Dr. Roberto Lewis Fernandez, Professor in the Department of Psychiatry at Columbia University speaks on “Novel Uses of DSM-5 in Global Mental Health” at the 2nd Annual Global Mental Health Forum in May 2013.
Dr. Roberto Lewis Fernandez, Professor in the Department of Psychiatry at Columbia University speaks on “Novel Uses of DSM-5 in Global Mental Health” at the 2nd Annual Global Mental Health Forum in May 2013.
The 2013 Advanced Study Institute (ASI) took place in June. The first four of the lectures, including an introduction to the conference by Laurence Kirmayer are now available for viewing and download.
Dr. Laurence Kirmayer introduces the questions that will be looked at during this year’s Advanced Study Institute.
-What are the meanings of mindfulness in Buddhism and other contemplative traditions?
-Does extracting techniques like meditation from the social context in which they originate change the nature and effects of the practice?
-What is the relationship of these practices to everyday Buddhism as lived in Asian countries or by migrants to the West?
-How has the Westernization and psychologization of Buddhism and other contemplative traditions altered their meaning?
-What does contemporary cognitive neuroscience tell us about the nature of mindfulness, meditation and allied techniques?
-What are the implications of a cultural and contextual view of mindfulness for continued dialogue between Buddhist thought and psychiatry?
Mindfulness or Mindlessness: Traditional and Modern Buddhist Critiques of “Bare Awareness”
Robert H. Sharf, University of California, Berkeley
Buddhist scholars have shown that the form of “mindfulness meditation” (sometimes called satipatthāna or vipassanā meditation) that has become popular in the West is, at least in part, a relatively modern phenomenon; it can be traced to Burmese Buddhist reform movements that date to the first half of the twentieth century. The features that made Burmese mindfulness practice—notably the form taught by Mahasi Sayadaw (1904-1982)—so attractive to a Western audience are precisely those features that rendered it controversial in the Buddhist world. For example, Mahasi’s technique did not require familiarity with Buddhist doctrine (notably abhidhamma), did not require adherence to strict ethical norms (notably monasticism), and promised astonishingly quick results. This was made possible through interpreting sati as a state of “bare awareness”—the unmediated, non-judgmental perception of things “as they are,” uninflected by prior psychological, social, or cultural conditioning. This notion of mindfulness is at variance with premodern Buddhist epistemologies in several respects. Traditional Buddhist practices are oriented more toward acquiring “correct view” and proper ethical discernment, rather than “no view” and a non-judgmental attitude. Indeed, the very notion of an unmediated mode of apperception is, in many traditional Buddhist systems, an oxymoron, at least with respect to anyone short of a Buddha. (Indeed, it is a point of contention even in the case of a Buddha.) It is then not surprising that the forms of Burmese satipatthāna that established themselves in the West have been targets of intense criticism by rival Theravāda teachers in Sri Lanka and Southeast Asia. This doesn’t mean that modern forms of “bare awareness” practice are without historical precursors. Both Tibetan Dzogchen and certain schools of Chinese Chan were, at least at first glance, similarly oriented toward inducing a mental state that was “pure,” “unconditioned,” “non-judgmental,” and so on. Not surprisingly, these traditions were also subject to sharp criticism; they too were accused of heterodoxy—of promoting practices that contravened cardinal Buddhist principles and insights. My paper will begin with the parallels between the teachings and practices of these three traditions, and suggest that some of these parallels can be explained by historical and sociological factors. I will then move on to the philosophical, psychological, ethical, and soteriological objections proffered by rival Buddhist schools.
The Relevance of Non-Self in Pre-Modern Asia to the Contemporary Mindfulness Movement
Geoffrey Samuel, Cardiff University
Mindfulness-related techniques are continuing to spread through psychiatry, therapy, counselling and related communities at a considerable speed. Clearly they are meeting a need of some kind. At the same time, questions of what these techniques meant in their original context(s), how they have been transformed in relation to their new Western and global field of activity, what might have been lost (or gained) on the way, and how the entire contemporary Mindfulness Phenomenon might be understood, are increasingly being raised. After sketching some of these developments, I focus on two related issues. Firstly, what is the role of non-self in the meditative procedures of pre-modern Buddhist societies? Secondly, is non-self a meaningful or relevant issue in the contemporary Western and global context, where mindfulness is being reworked within societies where individualism is taken for granted? While I am particularly concerned with Tibetan traditions, I also examine the relevance of these issues within Theravadin-derived meditation approaches.
