In 2003, 3,083,903,000 retail prescription drugs were filled in, of which California had the maximum of 268,114,000 followed by Texas, 214, 487,000 and Florida at 194,555,000 . In 1998, personal healthcare expenditure stood at $1,015,988,000,000 in US, and per capita total expenditure at $3,759. (www.statehealthfacts.kff.org).
FDA approval for drugs includes 6 month test period whereas many side effects of prescription drugs take years to surface. Most psychotropic drugs are experimental in that their sites of action are not understood (Carlson, 2004). Nearly 20% of prescription drugs have demonstrated a serious side effect that wasn’t apparent in the pre-approval testing phase (Napoli, 2002). Safe drugs like Amoxicillin have known to induce hallucinations, confusion, mania. Digoxin is reported to induce depressed libido, delirium, depression, dementia, hallucinations and psychosis, mania and hyperactivity, lethargy, sexual dysfunction. Neuroleptics/anti-psychotics like Haldol/ Thorazine create a zombie like state. Prozac and Haldol are implicated in drug induced violence and suicide and Thorazine is known as “chemical lobotomy,” leading to psychosis, hallucination and increased anxiety. More than 20% of the people treated with tranquilizers report tardive dyskinesia or dystonia. (Peters, 2004). Nearly 6 million children between the ages of 6 and 18 take mind altering drugs (O’Meara, 1999). Nearly 10-12% of boys in US, diagnosed with ADD/ADHD, are on Ritalin. US buys 90% of the world’s Ritalin – the drug is pharmacologically similar to cocaine.
These concerns with traditional methods of healing lend themselves to questions such as : Is there a better holistic, preventative approach that is agnostic towards cultural, religious, socio-economic and gender biases, that promotes healthy lifestyle and harmonious relationships, that prevents/mitigates distress, that empowers to create positive individual changes through improved cognition and also enables acceptance of those deterministic factors of our life and environment over which we have no control? Does spirituality have curative, healing properties that could be clinically harnessed ?
Mindfulness is an eastern philosophy that finds significant overlap with Western theories of empowerment, social constructivism and social cognition. It professes that practitioners are empowered to make positive changes in their lives. Since practice of mindfulness subscribes to goals identical to social work, the overlap needs to be acknowledged and embodied in the social work practice along with medical and psychological models.
Meditation is a practice that calms/quietens the mind, relaxes the body and increases concentration. Most religions incorporate some form of meditation, usually in the form of worship. From the psychological/clinical perspective, meditation is, or produces, an altered state of mind that is vulnerable to self-suggestions. Hypnosis and certain mind altering drugs produce the same effect.
Vipassana meditation is a meditational practice which embodies the philosophy of mindfulness in its practice of meditation. Mindfulness is not necessarily achieved through meditation, but meditation trains the mind to become mindful.
Conceptual Framework
According to Kegan (in Savola, 2004), theories of mindfulness find validity, among others, in Self-Regulation Models of Cognition and Mood (Carver & Scheier, 1981, 1991). The model of self regulation shows that our mental processes are constantly involved in managing the gap between our current and our desired states in life. This existential gap provides motivation for our behaviors (Miller, Galanter & Pribaum, 1960; Powers 1973); Carver Scheier 1981, 1990) and leads to cognitions of uncertainty and fear. Consequential negative affect is our mind’s attempt to bridge this divide (Carver & Scheier, 1990). Minimizing this divide enables a closure of the process and results in a feeling of well being. If this gap cannot be minimized, the mind can either dwell on the gap, which creates a pattern of ongoing rumination and anxiety (Martin & Tesser, 1996), or it can abolish the goal. Disengagement from the goals then creates a sense of well being, reduces depression and anxiety. (In Bishop et all, 2004).
Mindfulness also parallels Bandura’s theories of Social Cognition (1979) and Reciprocal Determinism (1986), Festinger's (1957) cognitive-dissonance theory, Bem's (1972) self-perception theory, and Weiner's (1985) attribution theory, all of which define various dimensions of cognitive processes. It embodies contemporary Cognitive models of psychopathology.
