Clinical Handbook of Mindfulness (14 page)

the executive function of the mind which initiates conscious or unconscious

choices. Whereas the first four systems yield a sense of
what
is happening at

any given moment, the fifth decides what we are going to
do
about it.

How do these processes unfold together? Imagine that you’re hungry, and

you open the refrigerator door. The eye
sees
patterns of light, dark, and color

in the visual field, which are quickly organized by the brain and
perceived

as a freshly made sandwich. Instantaneously, a positive
feeling
toward the

sandwich arises, and an
intention
forms to pick it up and eat it. This is soon

followed by the
behavior
of actually taking a bite. Consciousness creates and

responds to our reality so quickly that the process is usually unconscious.

Intentions and the behaviors that follow from them tend to become habit-

ual and turn into
dispositions
. Dispositions are the residue of previous deci-

sions, stored in memory as habits, learned behaviors, personality traits, etc.,

and provide historical precedents for how to respond to each newly arising

Chapter 1 Mindfulness

31

moment. Feedback loops develop, whereby one’s present response to any

situation is both shaped by previous experience and goes on to mold the dis-

positions that will influence future responses. If we enjoyed this and other

sandwiches in the past, we may develop the habit of reflexively picking up

and eating sandwiches, even when we’re not really hungry.

Putting this all together, the six sense doors and five systems interact simul-

taneously to form a dynamic interdependently arising process of mind and

body, constructing meaning from an ever-changing barrage of environmental

information. In each moment, which can be measured in milliseconds, all

this arises concurrently, organizes around a particular bit of data, and then

passes away.

One unique feature of Buddhist psychology is that consciousness is

regarded as an unfolding
process
, or an occurring
event
, rather than as an

existing entity. Nothing permanent abides (and there is no enduring “me” to

be found) because every “thing” is a series of interrelated events. The every-

day sense that we (and other beings) have separate existence comes from the

fact that each moment of cognition is followed by another moment of cog-

nition, yielding the subjective sense of a stream of consciousness. We have

simply learned to connect the snapshots together into a coherent narrative.

This is like the illusion of continuous action that our minds create out of sep-

arate frames in a movie. Among the great insights of the Buddhist tradition

is not only that this is all happening below the threshold of ordinary aware-

ness, but also that this process can unfold in either healthy or unhealthy

ways, depending on the skills of its handler.

This analysis of human experience has important and radical clinical impli-

cations. It suggests that our reality, including the sense of “self” around which

so much personal psychology is centered, is based on a fundamental mis-

understanding. It is as though we believed that a powerful automobile like

a Ferrari was a living being—until we saw it disassembled on the floor of

a workshop. When we know the component parts and how they’re put

together, we can never look at a Ferrari in quite the same way. Similarly,

seeing the way the “self” is constructed can help both us and our patients

loosen our identification with the changing kaleidoscope of thoughts and

feelings that arise in the mind, allowing us to live more flexible, adaptive,

happier, and productive lives.

A Physician of the Mind

The Buddha sometimes referred to himself as a physician, and to his teaching

as a kind of medicine. The illness he treated was the fact that conscious-

ness is continually influenced by patterns of conditioning that inevitably

result in unhappiness, frustration, and disappointment. This is certainly an

observation familiar to the modern psychotherapist. Rather than changing

brain chemistry by pharmaceuticals or probing past traumas arresting nor-

mal development, however, the Buddha’s approach was to help the patient

gain direct insight into the nature of experience. This takes many forms.

One track is to notice the extent to which the patterns of conditioning we

acquire, through learned behaviors, conditioned responses, or cultural osmo-

sis, are for the most part built upon certain
illusions
or even
delusions
. Fore-

most of these are our remarkably robust habit of taking what is impermanent

32

Ronald D. Siegel, Christopher K. Germer, and Andrew Olendzki

and subject to change to be stable or reliable; believing that the satisfaction

or gratification of desires is sustainable for longer than a few moments when,

because of the former point, it is not; and projecting again and again onto

the field of experience the notion of a person or agent that owns, controls,

or consists of what is happening. In other words, we continuously delude

ourselves into believing that we can hold onto what we want and get rid

of what we don’t want, despite considerable evidence to the contrary. And

on top of this, we delude ourselves into believing that a stable, independent

“I” or “me” is running this show. To the extent these misperceptions can be

gradually uncovered and corrected, considerable healing can occur.

For example, there is the story of a monk who complained to his Zen

teacher that he was an angry person. The teacher said, “Show me.” Since the

student was not angry at the moment, he could not show it, whereupon the

teacher said, “See, you are not an angry person because you are not angry all

the time.” Such insight into the fluidity of experience and insubstantiality of

identity can be enormously helpful to patients who have core beliefs about

being unworthy, unlovable, unintelligent, and so forth.

