{"id":3297,"date":"2018-03-16T17:44:01","date_gmt":"2018-03-16T16:44:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3297"},"modified":"2018-03-16T17:46:09","modified_gmt":"2018-03-16T16:46:09","slug":"guest-post-philosophical-tradeoffs-in-psychotherapy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2018\/03\/16\/guest-post-philosophical-tradeoffs-in-psychotherapy\/","title":{"rendered":"Guest Post: Philosophical Tradeoffs in Psychotherapy"},"content":{"rendered":"

Authors: Sahanika Ratnayake, David Merry.
\n<\/em><\/strong>Paper:\u00a0Forgetting ourselves: epistemic costs and ethical concerns in mindfulness exercises<\/span><\/a><\/em><\/strong><\/p>\n

Unlike pharmaceuticals, psychotherapy is often presented as an effective treatment without any side effects. Mindfulness exercises, popularised by Jon Kabat-Zinn in the 1970s and \u201880s, are seen as particularly gentle. According to Kabat-Zinn, mindfulness is nothing more than \u2018paying attention\u2019. Mindfulness programmes and techniques are increasingly moving away from their origins as interventions for particular conditions such as chronic pain and mood disorders to more mainstream techniques for managing stress in the workplace or the classroom and everyday malaise. Alongside this, mindfulness exercises and techniques are increasingly made available via novel mediums. For instance, mindfulness apps are a trendy adornment for smartphones. A colouring book for adults even includes the word mindfulness <\/em>in its title; we doubt that it would have received such a warm reception had it included the term SSRI,<\/em> tricyclic <\/em>or valium<\/em>.<\/p>\n

We suggest that contrary to how they are presented, mindfulness exercises, in fact come with potential costs, presenting possible trade-offs to those that use them.<\/p>\n

<\/p>\n

Mindfulness exercises are seen as harmless largely because they are portrayed as ideologically neutral. Whilst most proponents of mindfulness exercises acknowledge their roots in early Buddhist philosophy, they claim to have excised them from their original context. Mindfulness exercises are presented as free of any moral, religious or philosophical ideas that may deter people from using them. This seems initially plausible: the exercise of sitting there and breathing, or of noticing what one is thinking, seem neutral enough. Everyone breathes.<\/p>\n

However, mindfulness exercises have their roots in a context where rather radical philosophical doctrines about the self were in vogue. These doctrines were motivated in part by the observation that our self could not be made up of or found amongst our thoughts, sensations, experiences, memories, or body. The Buddhists concluded from this that there is no self: the self is an illusion.<\/p>\n

We show that some of the therapies that adopt mindfulness techniques use similar argumentation and approaches when explicitly discussing the self. Additionally, we consider parallels between contemporary mindfulness exercises and their original Buddhist counterparts to demonstrate that mindfulness exercises as interpreted by western psychotherapists emphasise their more metaphysical aspects.<\/p>\n

For example, the breathing exercises of Mindfulness Based Stress Reduction do not simply ask people to pay attention to their breath. While breathing, one is also asked to note any thoughts that arise, to see them as an event, to notice how they come and go. One learns not to see the thought as my<\/em> thought but simply as a<\/em> thought.<\/p>\n

Another particularly striking modern variant, the likes of which are often included in the mindfulness techniques of Dialectical Behaviour Therapy, asks us to imagine our feelings as rushing past like wagons on a train. Our feelings then are not part of who we are. In fact, they have little to do with us: they did not originate with us, they are not attached to us, we are not responsible for them. Often, you are explicitly told \u201cYou are not your thoughts\u201d or \u201cYou are not your feelings\u201d as part of these exercises.<\/p>\n

Ideas about the self concern matters central to people\u2019s world-views. Many think that our thoughts and emotions tell us about the nature of our soul, or even just about who we are, and that investigating these thoughts and emotions furthers self-knowledge. For such people, mindfulness exercises involve using portrayals of the world at odds with their core beliefs to achieve behavioural and emotional outcomes. For instance, a religious member of an audience when we presented this paper told us that he found transcendental meditation incompatible with following his religion<\/p>\n

These are trade-offs that should ideally be given careful consideration. Portraying mindfulness exercises as ideologically neutral, as just paying attention, forestalls such consideration, and undermines autonomy. Discussion of potential trade-offs is particularly pressing as mindfulness techniques and exercises are becoming disseminated more widely.<\/p>\n

There is at present very little work looking at the potential trade-offs of psychotherapy and philosophical perspectives on psychotherapy. Further work in this direction is vital for adequately evaluating contemporary psychotherapy.<\/p>\n