The Zen of Therapy

Description

“A warm, profound and cleareyed memoir. . . this wise and sympathetic book’s lingering effect is as a reminder that a deeper and more companionable way of life lurks behind our self-serious stories.”—Oliver Burkeman, New York Times Book Review

Drawing on decades of personal and professional experience, Dr. Mark Epstein considers how his practice of psychotherapy and meditation can be used in tandem to lead his patients, and himself, to greater awareness and fulfillment.

For much of his career, Dr. Mark Epstein kept his beliefs as a Buddhist separate from his work as a psychiatrist. But as he became more forthcoming with his patients about his personal spiritual leanings, he was surprised to find how many of them were eager to learn more. The divisions between the psychological, emotional, and the spiritual, he soon realized, were not as distinct as one might think.

In The Zen of Therapy, Dr. Epstein reflects on a year’s worth of selected sessions with his patients and observes how, in a given hour, his Buddhist background influences his work. He emphasizes how Western therapy can be considered a two-person meditation, and how mindfulness, much like a good therapist, can “hold” awareness, creating the necessary conditions for inner peace. Throughout this deeply personal and wise inquiry, Dr. Epstein illuminates the therapy relationship as a spiritual friendship, and reveals how a therapist can help us realize that there is something magical running through our fraught lives. For when we understand how readily we have misinterpreted ourselves, when we touch the ground of our own being, we come home.“A warm, profound and cleareyed memoir . . . this wise and sympathetic book’s lingering effect is as a reminder that a deeper and more companionable way of life lurks behind our self-serious stories.” —Oliver Burkeman, New York Times Book Review

“Epstein draws on a lifetime of personal and professional experience to deliver a profound and optimistic examination of the links between psychotherapy and meditation . . . A warm and accessible explanation of topics that defy easy explanation . . . Epstein makes abstract concepts understandable, and his accounts of his patients’ struggles and progress are laced with humor and hope . . . It’s a message receptive readers will embrace in these dark and difficult times. Empathetic and persuasive—one of the better books on psychotherapy and meditation in recent years.” —Kirkus (starred review)Dr. Mark Epstein is a psychiatrist in private practice in New York City and the author of a number of books about the interface of Buddhism and psychotherapy, including Advice Not Given, The Trauma of Everyday Life, Thoughts without a Thinker and Going to Pieces without Falling Apart. He received his undergraduate and medical degrees from Harvard University.

One

 

Inner Peace

 

I first tried to meditate during the summer of 1973, between my sophomore and junior years of college, when I was working as a research assistant for a cardiologist at Boston City Hospital. This physician, Dr. Herbert Benson, a specialist in the treatment of high blood pressure, or hypertension, was the first to publish a scientific paper about the relaxation benefits of Transcendental Meditation, made popular by the Beatles several years earlier. His coauthor, Robert Keith Wallace, was a student of Maharishi Mahesh Yogi, the Indian guru who popularized TM, and together Benson and Wallace were among the first to show that meditation had measurable physiological effects. According to their studies, meditation slowed the body’s metabolic rate, reducing both oxygen consumption and carbon dioxide output, inducing what they called a “wakeful hypometabolic state.” In essence, they suggested that meditation flipped the nervous system into neutral, allowing the body to rest, digest, recuperate, and recharge. They christened these bodily effects “the relaxation response” (the antidote to the stress-induced fight-or-flight response) and suggested that its regular elicitation might actually lower blood pressure as well as relieve stress. Meditation was given scientific credence by their research. It was a real thing, not just someone’s wishful thinking, and it had the potential to become an important tool of modern medicine. This research became the basis for The Relaxation Response, a popular book Dr. Benson published in 1975 that was among the first to suggest the health benefits of meditation.

 

I was intrigued by this work and met with Dr. Benson at the behest of my father, who had recently taken over as chairman of the department of medicine of which Dr. Benson was a part. I think it was an effort on my father’s part to keep me in the medical fold despite my burgeoning interest in what he considered a rather esoteric pursuit. I had become intrigued by Eastern thought in general and Buddhism in particular in my first years of college and regularly perused the spiritual bookstores then popular in Harvard Square. At the university itself Eastern spirituality was looked down upon, but I had stumbled upon two graduate students, one in the religion department and one in psychology, who quietly encouraged my nascent interests. Diana Eck, who went on to become a distinguished professor of religion, the first female “master” of a Harvard house, and the author of a comprehensive book on the Indian holy city of Banaras, was my section person in a freshman world religion class, and Daniel Goleman, who later wrote Emotional Intelligence and who had already been to India to learn about meditation, was my section leader for a second-year class in psychophysiology. They each, in their own discreet ways, supported my pursuits, while being careful to shield their own spiritual leanings from the greater Harvard milieu. Meditation was not yet something I had tried for myself, however; I was still in an exploratory phase, suspicious of cultish atmospheres and without any formal instruction. I had read books about meditation but had never tried it myself. That Dr. Benson’s influences were Hindu and not Buddhist meant little to me at the time.

