The Biopsychosocialspiritual Model of Mental Illness

emotional contagion 3The Biopsychosocialspiritual Model of Mental Illness

A frequently aired criticism of psychiatry is that it places too much emphasis on the role of biological factors as determinants of mental illness. Many people believe that an exclusively biological model of mental illness is a reductionist approach and that mental health problems are caused by a complex range of factors. According to Dr. Lucy Johnstone (as quoted by the Guardian newspaper earlier this week), there is “overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse”.

A model of mental illness that is increasingly subscribed to by mental health professionals and academicians is one that acknowledges the contribution and interplay of biological, psychological, and social factors. This is known as the ‘biopsychosocial’ model of mental illness. Whilst the biopsychosocial model appears to provide an encompassing explanation for why mental health problems arise, an important dimension seems to have been overlooked. There is increasing scientific evidence that spirituality plays a significant role in the etiology, maintenance, and treatment of mental health problems. Types of spiritual aptitudes that have been shown to be influential in this regard include (for example) dispositional mindfulness, faith, meditative insight, loving-kindness, compassion, death-awareness, and patience.

The Diagnostic and Statistical Manual of Mental Illness  (DSM) includes ‘Religious or Spiritual Problems’ as a V-code (V62.89). This means that a religious or spiritual problem could be the focus of clinical attention, but should not be confused with a mental illness. The DSM gives examples of religious or spiritual problems as “distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized church or religious institution”.

Although the DSM (and mainstream clinical literature more generally) acknowledges that spiritual factors can cause personal conflict, the emphasis is placed on conflict that arises specifically due to loss of faith and/or questioning of spiritual values. Very little consideration is given to the wider role that spiritual factors play in the etiology of diagnosable mental illnesses.

Thus, we would argue that a ‘biopsychosocialspiritual’ model of mental illness – that acknowledges the importance of biological, psychological, social, and spiritual factors as determinants of psychopathology – represents a much more acceptable and inclusive model. This is consistent with the view of a growing number of transpersonal psychologists (and that of most of the world’s spiritual traditions).

From the Buddhist philosophical perspective in particular, a person’s levels of spiritual development (and therefore the risk of them experiencing mental health problems) relates not only to the amount of spiritual insight acquired during this lifetime, but also to the amount acquired during all previous lifetimes. In other words, Buddhism asserts that people are born into this life with a ‘karmic baggage’. This karmic baggage is an additional factor (i.e., in conjunction with the degree of spiritual progress made during this lifetime) that may account for any deficits in spiritual awareness.

We think there is quite a lot of progress to be made before mainstream health disciplines begin to accept that spiritual factors play a central causal role in the onset of mental pathologies. So perhaps now is not the right time to introduce a model of mental illness that requires clinicians not only to assess impairments in spiritual intelligence that relate to this life, but also those that relate to previous lifetimes!

 

Further Reading

  1. Lukoff, D. From spiritual emergency to spiritual problem: The transpersonal roots of the new DSM-IV-TR category. Journal of Humanistic Psychology 1998;38:21-50 1998
  2. Parks, T. How is your personality formed? The Guardian, 2013, 22nd June.
  3. Shonin E, Van Gordon W, Griffiths MD. Buddhist philosophy for the treatment of problem gambling. Journal of Behavioural Addiction, 2013;2:63-71.
  4. Shonin E, Van Gordon W, Griffiths MD. Meditation Awareness Training (MAT) for improved psychological wellbeing: A qualitative examination of participant experiences. Journal of Religion and Health, 2013; DOI:10.1007/s10943-013-9679-0.
  5. Yang C, Lukoff D. Working with spiritual issues. Psychiatric Annals, 1998;36:168-174.

Ven Edo Shonin and Ven William Van Gordon

Meditation Research: The Top Ten

Meditation Research: The Top Ten

getting ahead

Based upon an extensive and comprehensive review of the literature, and based upon findings from our own research, the following is what we consider to be some key findings and/or emerging insights from the scientific study of meditation.

1.When correctly practiced, meditation can improve physical, psychological, and spiritual wellbeing.

2. Poorly administered meditation training can lead to deleterious health consequences.

3. In general, people (including many academicians) have a poor understanding of what constitutes meditation practice.

4. In general, people have a poor understanding of what constitutes authentic spiritual practice. For example, spiritual practice is often confused with religious practice (which may or may not be spiritually inclined).