Paying Attention to the Contents of Mindfulness: Meditation within the Context of Secular Ethics
Brendan Ozawa-de Silva, Life University
Mindfulness, often described as “moment-by-moment awareness,” is popularly taught as involving a change in the practitioner’s relationship to their thoughts, rather than a change in the content of the practitioner’s thoughts. Understood in this way, mindfulness might appear to be relatively unrelated to cultural context. In actuality, however, both traditional Buddhist forms of mindfulness practice and many secular contemporary forms of mindfulness practice understand mindfulness as retention of a familiarized mental object, which can and often does include virtuous thoughts, and therefore emphasize both the content and process of mindfulness. The Four Foundations of Mindfulness, for example, a fundamental Buddhist practice, involves becoming more and more mindful of specific aspects of one’s body, mind, and experience, such as one’s mortality, in order to live in better accord with reality and thereby achieve greater wellbeing. Many of the beneficial aspects of contemporary mindfulness practices may result not merely from more refined “moment-by-moment awareness,” but from the insights that are achieved through increased awareness and the content of what the practitioner retains in mind. By focusing on only a limited portion of what mindfulness means in its indigenous traditions, such as Buddhism, such modern presentations of mindfulness can obscure the close relationships between mindfulness practices and their cultural, normative context, and may even limit the full effectiveness of mindfulness practice. Some contemporary secular practices, however, employ mindfulness in an explicitly normative way. Cognitively-Based Compassion Training (CBCT), developed at Emory, and Compassion Cultivation Training (CCT), developed at Stanford, employ mindfulness along normative lines to help the practitioner bring about specific changes, such as a decrease in excessive self-centered thinking and an increase in other-orientation. These meditation practices are also explicitly relational, whereas most other mindfulness practices, by focusing so heavily on the self’s relationship to thoughts as thoughts, tend to be more nonrelational and individual-centered. Emerging data suggests that other-oriented meditation styles lead to more other-oriented and social behavior as opposed to non-relational styles of mindfulness. Maintaining the links between mindfulness and normative values in meditation practices may help us retain the full strength of these practices as tools for promoting flourishing, happiness and well-being, while not endangering their secular character in contemporary use. Moreover, without attention to culture, we will remain unaware of the culturally-embedded notions of flourishing and happiness that influence contemporary mindfulness-based practices and which may differ in significant ways from traditional Buddhist contexts. This would limit the adoption and secularization of mindfulness practices.
“The Best Dharma for Today”: Mindfulness Meditation and Modernity in Contemporary Nepal
Lauren Leve, University of North Carolina at Chapel Hill
Recent years have seen the dramatic spread of popular interest in Buddhist teachings and contemplative practices in North America and Europe. The phenomenon has generated an increasing body of scholarship on the establishment of Buddhism in the West and, particularly, on the ways that these diverse religious and ethical traditions have been transformed as they have adapted to new cultural and historical environments. What is less often remarked in these discussions, however, are the ways that Asian Buddhisms have often already been impacted through contact with Western modernity. Furthermore, Asian Buddhists are themselves embracing the same techniques and traditions that have captured Westerners’ attention—often, indeed, flocking to the same teachers as Europeans and Americans. This paper examines the rise of a transnational vipassana movement among traditional Buddhists in Nepal, and the ways that the Nepalese embrace of the modernized, rationalized form of meditation taught by S.N. Goenka sheds light on the parallel rise of mindfulness meditation in the United States. While rooted in Nepal and most heavily patronized by traditionally Buddhist families, the Kathmandu meditation center I discuss is, in fact, one of over one hundred sister-centers around the world that conduct courses according to identical schedules and structures, offer the same (pre-recorded and mass produced) instructions and discourses, and represent vipassana as a universal, secular, scientific technique that is essentially about healing—and emphatically not about religion. Understanding why Goenka’s followers claim that vipassana meditation is “the best dharma for today” troubles standard notions of sociocultural boundaries and offers a new lens onto meditation and its popular spread.
Dr Constantin Tranulis, psychiatre et professeur adjoint à l’Université McGill et à l’Université de Montréal et l’un des auteurs d’une lettre s’opposant à la charte des valeurs, parle avec M. Michel C. Auger à l’emission Le 15-18 au Radio Canada. Vous pouvez écoutez l’entrevue ici.
Dr. Laurence Kirmayer, Head of the Division of Social and Transcultural Psychiatry at McGill University and Dr. Jaswant Guzder, Head of Child Psychiatry at the Jewish General Hospital in Montreal have co-authored “The Charter of Quebec Values: A View from Cultural Psychiatry” - the paper provides references to support claims made by Drs. Kirmayer, Guzder and other professors and researchers at McGill in their open letter on the potential negative effects of the proposed Charter of Quebec Values.
