A number of practical conclusions may be drawn from the five forms of dialectics of mindfulness: (1) activity vs. passivity, (2) wanting vs. non-wanting, (3) changing vs. non-changing, (4) non-judging vs. non-reacting, and (5) active acceptance vs. passive acceptance, as presented in this paper.Good stuff.
Dialectics of mindfulness: implications for western medicine
Sebastian Sauer1,2, Siobhan Lynch4,3, Harald Walach6,5 and Niko Kohls6,1,2Philosophy, Ethics, and Humanities in Medicine 2011, 6:10 doi:10.1186/1747-5341-6-10
© 2011 Sauer et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Mindfulness as a clinical and nonclinical intervention for a variety of symptoms has recently received a substantial amount of interest. Although the application of mindfulness appears straightforward and its effectiveness is well supported, the concept may easily be misunderstood. This misunderstanding may severely limit the benefit of mindfulness-based interventions. It is therefore necessary to understand that the characteristics of mindfulness are based on a set of seemingly paradoxical structures. This article discusses the underlying paradox by disentangling it into five dialectical positions - activity vs. passivity, wanting vs. non-wanting, changing vs. non-changing, non-judging vs. non-reacting, and active acceptance vs. passive acceptance, respectively. Finally, the practical implications for the medical professional as well as potential caveats are discussed.
Background
In the last two to three decades, the concept of mindfulness has received increasing attention, particularly in the health sciences. Mindfulness is about being aware of actual experiences from one moment to the next with gentle acceptance [1-3]. This concept has been proposed to contribute to the coping and recovery process in many health conditions.
Both clinical as well as basic science researchers have devoted a significant amount of study to this topic [4]. Moreover, with rapidly mounting evidence regarding the therapeutic capacities of mindfulness practice, medical professionals are increasingly incorporating such techniques into their clinical repertoire. Probably the best known and evaluated mindfulness-based treatment is the Mindfulness-Based Stress Reduction (MBSR) that is used in many clinical settings in the US and Canada and evermore, in Europe [4].
Yet, integrating mindfulness into existing therapeutic concepts may challenge medical professionals' usual practices for number of reasons. First and foremost, mindfulness approaches do not aim at symptom reduction. Fundamentally, mindfulness is not intended to explicitly eradicate pain, distress, or unwanted emotions. However, philosophically and practically, medical professionals endeavor to reduce suffering. If mindfulness does not aim at reducing symptoms, then how can it be helpful? In this essay, we argue that while mindfulness is not meant to actively reduce symptoms, it may passively modify their impact by changing an individual's perceptions and mindset. Mindfulness is a set of practices, if not a "way of being" that may incur salutogenic (i.e., health-promoting) effects. This may lead to a misconception of what mindfulness is, and how it works. We believe that some of the apparently contradictory aspects of mindfulness can be best understood by taking a dialectical approach. It is not a new idea to explain psychological health-related processes through the use of paradoxical or dialectical approaches [5]. Indeed, we propose that the dialectical structure of mindfulness hallmarks its essence, which may easily be misunderstood in clinical practice.
The dialectical approach is quite different from the conventional approach of symptom evaluation. The conventional approach uses the current logic: a symptom is either good or bad; present or absent; relevant or not. The dialectical approach stresses that each thesis also has to be considered in the light of its opposite (the antithesis), and only both facets together (the synthesis) yield a full picture. In this light, depression might be a sign of a disorder that should be mitigated. But at the same time, it must be acknowledged that there are inner experiences that cannot be controlled or altered "at will". Hence, although the phenomenal quality of going through depression may not be altered, a patient's relation towards relevant inner states relevant to depression may be changed due to mindfulness or other forms of spiritual exercise [6,7].
Herein, we first elaborate on the dialectical structure of mindfulness by providing an overview of 1) the theoretical foundation of the construct, 2) evidence of the clinical effectiveness, and 3) putative neurobiological correlates of mindfulness. We then introduce five dialectical positions that we believe are useful for resolving the apparent paradox associated with mindfulness and its relevant mechanisms of action. Finally, on the basis of this discussion, we derive the utility and implications of mindfulness for medicine, and address potential caveats.
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