5. There is a tendency for people to search outside of themselves for spiritual happiness (i.e., to believe that ‘liberation’ can only be granted by some kind of enlightened being or divine entity). However, the evidence suggests that people experience the greatest gains in spiritual and psychological wellbeing when they start to look ‘inside’ and take accountability for their own spiritual growth.

6. Most people have difficulty in understanding that they inherently don’t exist. In other words, they ‘cling’ to the idea of an independent and intrinsically existing ‘self’ or ‘I’. This ‘addiction to self’, which we term ‘ontological addiction’ (Shonin, Van Gordon, & Griffiths, 2013), appears to play an integral role in the maintenance of psychological distress and spiritual bewilderment.

7. Simply letting the mind rest in the present moment, whilst anchoring ones concentration on the natural flow of the in-breath and out-breath, appears to calm the mind and reduce psychological and autonomic arousal.

8. It seems that spiritual practice comes low-down on people’s priorities with most people placing greater importance on material pursuits (e.g., career, wealth, reputation, etc.).

9. In consequence, most people are unprepared for death and generally meet it with a great deal of fear and regret. Furthermore, although there is a superficial understanding that death is inevitable, it seems that most people are self-deceived due to the construction of a deeply-held and maladaptive belief that death will never happen to them.

10. ‘Spiritual addiction’ (Shonin, Van Gordon, & Griffiths, 2013) appears to be a multifaceted and valid construct in which ego-clinging plays an important aetiological role.

Ven Edo Shonin & Ven William Van Gordon

The Life Gamble

making choices

The Life Gamble

Along with Professor Mark Griffiths who is one of the world’s leading experts in the study of behavioural addictions, we recently published an article in the Journal of Behavioural Addictions entitled ‘Buddhist Philosophy for the Treatment of Problem Gambling’. In our article, we made reference to a phenomenon that we call ‘the life gamble’.

The life gamble refers to a basic ‘universal choice’ that all people have. It is a choice that transcends religion, ethnic origin, wealth, sex, and culture. What we are referring to here is the choice of whether or not to engage in spiritual practice. Given that this is a choice that affects everybody, then we might all be referred to as ‘life gamblers’.

On the one hand, the life gambler can choose to adopt a self-centred outlook and bet ‘all-in’ on the belief of no ‘afterlife’ and no karmic consequence to actions in this life or beyond. After all, if this life is all there is then why should we waste our time thinking about anything other than ourselves? On the other hand, the life gambler can choose to ‘hedge their bets’ and integrate spiritual practice (in whatever guise) into their life in order to cultivate spiritual wellbeing during this life, and to prepare themselves for death.

According to the Buddhist perspective, the first scenario reflects a ‘high-risk low-reward’ strategy because if the life gambler is wrong and ‘mind-essence’ continues beyond this lifetime, then there is a strong probability of mental anguish, regret, and disorientation during the death phase transition. The second scenario therefore reflects a ‘low-risk high-reward’ strategy because if it transpires that there is no ‘existence’ after death, then there will be no stream of consciousness to experience regret due to having needlessly engaged in spiritual practice.

However, if it transpires that the thread of subtle-consciousness does indeed endure throughout successive lifetimes, then the life gambler not only reaps the benefit of spiritual practice during this life, but is also better prepared for experiencing the various (and otherwise petrifying) death visions, sounds, and faints with greater confidence and awareness. Similarly, they are also in a better position to further their spiritual progress during subsequent lifetimes (i.e., until the attainment of liberation).

The saying ‘gambling with their life’ is sometimes used to refer to people who engage in life threatening or potentially harmful activities. However, from the Buddhist perspective, the person who doesn’t engage in spiritual practice might be said to be ‘gambling with their lifetimes’.

Ven Edo Shonin & Ven William Van Gordon

moment 4

Further Reading

Shonin, E., Van Gordon W., & Griffiths M. D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioural Addictions. DOI: 10.1556/JBA.2.2013.001

 

Teaching Mindfulness to Children

Teaching Mindfulness to Children

evidence

Clicca qui per Italiano

Along with a friend and colleague of ours – Professor Mark Griffiths – we recently published an article in the journal of Education and Health about the health benefits of mindfulness for children and adolescents. In our paper, we made reference to an on-going debate amongst scientists regarding the most appropriate age to teach mindfulness to children. For example, some scientists are of the view that children are developmentally suited to be taught mindfulness from around 7-8 years old. Other scientists believe that a child’s concentration span is too underdeveloped at this age and that mindfulness should not be taught to children until they are 12-14 years old.