From the abstract:
Cultural diversity can contribute to mental health. Research demonstrates that familiarity with others can reduce prejudice and that the positive valuation of one’s own cultural identity by others can reinforce self-esteem and well-being. Recognition in public institutions is one important dimension of such social recognition. As well, there is evidence that systematic recognition of cultural and religious identity in health services contributes to improved care. The presence of clinicians from diverse backgrounds in the health care system is an essential resource to improve the accessibility, appropriateness and effectiveness of health care. In addition to undermining fundamental human rights, therefore, the proposed Quebec Charter of Values may negatively affect the health of minority groups as well as impeding their access to safe, equitable, and effective health care.
You can read the entire paper here.
Dr. Laurence Kirmayer, head of the division of Social and Transcultural Psychiatry at McGill University along with other professors and mental health researchers at McGill have written an open letter published in The Gazette voicing their concerns about the proposed Charter of Quebec Values. The proposed charter calls for a ban on wearing “overtly religious” symbols for public employees such as doctors and nurses, judges, the police, and daycare workers. Spearheaded by Democractic Institutions Minister Bernard Drainville, the proposed charter has spurred many voices of both support and dissent.
Those who support it say that enforced secularization is an important step towards protecting the rights of women by ensuring equality of the sexes. Those against the charter, such as Dr. Kirmayer and his co-signatories, warn that the charter will divide Quebec society. “Excluding personal expressions of culture, religion and spirituality by employees working in public institutions will prevent people from learning about each other and will lead to more stereotyping, discrimination and social exclusion” the letter states. The authors are concerned about the effect the charter would have on the mental health of immigrants and minorities in Quebec: “Diversity is good for your health: Recognition of cultural identity is important for the mental health and well-being of individuals and communities. Language, religion, ethnicity and other aspects of cultural background are sources of strength, resilience and belonging. There is evidence that many of those who practice religion or other spiritual or moral traditions have better mental health — perhaps because they enjoy a supportive community — and a world view that provides meaning and value to their lives. The positive effects of identity also come from recognition by, and respect from, others. To promote mental health, therefore, we need to actively engage others in ways that respect their backgrounds.”
You can read the entire letter on the Montreal Gazette’s website.
The details of the proposal are still being debated within the Parti Quebecois and legislation has yet to be presented at the Quebec National Assembly. The Quebec Human Rights Commission has stated that the proposed Charter would contravene the existing human rights charter. For further information, please see their commentary on the charter on their website.
Select lectures of the Critical Neuroscience course are now online. All of our lectures are downloadable, feel free to share them! To download any of our videos, click on “vimeo” on the bottom right hand side of each video player, this will bring you to the video’s vimeo page. There, you will see four buttons underneath the description of the video. Click on “download” (the last button), right click on the file name and choose “Download linked file”.
The Critical Neuroscience course provides an overview of recent controversies surrounding cognitive neuroscience and the implications of recent advancements for psychiatry, industry, policy and other areas of social life. It will present key studies in social and cultural neuroscience from the last two decades and examine the potentials and limitations of predominant methodologies, particularly neuroimaging. The course will present the interdisciplinary project of critical neuroscience as a framework and set of tools with which to critically analyze interpretations of neuroscience data in the academic literature, their representation in popular domains and more broadly, the growth of neurocultures since the Decade of the Brain. The course will provide a forum to problematize, and consider alternatives to, neurobiological reductionism in psychiatry, areas of neuroethics, cultural neuroscience and neuropolicy, attending to the models, metaphors and political contexts of mainstream brain research. It will also explore various avenues for engagement between neuroscience, social sciences and the humanities.
Lecture 1: Critical Neuroscience and the Cultural Brain
How do we make sense of what is going on in the field of neuroscience? How can we make sense of the many discourses about neuroscience? Lecture given by Suparna Choudhury of McGill University, Montreal and Jan Slaby of Freie Universitat, Berlin. Part of the Summer School in Social and Cultural Psychiatry from the Division of Transcultural Psychiatry at McGill University.
Lecture #2 An overview
Dr. Laurence Kirmayer gives an overview on the field of Critical Neuroscience, covering varieties of critical neuroscience, cultural constructions of the brain, reductionism in psychiatry, the social brain, cultural neuroscience and neurodiversity and posthuman futures. Part of the Summer Programme in Social and Cultural Psychiatry from the Division of Social and Transcultural Psychiatry at McGill University.
Lecture #3.1 Philosophy of Mind and Neuroscience
Ian Gold discusses the history of the mind as a concept, covering Cartesian mind/body dualism, cognitive scaffolding, the embodied and embedded mind, and situated cognition. What is the mind? Where is the mind located? Where does cognition take place? Part of the Summer Programme in Social and Cultural Psychiatry from the Division of Social and Transcultural Psychiatry at McGill University.