Another approach is to recognize the fact that behavior is
driven by desire
,

both conscious and unconscious, and to use that knowledge to diminish and

eventually eliminate the role of desire in the moment-to-moment functioning

of mind and body. The impulse to like some things and dislike others leads to

pulling some objects of experience closer and pushing others farther away

from a sense of self that sets itself apart from what is actually happening.

Ironically, say the Buddhists, the very strategies we employ to overcome the

perceived shortcomings of the world as we find it—embracing what offers

pleasure and rejecting what brings pain—have the result of causing and per-

petuating greater suffering. The solution is to practice letting go of desire

itself, which can be replaced by an attitude of equanimity or acceptance. In

clinical practice, we see countless examples that “what we resist persists”

and how patients suffer terribly from wishing that things would be other

than they are, that is, from not facing “reality.”

The underlying tendencies of both delusion and desire are deeply embed-

ded in human nature, but can be successfully diminished and even elimi-

nated. The word “Buddha” actually means “awake,” and the historical Bud-

dha was a man who undertook a program of transformation that resulted in

his “awakening” from the misconceptions of delusion and the addictions of

desire.

Bottom-Up Versus Top-Down Processing

Modern cognitive scientists distinguish between bottom-up and top-down

information processing
(Eysenck & Keane, 2000).
At the heart of mindfulness meditation is an emphasis on bottom-up, rather than top-down, func-

tions of the mind. That is to say, mindfulness seeks to bring attention directly

to the stream of sensory data entering experience through each of the sense

doors—the visual forms, sounds, smells, tastes, and bodily sensations—as

well as to the arising of thoughts and images in the mind. In doing so, it steers

attention away from the many “upper level” schemas, narratives, beliefs,

and other conceptual maps we normally use to guide our way through a

day’s experience. This is cognitive–behavioral therapy on steroids—bringing

Chapter 1 Mindfulness

33

attention to subtle sensory experience, and in so doing, coming to see all

thoughts and their associated feelings as arbitrary, conditioned events. While

ordinary consciousness tends to overlook the details of sensory experience

(usually we are just trying to extract from it what is of interest to achieve

our goals), mindfulness practice instead focuses on the sensory data itself,

for its own sake, and invites the practitioner to consistently abandon con-

ceptual judgments and narrative stories. Such a method has the effect of

depriving the mind of much of the energy that fuels its stories and delusions,

and transfers our awareness to the areas that will directly reveal the transient,

constructed, and selfless nature of experience.

Mindfulness in Context

As mentioned earlier, mindfulness is part of a project designed to uproot

harmful habits of mind. In the traditional Buddhist context, mindfulness is

embedded in an eight-fold path to alleviate suffering; mindfulness is guided

and directed by seven other factors. They are as follows: (1) the
view
one has

of what is real, important, valuable, and useful; (2) how
intention
is used to

initiate and sustain action in skillful ways; (3) the nature of
speech
that can

be either harmful or beneficial; (4) the quality of
action
as it relates to eth-

ical principles; (5) one’s means of sustaining oneself in the world as
liveli-

hood
; (6) the degree and quality of
effort
employed to bring about change;

and (7)
concentration
as a focusing and supporting factor to mindfulness.

When mindfulness is taken out of this broader context, its power may be

limited. For example, it is difficult to sustain mindful awareness if we are

causing harm to ourselves or others, or if we do not have the concentra-

tion and beneficial intentions to focus our efforts. In other words, it’s hard

to have a good meditation session after a busy day of cheating, stealing, and

killing.

The Buddhist tradition has focused on universal challenges in human life,

such as the problem of suffering in general. Many aspects of Buddhist psy-

chology are therefore as applicable today as they were in ancient India. As

this book demonstrates, psychotherapy is harnessing the power of mindful-

ness and acceptance to bring relief to intractable psychological conditions.

However, the proposed outcome of dedicated Buddhist practice is radically

different:
the complete cessation of suffering
. In modern terms, this means

envisioning a life without a trace of psychological symptoms found in our

diagnostic manuals. Such an “awakened” person lives naturally, with a full

range of physical, emotional, and intellectual capacities, but without need-

ing events to be other than what they are in order to feel fulfilled. By prac-

ticing mindfulness, we can learn to lead a peaceful, balanced, and loving life,

all the while working for the benefit of others. There is no need to wait for

another time, place, or condition for this to occur—we can begin where we

are, therapists and patients alike.

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