 

In the year or two since publishing his research on meditation, Dr. Benson had broken away from the Maharishi. He concluded that there was nothing special in Transcendental Meditation’s approach, that a generic form of meditation could work just as well as the expensive training offered by the guru and his disciples, and that it was up to him to bring meditation into the medical armamentarium. Dr. Benson decided that the Sanskrit mantra at the heart of TM’s approach was not essential and that the simple act of alertly concentrating one’s attention, using whatever word, phrase, or prayer a person chose, could evoke an identical physiological response. For the patients in his hypertension clinic, he used the blandest word he could think of: the word “one.” (Only later did he realize all of its potentially sacred meanings.) Needless to say, his appropriation of TM’s technique earned him the enmity of the guru and his followers. At the same time, despite the widespread media attention given to his research, his mainstream academic colleagues treated him as a rather marginal figure because of his embrace of meditation. It might be okay for the Beatles, but a Harvard cardiologist should know better; that was the general consensus. They pressed him on the quality of his research and upbraided him for drawing sensational conclusions from preliminary findings. As a result, despite his growing fame, Dr. Benson was a rather isolated figure when I met him. He felt misunderstood and inappropriately judged by both his medical and meditative peers.

 

None of this concerned me, however. I was happy to have a prestigious summer job with someone who was open to my abstruse interests. I knew that Dr. Benson was doing my father a favor by taking me on, but I surprised him in our first meeting by talking at length about the placebo effect, a subject I had explored and written about during the previous semester in my psychophysiology course. Placebos have been confounding modern medicine for generations. Pills that have no active ingredients, given as part of a routine doctor-patient interaction, regularly produce meaningful, and scientifically documented, improvement in a variety of illnesses more than one-third of the time. Having grown up in a family in which academic medicine was king, and with a budding interest in the mind’s pervasive influence on the body, I was taken with the placebo effect and thought Dr. Benson might be also. He was. He put me to work in the medical library exploring and reviewing fifty years of relevant clinical research. Was there something that could be cultivated in the doctor-patient relationship that might be important for healing? Did the physician’s concern for the patient or the patient’s faith in the doctor make a difference in a person’s recovery? Might the placebo be somehow eliciting the relaxation response? Or was the relaxation response itself a manifestation of the placebo effect? Whichever way we looked at it, was there a key here to unlocking the body’s ability to heal itself? I set out to analyze all of the pertinent studies in the medical literature.

 

Meditation was not a big part of my summer experience. Dr. Benson was using it in his clinic for patients with borderline high blood pressure but I was not involved in that work. I was back and forth to the library and only peripherally aware of Dr. Benson’s other activities. I wondered about meditation though. I remember sitting, one sweltering August afternoon, at my paper-strewn desk in the back room of Dr. Benson’s confined hospital suite and finally trying out his technique. “One, one, one,” I repeated as my breath went in and out of my nostrils. “One, one.” Nothing in particular seemed to happen. It felt like a radical thing to interrupt my work to sit there with my eyes closed, but at the same time the exercise seemed empty to me. I liked the idea in principle-the possibility of quieting my body’s tensions with a trick of the mind appealed mightily to me-but I did not feel engaged by the technique. I tried it a few more times and then put it back on the shelf. While some people found the simplicity of Dr. Benson’s instructions and their scientific credibility to be helpful, I was put off. Even if there was such a thing as the relaxation response, and even if I could be sure I was eliciting it, the whole approach felt too mechanical to me. Somewhere in me I knew that the relaxed hypometabolic state Dr. Benson envisioned could not be the be-all and end-all of what meditation was about.

 

In thinking about it now, I can see how my research into the placebo effect helped explain why this approach to meditation seemed so constrained. Science was of several minds about the placebo effect. Some researchers wanted to get rid of it altogether because it was impossible to know whether a new drug had anything to offer if it was no better than a placebo. Others, taking the phenomenon more seriously, wanted to tease out its active ingredient. What molecules, what neural pathways, were being stimulated by something as innocuous as a sugar pill? Yet others saw the placebo effect as inextricably bound up with the doctor-patient relationship, not as something that could be isolated from it. Something mysterious happens when we turn our illness over to a caring physician, they concluded. Could the very act of trusting someone to heal us stimulate healing? Is there something in the human touch or in the caring human interaction or in human kindness that has beneficial medical results? In the article that I cowrote with Dr. Benson that summer, published shortly thereafter in the Journal of the American Medical Association, we came down on the latter side. The placebo effect, whatever it is derived from, is a neglected asset in the care of patients, we concluded. Modern medicine could benefit from taking it more seriously.

