Mindfulness and the myth of mental illness: implications for theory and practice

Over the past 60 years Thomas Szasz (1960, 1961[1974], 2008) has forcefully argued that mental illnesses are mythical since all medical diseases are located in the body and, thus, have somatic causes. This has been accompanied by a scathing and coruscating critique of the whole mental health profession—particularly, those psychologists, psychiatrists and psychotherapists who collude in and exploit the alleged mythology of counterfeit mental disorders and often (unwittingly or deliberately) justify coercion, oppression and pharmacological manipulation of so-called ‘mental patients’ in the name of ‘treatments’. Since mindfulness practitioners—perhaps especially teachers of mindfulness-based cognitive therapy, mindfulness-based stress reduction and related programmes—may, by association, be partially implicated in Szasz's allegations, this article seeks to explore and examine the implications for theory and practice in the field. It will be suggested that the strong foundational, theoretical, research and teaching bases of mindfulness-based interventions offer practitioners a solid defence against the general critique offered by Szasz, and more specific challenges advanced by critics such as Boysen (2007) and Whitaker (2010). However, there may still be potential pitfalls for those mindfulness-based interventions which are too closely allied to the psychiatric/pscychotheraputic establishment, and some suggestions for avoiding such obstacles will be offered through recommendations for maintaining connections between mindfulness and its Buddhist origins.     

Adult attachment and Mindfulness: Examining directionality,causality, and theoretical implications

We present two studies that together provide preliminary evidence to challenge the view that the relationship between adult attachment and mindfulness is bi-directional (Study 1: repeated measures design and Study 2: a repeated measures study examining the efficacy of attachment security priming and a mindfulness induction). Adult attachment anxiety emerged as a significant predictor of some facets of mindfulness, over time, but the reverse was not true. Priming attachment security increased state mindfulness of mind to a greater degree than a mindfulness induction or control. These findings challenge previous research suggesting that the relationship between adult attachment and mindfulness is bi-directional, suggesting that attachment orientation plays a causal role in the development of mindfulness.     

Mindfulness and the treatment of anger problems

Clinical interventions based on training in mindfulness skills are an increasingly common part of psychological practice. Mindfulness training can lead to reductions in a variety of problematic conditions including pain, stress, anxiety, depressive relapse, psychosis, and disordered eating but to date there have been few attempts to investigate the effectiveness of this approach with problematic anger. In this paper, the literature in relation to the theory and treatment of problematic anger is reviewed, with the aim of determining whether a rationale exists for the use of mindfulness with angry individuals. It is concluded that anger as an emotion seems particularly appropriate for the application of mindfulness-based interventions, and the potential mechanisms for its proposed effects in alleviating the cognitive, affective and behavioral manifestations of anger are discussed.     

Perceived trauma: its etiology and treatment

Female adolescents in treatment for emotional disturbances are often diagnosed as suffering from borderline personality disorder. The usual treatment plan for such a diagnosis is based upon limit setting and boundary reinforcement. When this fails to produce results, the diagnosis comes into question. The present paper investigated 85 female adolescents who were being treated for problems associated with differentiation and emancipation in an inpatient setting. A treatment variation was introduced which suggested that these females were more likely to be suffering from a variety of post-traumatic stress disorder (PTSD). When their ritualistic behavioral repetitions were addressed by cognitive behavioral approaches, the behavior decreased. The struggle with boundary issues and references to the historical context of misery and deprivation became less frequent when the focus shifted to current behavior. Two groups emerged through the analysis of data. No difference in behavior or response to treatment could be established, but one group lacked a specific troubling experience which is essential for a diagnosis of PTSD. Maladaptive social behavior (e.g., splitting and projection) were accepted as confounding factors associated with cognitive style rather than "borderline" symptoms. With the new approach, recidivism decreased 14% and the number of outbursts diminished 10% to 12%. The altered treatment approach confirmed the hypothesis that these adolescents were experiencing the effects of trauma (actual or perceived) rather than some disabling personality disorder.     

Mindfulness and False-Memories: The Impact of Mindfulness Practice on the DRM Paradigm

Mindfulness practice is the cultivation of awareness to the present moment and has been shown in recent years to have beneficial effects on cognition. However, to date, the data regarding the impact of mindfulness on memory—and specifically on memory distortions—is scarce and incomplete. The present study was aimed to examine whether mindfulness practice would have an effect on true and false memories. To this end, the effect of mindfulness meditation practice on memory performance was examined in two experiments in which false memories were provoked using the Deese-Roediger-McDermott (DRM) paradigm (Roediger & McDermott, 1995). In Experiment 1, college students were randomly divided into either a 5-week mindfulness-practice group (n = 29) or a waitlist control group (n = 22). In Experiment 2, college students were randomly divided into either a brief mindfulness session (n = 21) or a mind-wandering control group (n = 19). The results indicated that mindfulness increased the recognition of true memories with no effect on spontaneous false-memories, yet increased the rate of provoked false-memories. These findings are discussed in terms of memory sensitivity and response bias, and it is argued that mindfulness may have a lesser effect on encoding processes than previously suggested.     