These different scientific standpoints offer interesting perspectives on the most appropriate time to introduce children to the practice of mindfulness. However, from the Buddhist view, the best time to teach mindfulness to children is right now. In other words, the earlier a child is introduced to mindfulness the better. The idea of teaching mindfulness to very young children may sound a bit strange, but perhaps less so if one is prepared to think outside of the box (or outside of the classroom) a little.

Conducting classroom sessions or giving individual instruction is only one way of teaching mindfulness. Another way is for the teacher or parent to just simply be mindful. In our teaching and research of mindfulness and meditation (whether with children or adults), something we observe again and again is that students place a great deal of importance on the extent to which the instructor or teacher is able to impart an embodied authentic experience of mindfulness. Put differently, if the person teaching mindfulness is on some kind of spiritual trip, or their experience is limited to information they have derived from reading a few books or from attending a few meditation retreats, then children tend to notice this and become less receptive. On the other hand, a parent or teacher who is ‘well-soaked’ in meditation is teaching from an experiential standpoint. They naturally exert a reassuring presence that helps children to relax and connect with their own capacity for spiritual awareness.

An analogy sometimes used in the Buddhist teachings is that the person teaching mindfulness should be like a graceful swan. The swan is confident and elegant in the way it moves. It glides effortlessly through the water without disturbing it too much. When a parent is mindful of their being, when they walk around the home fully conscious of each and every breath and each and every step, then they assume a calming presence that naturally pervades the entire household. When a child observes their mother or father living gently, having time for life and for one another, and not rushing their lives away, then happiness grows in the child’s heart and they feel secure and cradled by their parents’ spiritual presence.

Rather than lots of individuals living separate and fragmented lives within the same household, the family becomes a real home once again. Family members are happy to sit and truly enjoy each other’s company without needing to be constantly plugged into computer games or television shows. The children naturally begin to think, speak, and act with clarity and awareness. They shine with joy and happiness which is the greatest gift a parent can bestow upon them.

When this wholesome living environment has been cultivated effectively, the home becomes a place of spiritual refuge and nourishment.  In these circumstances there’s no real need to sit down and instruct the child in how to practice mindfulness because mindfulness has become a part of their being. Giving instructions in this manner would be like teaching a child how to walk after they have already learned to do so. The child understands intuitively what it means to be awake to the present moment and doing so becomes as natural as riding a bicycle.

Please don’t misunderstand what is being said here. We are not saying that children should not be instructed in how to practice mindfulness. Unfortunately, the family environment that we outlined above is not realistic for many children and therefore other methods of teaching mindfulness are required. However, what we would like to emphasise is that without authenticity in the transmission of mindfulness teachings, then any beneficial effects are likely to be short-lived. Moreover, a person who teaches mindfulness without an experiential grounding can actually cause harm for all concerned.

Ven Edo Shonin & Ven William Van Gordon

Further Reading

Burke, C. A. (2010). Mindfulness-based approaches with children and adolescents: A preliminary review of current research in an emergent field. Journal of Child and Family Studies, 19, 133-144.

Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19, 190-202.

Flook, L., Smalley, S.L., Kitil, M.J., Galla, B., Kaiser-Greenland, S., Locke, et al. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26, 70–95.

Mendelson, T., Greenberg, M.T., Dariotis, J.K., Feagans Gould, L., Rhoades, B.L., & Leaf, P.J. (2010). Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. Journal of Abnormal Child Psychology, 38, 985-994.

Schonert-Reichl, K.A. & Lawlor, M.S. (2010). The effects of a mindfulness-based education program on pre- and early adolescents’ well-being and social emotional competance. Mindfulness, 1, 137-151.

Singh, N., Lancioni, G., Winton, A., Karazsia, B., & Singh, J. (2013). Mindfulness training for teachers changes the behavior of their preschool  students. Research in Human Development, 10, 211-233.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2012). The health benefits of mindfulness-based interventions for children and adolescents. Education and Health, 30, 94-97.