Lecture #3.2 Philosophy of Mind and Neuroscience
Ian Gold continues his talk on the philosophy of the mind, covering reductionism of the mind sciences, psychology and psychiatry to neuroscience. Part of the Summer Programme in Social and Cultural Psychiatry from the Division of Social and Transcultural Psychiatry at McGill University.
Lecture #4 Resting State – The Question of Baseline
Daniel Margulies, PhD talks us through the history of the concept of baseline in cognitive neuroscience and the future directions of this field of neuroscience. Part of the Summer Programme in Social and Cultural Psychiatry.
Lecture #5 Neuroimaging
Dr. Amir Raz gives an overview on the different types of neuroimaging methods: NMR, MRI, fMRI, ERP, EEG, PET, Cyclotrone, TMS and CT. Part of the Summer Programme in Social and Cultural Psychiatry from the Division of Social and Transcultural Psychiatry at McGill University.
Lecture #6 Brain Images and Neurosubjectivities
Dr. Suparna Choudhury and Dr. Jan Slaby talk about objective self-fashioning, how neuroscience is impacting selfhood. Is our brain our sense of identity? Does framing ourselves in terms of the brain (ie using “endorphin challenged” instead of “alcoholic”) take away responsibility for ourselves? How plastic is our brain? Do we have a neurosignature? What affect does looking at the brain have on how we understand ourselves and our actions? Part of the Summer Programme in Social and Cultural Psychiatry from the Division of Social and Transcultural Psychiatry at McGill University.
Lecture #7 Culture and Psychosis
Dr. Ian Gold talks about the role of culture in psychosis. The popularity of the film The Truman Show has led a people who believe that they are part of a secret television show. Gold discusses social/environmental factors that have been shown to lead to schizophrenia, such as living in a large urban centres. What happens when we consider the large online community that we increasingly spend more time in? Part of the Summer Programme in Social and Cultural Psychiatry from the Division of Social and Transcultural Psychiatry at McGill University.
Lecture #8 Neurophenomenology in Psychiatry
Dr. Laurence Kirmayer speaks on phenomenology and the ways in which it has mutated in a North American context. How are people framing the nature of their mental illness? How can we think of embodied experience (such as sleep paralysis) through metaphor as a bridge between neurology and a cultural point of view? Part of the Summer Programme in Social and Cultural Psychiatry from the Division of Social and Transcultural Psychiatry at McGill University.
“The logic of modern health care does not admit rituals into it and it cannot do so.”
William Sax, Head of the Department of Anthropology at Heidelberg University, discusses his field work on healing rituals in the Himalayas and the difficulty of finding a place for traditional healing within the institutionalized health system and evidence-based medicine. Dr. Sax voices his concern that rituals shown to be effective such as possession may be marginalized, diluted and excluded in the push for Global Mental Health.
“I think having a capability approach towards refugees which acknowledges agency and aspiration while at the same time provides the mental health and social care support they need is the way forward”
Charles Watters, Chair of the Department of Childhood Studies at Rutgers University, talks about his work with refugees. In order to access refugee services and programs, the negative aspects of the refugee experience are often emphasized: refugees are characterized as traumatized people who had to flee for safety, torn from their home country. Indeed, there can be a pressure for refugees to emphasize suffering in their encounters with service providers in order to be considered legitimate. But what is the mental health effect of this? Is it possible to promote empowerment and aspirations within the refugee population without refugees being wrongly considered an economic migrants?
“In many lower middle income countries there are various ground realities that one has to take on board if you’re going to develop a service that is going to be effective and be sustained.”
In the push for global mental health, there is a pressure to develop mental health systems from the “top down”, using a biomedical model. Dr. Suman Fernando of London Metropolitan University discusses the importance of developing care from the bottom up. A home grown mental health model incorporates the varying cultural, economic, and social realities for each community. Touching on the marketing techniques of some pharmaceutical companies in lower middle income countries, Dr. Fernando emphasizes the need for mental health care to be embedded into a community with local controls or through association with local religious groups, in order to be sustainable and to lessen the threat of corruption.
“Globalization itself, the idea of everyone connecting isn’t necessarily a bad thing but the way it’s being enacted is causing problems”
Kwame McKenzie, of the Univesity of Toronto shares his thoughts about mental health issues surrounding globalization. In a globalized economy, city centres swell as populations move from rural to urban spaces to better access opportunities, especially in low income countries. In tandem with higher urbanization there is an increased prevalence of depression, schizophrenia, anxiety disorders, and poverty, which presents a pressing mental health issue in a time of rapid social change. Stressing the link of mental well being to economic prosperity, Dr. McKenzie advocates for a public health approach where the causes of mental health problems are addressed directly, as a better alternative to increasing services, which he feels is “a solution” but not “the solution”.