Mindfulness: Theoretical Foundations and Evidence for its Salutary Effects

Interest in mindfulness and its enhancement has burgeoned in recent years. In this article, we discuss in detail the nature of mindfulness and its relation to other, established theories of attention and awareness in day-to-day life. We then examine theory and evidence for the role of mindfulness in curtailing negative functioning and enhancing positive outcomes in several important life domains, including mental health, physical health, behavioral regulation, and interpersonal relationships. The processes through which mindfulness is theorized to have its beneficial effects are then discussed, along with proposed directions for theoretical development and empirical research.     

Model scenes: implications for psychoanalytic treatment.

Model scenes are constructed by analyst and patient to organize puzzling information, integrate previous understanding, and initiate further exploration of experience. They are derived from a variety of sources: literature (oedipal myth); transference; ordinary or traumatic childhood events that occupy a pivotal position. Model scenes may conceptualize experiences of any age and motivational system, and are contrasted with screen memories and "telescoping" of events. Two clinical examples are used to illustrate the relation between the model scene and the transference. Model scenes provide a valuable clinical tool for moving from general to specific experience. They afford empathic entry into the transference experience and the opportunity through which the experience of motivations representative of past and present can be conceptualized and integrated into a cohesive self organization.     

Mindfulness Based Interventions for Youth

Application of mindfulness based interventions for youth is growing exponentially within clinical and educational settings. Proponents emphasize benefits in reduction of a wide range of psychopathology including internalizing and externalizing disorders, as well as enhancement of functioning and skills in attentional focus and concentration, emotion regulation, social and academic performance, adaptive coping, frustration tolerance, self-control, and self-esteem. Findings to date are encouraging, though research design reflects the nascent nature of the field and continues to be insufficient to confirm treatment efficacy or mechanisms of change. This article is aimed at providing the clinical practitioner with a review of the current state of the field with regard to application of mindfulness for youth, placing it in context of the broader history of the CBT movement. Specifically mindfulness based stress reduction, mindfulness based cognitive behavioral therapy, acceptance and commitment therapy, and dialectical behavior therapy treatments for youth are critically reviewed, and mindfulness as a technique and as a unifying mechanism of action in “third-wave” youth psychotherapies discussed. Developmental considerations are highlighted, and the application of mindfulness as a universal preventative health measure versus tertiary treatment intervention examined, with consideration for future directions.     

Mindfulness and self-acceptance

The present article will focus on the cognitive theory of mindfulness and its importance in achieving unconditional self-acceptance. The goal of the mindful perspective is to increase cognitive flexibility and to thereby increase behavioral flexibility and the ability to adapt to one’s current environment in a meaningful manner. Empirical evidence spanning four decades attests to the beneficial effects of a mindful vs. mindless perspective. The article will focus on the following aspects of mindfulness as they apply to self-acceptance: the importance of authenticity, the tyranny of evaluation, the benefits of mistakes, the mindlessness of social comparison, the trap of rigid categories, and the acceptance of self as a mindful choice. The article concludes with a number of mindfulness applications geared toward enhancing self-acceptance.     

Rrepresentations of trauma in infancy: Clinical and theoretical implications for the understanding of early memory

Understanding the nature of the infant's internal experience is a crucial prerequisite for delineating the developmental effects of an early trauma. In addition, to the extent that internal representations of a trauma can be traced over time, traumatic experiences present unique opportunities for the study of early memory. This article will describe case vignettes of children who experienced a trauma in the preverbal period and who evidenced forms of memory of their trauma at subsequent points in time. In conjunction with the clinical material, developmental research bearing on the types of early memories described will be discussed. The clinical data, reinforced by research findings, indicate that preverbal children, even in the first year of life, can establish and retain some form of internal representation of a traumatic event over significant periods of time. The specificity and enduring nature of the internal representations suggest that specific therapeutic interventions over and above general comforting will be required if an infant is to maximally recover from a trauma. The clinical findings have relevance for a number of issues currently under debate in the area of infant memory, including the role of reminders in memory retention, the nature of early memory systems, and the development of autobiographical memory. ©2002 Michigan Association for Infant Mental Health.