Thompson, M. & Gauntlett-Gilber, J. (2008). Mindfulness with children and adolescents: Effective clinical application. Clinical Child Psychology and Psychiatry, 13, 395-407.

 

Insegnare mindfulness ai bambini

evidence

Insieme a una amica e collega nostra – Dr Giulia Cavalli – abbiamo recentemente pubblicato un articolo sulla rivista Educare03 sui benefici per la salute di mindfulness per bambini e adolescenti Nel nostro articolo, abbiamo fatto riferimento a un dibattito in corso tra gli scienziati per quanto riguarda l’età più appropriata per insegnare mindfulness ai bambini. Ad esempio, alcuni scienziati sono del parere che i bambini sono evolutivamente adatti per essere insegnato la mindfulness da circa 7-8 anni. Altri scienziati ritengono che la concentrazione di un bambino è troppo poco sviluppato a questa età e che la mindfulness non dovrebbe essere insegnata ai bambini fino a 12-14 anni.

Questi diversi punti di vista scientifici offrono interessanti prospettive sul momento più appropriato per introdurre i bambini alla pratica della mindfulness. Tuttavia, dal punto di vista buddista, il momento migliore per insegnare ai bambini la mindfulness è adesso – proprio in questo momento. In altre parole, prima un bambino viene introdotto alla mindfulness meglio é. L’idea di insegnare la mindfulness ai bambini molto piccoli può sembrare un po’ strano, ma forse meno se uno è disposto a pensare fuori della scatola (o fuori dell’aula) un po ‘. Lo svolgimento di sessioni in aula o dando istruzione individuale è solo un modo di insegnare la mindfulness. Un altro modo è per l’insegnante o il genitore di semplicemente essere mindful. Nel nostro insegnamento e ricerca di mindfulness e meditazione (sia con i bambini che con gli adulti), qualcosa che osserviamo di ripetutamente è che gli studenti pongono molto importanza alla misura in cui l’istruttore o insegnante è in grado di impartire un’autentica esperienza incarnata della mindfulness. In altre parole, se la persona che insegna la mindfulness è in una sorta di fantasia spirituale, o la loro esperienza è limitata alle informazioni che essi hanno tratto dalla lettura di qualche libro o di frequentare un paio di ritiri di meditazione, i bambini tendono a notare questo e diventano meno ricettivo D’altra parte, un genitore o un insegnante che è ‘ben saturato’ nella meditazione inmsegna dal punto di vista esperienziale. Essi naturalmente esercitano una presenza rassicurante che aiuta i bambini a rilassarsi e connettersi con la propria capacità di consapevolezza spiritual

Un’analogia a volte utilizzata negli insegnamenti buddisti è che la persona insegnamento consapevolezza dovrebbe essere come un cigno grazioso. Il cigno è fiducioso ed elegante nel modo in cui si muove. Si scivola senza sforzo attraverso l’acqua senza disturbarla troppo. Quando un genitore è consapevole del loro essere, quando camminano intorno alla casa completamente cosciente di ogni respiro e ogni passo, allora assumono una presenza calmante che naturalmente pervade l’intera famiglia. Quando un bambino osserva la madre o il padre che vive con delicatezza, che hanno tempo per la vita e per l’un l’atro, che non permettano la loro vita a scorrere via, allora la felicità cresce nel cuore del bambino e si sentono sicuri e cullati dalla presenza spirituale dei genitori.

Piuttosto che un sacco di individui che vivono una vita separata e frammentata all’interno della stessa famiglia, la famiglia diventa ancora una volta una vera casa. Membri della famiglia sono felici di sedersi e veramente godere della reciproca compagnia senza la necessità di essere costantemente collegato a giochi per computer o programmi televisivi. I bambini naturalmente iniziano a pensare, a parlare e agire con chiarezza e consapevolezza. Essi brillano con gioia e felicità che è il dono più grande che un genitore può dare loro.

Quando questo ambiente di vita sano è stato coltivato in modo efficace, la casa diventa un luogo di rifugio spirituale e di nutrimento. In queste circostanze non c’è alcuna necessità reale di sedersi e istruire il bambino a come mettere in pratica la mindfulness perché la mindfulness è diventata una parte del loro essere. Dare istruzioni in questo modo sarebbe come insegnare a un bambino come camminare dopo che il bambino ha già imparato a farlo. Il bambino capisce intuitivamente che cosa significhi essere sveglio al momento presente e facendo così diventa naturale come andare in bicicletta.