 

For some people, the very medicalization of meditation, the assurance that science had proven its validity, creates a positive placebo effect. It helps them believe meditation is real. For these people, Dr. Benson’s efforts to tease out the active ingredient in meditation and give it to them in a stripped-down form was a real gift. But for me the opposite was true. I was drawn to meditation for the same reason I was interested in placebos. The placebo effect points to the body’s capacity to heal itself, helped along by some combination of trust, faith, and human empathy. Meditation seemed to be promising something similar for the mind. Given the right conditions, the mind could realize its own potential, healing itself through a combination of self-awareness, mindfulness, insight, and compassion. In turning meditation into a standardized medical treatment, something was being sacrificed, akin to what is lost when one’s kindly country doctor is replaced by a harried technician or a robot. I saw how readily meditation in the stripped-down version could be adapted for the West, but, at the same time, I felt the lack of the ancient wisdom I was increasingly in search of. I did not fault Dr. Benson for his critique of Transcendental Meditation and I was not looking for a return of the Sanskrit phrase or the guru, but I knew I was searching for an approach more grounded in the traditions long associated with it, not one that was wholly divorced from them. As much as I appreciated the burgeoning science of meditation, I was also in search of its art. I completed my report on the placebo effect, praising it for what it implied about the mystery of healing, submitted it for publication, and returned to my studies. It was another year before I meditated again.

 

My karma with Dr. Benson was not over, however. Our placebo article received a good deal of media attention and became the basis for his next bestseller, The Mind/Body Effect: How to Counteract the Harmful Effects of Stress. I observed how he dealt with both the press and the medical establishment, and took note of what a fine line he had to walk in talking publicly about such esoteric topics. We had a special relationship; he showed me that it was possible to work within the Western medical system but still be open to ancient Eastern wisdom, and he encouraged me to follow in his footsteps. (And I am sure the recommendation he wrote for me was instrumental in getting me into medical school!) In return, I maintained a dialogue with him over the next seven years as I turned toward Buddhist meditation, bringing him news from the front lines of a “spiritual” counterculture he was wary of engaging with too overtly. The mid-1970s marked the beginning of my engagement with mindfulness, the core Buddhist meditation technique, and I was fortunate enough, the very next summer, to connect with many of its first American ambassadors. By the time I entered medical school in 1977, I had befriended and sat numerous silent vipassana retreats with Joseph Goldstein, Jack Kornfield, Ram Dass, and Sharon Salzberg and traveled with them throughout India and Southeast Asia to meet many of their Eastern teachers. “Vipassana” is the ancient word for “insight,” and this form of meditation, of which mindfulness is an essential component, is also known as “insight meditation.”

 

In the meantime, Dr. Benson’s books continued to break through to the mainstream, and Dr. Benson, always interested in esoteric reports of how the mind affected the body, was privately reading the exotic journals of a turn-of-the-century French explorer of Tibet named Alexandra David-Neel. She described witnessing Tibetan Buddhist monks nakedly meditating in subzero temperatures and warming themselves with a special practice of yoga and meditation called gtum-mo. Buddhism, in its time in Tibet, had merged with a shamanic tradition that had long preceded it there while keeping alive practices that dated from Buddhism’s heyday in medieval India. David-Neel was one of the first Western explorers to document the result. Dr. Benson, as part of his inquiry into how the mind could affect the body, wanted to know if I knew anything of these practices, and, while I did not, in one of my periodic meetings with him I told him that in September of 1979 the Dalai Lama would be passing through on his first American visit and if we could secure a meeting, we could ask him ourselves. I had been to his palace in exile in India two years before, and I knew that he was scheduled to visit the Insight Meditation Society, the retreat center in western Massachusetts founded by my mindfulness teachers on the grounds of a former seminary. The Dalai Lama liked scientists, and Dr. Benson liked to associate with spiritual leaders. It seemed to me like a match made in heaven.

 

Using our Harvard Medical School credentials, Dr. Benson reached out to the Office of Tibet to ask for an appointment. He heard back some time later that it would indeed be possible. I was present for the conversation and remember the somewhat awkward moment when the Dalai Lama, while acknowledging the veracity of some of David-Neel’s reporting, recoiled at the idea of Western scientists measuring his meditating monks. Nevertheless, Dr. Benson persisted. He told the Dalai Lama of his success with the transcendental meditators and pressed him to see if we could come to India to document this esoteric Tibetan practice. These meditations are for private spiritual purposes, the Dalai Lama responded, not for public display. They have always been shrouded in secrecy so as not to make people think that so-called miracles are more important than the healthy mental development that is the real goal of such pursuits. But then he abruptly changed his mind. “For skeptics, you must show something spectacular,” he said, “because, without that, they won’t believe.”

US

Additional information

Dimensions	0.8500 × 5.4200 × 8.3000 in
Imprint	Penguin Books
ISBN-13	09780593296639
ISBN-10	059329663X
Author	Mark Epstein, M.D.
Audience	General / adult
BISAC	BIO026000, REL007000
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