
I have one further question about mindfulness and therapy, but only time can tell the answer. Therapy has always had new methods which were supposed to revolutionise things until they faded into routine procedures. Hypnosis first fascinated Freud as a healing technique until he abandoned it for free association. And free association itself was once thought to be the only way therapy could work effectively until some therapists elected to use other methods. In fact, both hypnosis and free association can still work, as can focussing, the body awareness technique that accesses the so-called second brain of the enteric nervous system which governs our emotional reactions. So will therapeutic mindfulness follow the pattern of these other techniques which were at first wildly praised before becoming just another way of dealing with psychological problems? I suspect so. But perhaps this is the wrong question to raise about mindfulness. Perhaps the better question is how is mindfulness helping therapy now?
One of the more common, as well as most enduring prejudices against psychotherapy is that it is alleged to make people so self preoccupied that they become excessively consumed with what they are thinking and feeling and by doing so, lose all vital connection to others, to the world, to life itself. In truth, becoming so self preoccupied that finding meaningful relationships based in reciprocity and mutual trust becomes impossible would indeed constitute a problem for anyone who happened to suffer from it. But the idea that such a problem must always trace back to an introspective disposition and that its solution can be found only by making an outward engagement in the world often comes a little too automatically, usually without consideration of the actual difficulties that the person in question may be experiencing. Moreover, whenever introversion is condemned as a disposition, little thought seems to be given to the dangers of extroversion, the opposite disposition, in which preoccupation with external affairs turns the inner world into a dim and alien realm of experience. In contrast to the introvert, the problems that the extrovert tends to face are less about his failure to form relationships with others than they are about finding any meaning within his internal experience of being himself. Yet, although this can be no less serious a problem than what the introvert faces in his inability to relate to others, the dangers of introversion are usually regarded as somehow more serious.
Ideally, of course, there should be a balance between the two tendencies and we might say as generalised prescriptions that the introvert should find renewal by looking outward and the extrovert should be encouraged to cultivate a more reflective attitude in order to discover the enriching possibilities of introspection. But as a therapist, I find that popular opinion greatly favours extroversion over introversion and tends to regard introversion as almost inherently pathological. And this bias, I would argue, suggests a widespread popular mistrust about the uncertain realities of the inner world that affects almost every individual's attempts to make sense of his or her self experience. Don't look within, such conventional wisdom advises, for there is nothing there but dangerous and empty self indulgence. And most of us believe this advice, even if it is unhelpful or even harmful, as well as untrue. Although an introspective turn can often indicate a withdrawal into sterile inwardness, looking within can also hold the possibility of finding depth and meaning within the farthest reaches of inner experience. As mystics of virtually all traditions attest, travel far enough within the self and an inner light that illuminates all things can be found. The question then is how such a potentially enlightening journey can be made, especially when the far more common experience of turning inward is to find confinement in a dark space within which the only possible light could seem to come from exterior sources.
The terms introversion and extroversion were coined by Jung to describe a person's characteristic orientation to either the inner or outer realm of experience. According to Jung , these characteristics are not much different than physical traits like height and eye colour and so forth, but unlike such physical characteristics which remain more or less fixed throughout a person's life, a psychological disposition can change over the course of a lifetime to become its opposite in accordance with the principle of enantiodromia, a pre-Socratic concept which Jung took from Heraclitus. In Jungian terms, enantiodromia may be understood as a psychological process of transformation in which a conscious position reaches an extreme limit and then begins to change into its opposite. How this principle applies in any particular case will always be an open question, but in general, both introverts and extroverts would experience life from different orientations before migrating to the opposite position. What induces this profound shift is that if an orientation becomes deeply unsatisfying it will produce any number of symptoms of distress verging on breakdown. Indeed, Jung went so far as to claim that a neurosis is a signal of a psychic imbalance that desperately requires redress.
People may come into therapy suffering from all manner of psychological complaints, but they seldom think about their difficulties in explicit terms of introversion or extroversion. Although there is nothing inherently wrong with being either introverted or extroverted, either disposition could be problematic if it impedes adaptation or personal growth. If, for example, a client comes in claiming that he is suffering from loneliness and an inability to relate to people, his problems probably spring from an introverted disposition. And if another client comes in complaining about how bored and empty she feels whenever she finds herself alone, it is likely that her extroverted temperament rules her life. As always, it would be necessary to examine each case to see how a person's disposition affects the problem at hand. The starting point in all cases would be what the client finds disturbing in his or her self experience. In general, introverts will tend to focus on themselves and their feelings of self inadequacy, while extroverts are more likely to complain about external circumstances and why they can't achieve insight for the conditions they chronically suffer. But introversion and extroversion require each other as complements or counterparts for locating self experience in the world. This means that we are never without others even when we are alone. But it also means that we are always alone in our self experience, even in the company of others. RD Laing once made an astute observation by analysing the term self consciousness which illustrates this duality in action. On the one hand, self consciousness refers to being self aware as an individual subject; on the other, it refers to being self aware as an object of interest to others. But the two perspectives oscillate so frequently that we may fail to notice that they are actually apart.
Indeed, it is possible to be trapped in a cycle of futility as either an introvert or extrovert, though in rather different ways. An introvert may rehearse his frustrations in endless rumination, while an extrovert may follow a pattern of heedless behaviour without any meaningful self reflection. One may be immured in self defeating preoccupation with possibilities that will never occur, while the other may be infatuated with trivial things. But in both cases, the self becomes engrossed in affairs that will bring neither satisfaction nor self insight. Buddhism teaches that by regarding both self and world as transitory phenomena they can be seen for what they are and the light of consciousness can shine with impartial radiance over all things. Both the inner and outer become illuminated, but the light comes from within. Indeed, that is what consciousness in itself is and by cultivating mindfulness, or awareness of things without preference or self interest, consciousness becomes increasingly clear. Although finding the light of awareness does require introspection, it as much a matter of seeing through our self preoccupations as it is of looking inward and away from from external concerns.
Finding the light within is not what psychotherapy is usually all about. Therapy usually goes into those dark cul-de-sacs of the self that hold the shame or trauma of past experiences with scant hope of finding any light within them. Yet, making things conscious is what therapy is all about, even if reaching such consciousness appears to be a humble achievement. Sometimes, therapy does as much as it can do by helping people stop being foolish. But that in itself may open the possibility of becoming more self aware and even of finding the light within.