Si prega di non fraintendere ciò che viene detto qui. Non stiamo dicendo che i bambini non devono essere istruiti a come mettere in pratica mindfulness. Purtroppo, l’ambiente familiare che abbiamo descritto sopra non è realistico per molti bambini e pertanto sono necessari altri metodi di insegnamento della mindfulness. Tuttavia, ciò che vorremmo sottolineare è che senza autenticità nella trasmissione degli insegnamenti di mindfulness, eventuali effetti benefici rischiano di essere di breve durata. Inoltre, una persona che insegna consapevolezza senza un’adeguata esperienza in realtà può causare danno per tutti gli interessati.

Ven Edo Shonin & Ven William Van Gordon

Ulteriori letture

Burke, C. A. (2010). Mindfulness-based approaches with children and adolescents: A preliminary review of current research in an emergent field. Journal of Child and Family Studies, 19, 133-144.

Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19, 190-202.

Flook, L., Smalley, S.L., Kitil, M.J., Galla, B., Kaiser-Greenland, S., Locke, et al. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26, 70–95.

Mendelson, T., Greenberg, M.T., Dariotis, J.K., Feagans Gould, L., Rhoades, B.L., & Leaf, P.J. (2010). Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. Journal of Abnormal Child Psychology, 38, 985-994.

Schonert-Reichl, K.A. & Lawlor, M.S. (2010). The effects of a mindfulness-based education program on pre- and early adolescents’ well-being and social emotional competance. Mindfulness, 1, 137-151.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2012). The health benefits of mindfulness-based interventions for children and adolescents. Education and Health, 30, 94-97.

Thompson, M. & Gauntlett-Gilber, J. (2008). Mindfulness with children and adolescents: Effective clinical application. Clinical Child Psychology and Psychiatry, 13, 395-407.

Carry your Meditation Cushion with You

Carry your Meditation Cushion with You

When you blow out your candles and stand up from your meditation cushion – that’s when your meditation practice starts. As meditators, we should try not to create a separation between formal meditation sessions and everyday living. In fact, it’s only when a person can retain their meditative awareness whilst, for example, travelling on a congested tube, writing at the computer, or watching the television that they can truly call themselves a meditation practitioner. That’s why some meditation teachers tell their students to carry their meditation cushions with them at all times.

There is a lot of scientific evidence that supports this approach to meditation practice. For example, in the psychological literature there is a concept known as ‘dispositional mindfulness’. Dispositional mindfulness refers to the natural or enduring level of mindfulness a person has rather than a temporary level that expires at the end of a given meditation session. Dispositional mindfulness is therefore sometimes referred to as a person’s ‘trait’ level of mindfulness rather than their ‘state’ level. Studies have shown that people with higher levels of dispositional mindfulness are less likely to be overcome by anxiety or stressful life situations1-3. Similarly, in our own research based on an eight-week meditation and mindfulness intervention known as Meditation Awareness training (MAT)4,5, those participants who best manage to integrate their mindfulness practice into daily living tend to be the ones who show the greatest improvements in overall levels of psychological and spiritual wellbeing.

Ven Edo Shonin,  & Ven William Van Gordon, 

References

  1. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848.
  2. Lakey, C. E., & Campbell, W. K., Brown, K.W., Goodie, A.S. (2007). Dispositional Mindfulness as a Predictor of the Severity of Gambling Outcomes. Personality and Individual Differences, 43, 1698–1710
  3. Modinos, G., Ormel, J., & Aleman., A. (2010). Individual differences in dispositional mindfulness and brain activity involved in reappraisal of emotion. Social Cognitive and Affective Neuroscience, 5, 369-377.
  4. Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M.D. (2013). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness. DOI: 10.1007/s12671-012-0191-5.
  5. Shonin, E., Van Gordon W., & Griffiths M. D. (2013). Meditation Awareness Training (MAT) for improved psychological wellbeing: A qualitative examination of participant experiences. Religion and Health. DOI: 10.1007/s10943-013-9679-0.