On philosophical end, it is aligned with the philosophies of Social Constructionism in that it seeks answers to questions like : is our reality a by-product of human activity or does independent reality truly exist? If our worldviews are social constructs, then our negative thought patterns do not represent reality and can be deconstructed and reconstructed easily. Mindfulness embodies theories of Empowerment through changes in cognition. It asserts that if the information about one’s unique experience of the world is unavailable to anyone else except in the form of generic, agreed upon, symbols limited in scope and contaminated by their experiential lenses, then the individual has the ability to change/accept his socially constructed reality. It leans towards Symbolic Interactionism and most Cognitive/Emotive/Behavioral Theories in its recognition that psychological angst in a person arises due to the meaning they attach to these external objects, and strives to create acceptance and reduce attachments to external objects. It draws from Subject-Object theory (Kegan, 1994) which involves itself with explanations of transmutation of our subjective experiences into objective experiences that enable us to anticipate and predict behaviors and their outcomes.
Theories of mindfulness spring from Eastern Buddhist philosophies. Gautam Buddha held that the world, and our lives, were social constructs, that all misery arose from the meaning we ascribe to events and objects. Through knowledge and wisdom about the process of construction and transient nature of events and objects, Buddhism strives to deconstruct individual reality that represents a source of psychological angst. The awareness and knowledge, according to him, prevents humans from struggling as emotional, reactive participants and empowers them to become accepting observers of the events unfolding in their life so that they can be dispassionate, rational, logical agents of change. Through mindfulness, hopeless and negative thoughts are recognized simply as transient thoughts arising out of socially constructed world. Since they do not represent reality, the need to find a solution to those thoughts is alleviated. As a detached observer one is empowered to reconstruct their reality through rational cognition and conscious effort. To that effects, mindful meditation represents a strong application base for theories of empowerment, social constructionism and social cognition. Mindfulness is not necessarily achieved by meditation. However, meditation helps train the mind to become more mindful.
Bishop, Lou, Shapiro et all (2004) define mindfulness as “a process of regulating attention in order to bring a quality of nonelaborative awareness to current experience and a quality of relating to one’s experience within an orientation of curiosity, experiential openness, and acceptance.” They claim mindfulness involves “gaining insight into the nature of one’s mind and the adoption of a decentred perspective on thoughts and feelings so that they can be experienced in terms of their subjectivity (versus their necessary validity) and transient nature (versus their permanence).”
Mindfulness encompasses “patience (allowing things to unfold in their own time), trust (confidence in one’s ability to stay in contact with private experience), non-reactivity (calmness), wisdom (self knowledge) and compassion (empathy for oneself),” (Bishop et all, 2004). Ellen Langer’s work establishes mindfulness as a creative cognitive process. Mindfulness embodies “constructs that describe the ability to observe the temporal stream of thoughts and feelings including introspection (James, 1890, in Bishop et all, 2004), observing self (Deikman, 1982, in Bishop, Shapiro, Lau et all, 2004), presence (Bugenthal, 1987, in Bishop et all, 2004), reflective functioning (Fonagy & Target, 1996, 1997, in Bishop et all, 2004) and deautomatization/decentering (Safran and segal, 1990, in Bishop et all, 2004).”
Even though most psychopathology involves intolerance of private experiences, nevertheless, most therapeutic models adopt a confrontational approach towards these experiences, thereby overloading the ego defence mechanisms of the client. Mindfulness encourages patients to give up avoidance strategies simply by exploring and being in the present.
Meditation has been scientifically proven to produce altered state of mind. It slows down the heart rate (Barnes et all, 2004), reduces blood pressure (Barnes et all, 2004), helps in overcoming depression (Ramel et all, 2004) and grieving (Sagula & Rice, 2004), improves concentration (Davidson et all, 2003), improves the brain and immune functions (Davidson et all, 2003) and has been proven effective as a therapy for GAD (Roemer & Orsillo, 2002) and other anxiety disorders (Tory, 2004) as well as Axis-II disorders (Ferrin, 2004). It is resulted in improvement in behavior of children with ADHD (Harrison et all, 2004) and enhancement in quality of life in acute/chronic pain patients (Sagula & Rice, 2004, Moriconi, 2004). It is known to reduce recidivism in criminals and has been effective in substance abuse treatments. |
