The Origins of Mindfulness and Informed Consent
Does informed consent require detailing the "religious" origins of mindfulness?
Posted Jan 28, 2020
Among psychotherapists interested in mindfulness practices, there is a robust, at times contentious debate surrounding a number of ethical issues that date back to the 1990s. On one side, therapeutic mindfulness practices are critiqued for having been culturally appropriated from Buddhist traditions and harmfully secularized into denatured biomedical techniques. Meanwhile, other critics or, fascinatingly, at times the same critics argue that mindfulness practices have, in fact, not been fully secularized. They claim that mindfulness should actually still be considered religious and that its use in clinical practice is thus problematic for a different set of reasons.
Next month in Therapy and Buddhist Traditions, I will examine the idea that even those mindfulness methodologies that were expressly designed to be not-religious still hold characteristics that should be defined as religious and that they can elicit what some clinicians have called “religious or spiritual effects.” In this post, however, we will focus on the contention that therapists need to account for the roots of mindfulness practices before bringing them into their clinical work. When he designed his famous Mindfulness-Based Stress Reduction, Jon Kabat-Zinn intentionally sought to leave far in the past the U.S. Zen and yoga communities from which he drew the practices of his program. When he discusses the tactical moves he made to legitimate MBSR to medical authorities, he can sound to some less strategic than duplicitous, engaged in an ethically dubious deception.
Psychotherapists like Len Sperry and George Stoupas have expressed the concern, “by intentionally concealing the Buddhist roots of MBSR, might Kabat-Zinn be behaving unethically?” The same could be asked of the development of mindfulness-based psychotherapies such as mindfulness-based cognitive therapy (MBCT), which even went so far as to replace the meditation techniques Kabat-Zinn taught to cultivate mindfulness skills with “attentional control training.”
Further, beyond the choices made in their development, some therapists have argued that the history of therapeutic mindfulness practices should be disclosed if they are to be used in clinical sessions today. If we believe that the mindfulness practices have Buddhist roots, wouldn’t it be, at the least, ethically questionable not to disclose them to help-seekers anticipating secular psychotherapy, particularly if the help-seeker is, for example, an evangelical Christian?
Both psychotherapists like Stephen Stratton and some outside observers have evoked the concept of “informed consent” in this context. As broadly outlined in the professional standards and ethical codes of conduct for the various talk therapy disciplines, informed consent refers to clinicians’ ethical obligation to provide the necessary information to allow help-seekers to freely choose to participate in therapy. The American Counseling Association’s guidelines on the topic, for example, begins by stating that “counselors explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following: The purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services.” While the ACA and other ethical codes of conduct do not specifically mention the issues of history or development, we might wonder whether the above-mentioned evangelical Christian can truly give informed consent if they are unaware that the practices being taught to them were apparently derived from Buddhist traditions.
As far as the question of mindfulness’ origins are concerned, I do not believe that the notion of informed consent is the best way of framing these ethical issues and briefly examining why highlights some of the important issues at stake here. To begin, put simply, as anyone who has sought therapy can attest to, psychotherapists generally do not believe that obtaining informed consent means detailing the history and development of the individual-specific practices they utilize in treatment. Often as a component of their initial paperwork, clinicians typically seek informed consent for psychotherapy as a whole which comprises a multitude of possible specific techniques and procedures.
The focus tends to be reviewing the possible risks and benefits of treatment, rather than, for example, the values and principles that influenced the developers of an individual treatment intervention; what was included or left out of a therapeutic modality; etc. Readers might imagine what counseling would feel like if their therapist was constantly pausing to review informed consent in detail with each new practice or technique that they used in a therapy session (“I am now using an active listening skill called ‘mirroring’ which was first named by...").
Many believe, however, that mindfulness-based interventions are extractions and adaptations from religious frameworks, from Buddhist traditions. Perhaps this makes them a unique class of treatment intervention that requires special consideration.
The Origins of “Mindfulness”
When a humanistic psychotherapist adopts a posture of “unconditional positive regard” or when a psychoanalyst asks an analysand to share “stream of consciousness” they typically do not name and describe the history and development of their techniques. But perhaps mindfulness practices should be distinguished from such practice if their origins are within Buddhist traditions.
The difficulty is that determining the origins of contemporary mindfulness practices is an extremely thorny issue. First, mindfulness practitioners have long maintained that “mindfulness” was not drawn exclusively from Buddhist traditions, but can actually be found within philosophies and religions across time and cultural context. A number of Buddhist studies scholars, meanwhile, have noted that contemporary mindfulness-based interventions bear so little resemblance to the practices they are said to have been derived from that it is worth challenging, as the Buddhologist Robert Sharf has asked, “Is mindfulness Buddhist?” at all.
Beyond my own work, recent publications from scholars like Wakoh Shannon Hickey elucidate that some of the primary influences on mindfulness practices can be traced to strands of what is often called “U.S. liberal religious” activity initiated largely within 18th and 19th-century Protestant communities. There is a strong argument that “mindfulness,” as we know it today, is far, far more influenced by, for example, Emersonian transcendentalism than historical Buddhist doctrine. Taking this contestation into account makes sharing the origins of mindfulness practices in a therapy session no easy matter. Therapists would be left asking: “Which origins exactly? Should I explain what the 19th-century New Thought movement was?”
All of this is only scratching the surface of the complex subject of mindfulness' transmutations into it's present-day forms. But, nonetheless, we could simplify and consider that an evangelical Christian might want to know that many people believe mindfulness practices were extracted from Buddhist traditions whether or not these people are mistaken in that belief. (And while determining their true derivation may be difficult, there are certainly now growing Buddhist communities in the U.S. and beyond that make our present-day mindfulness central to their practice.) Whichever religious or quasi-religious frameworks from which they were drawn, these roots might distinguish mindfulness practices from above mentioned therapeutic techniques like “stream-of-consciousness.”
The Religious Roots of Psychotherapy (And Everything Else)
But, as it may already be obvious to some readers, I chose my counter-examples with intention. “Unconditional positive regard” was developed by the former Christian seminarian Carl Rogers and entire dissertations have been written on how elements like stream-of-consciousness, one of the very earliest of talk therapy techniques, may have originated with the Catholic practice of confession. Say that a psychoanalyst asks their analysand to share stream of consciousness, allowing their unconscious to associate with whatever it will. Should they first explain that this practice has roots in Catholic traditions? That it carries within it the embedded assumption that we can find relief and liberation by bringing our guilt and shame-inducing desires into the light of day?
Beyond individual practices, my fellow “religion and psychology scholars” like Peter Homans have long explicated that we can discern the roots of all psychotherapies within religious traditions. Some of the very first talk therapists, such as Carl Jung, saw psychotherapy as a new “modern" source for the meaning-making and self-actualization that communities looked for in religious practice. Theorists have drawn a line from the shaman to the priest to our present-day therapists. Does informed consent require that every psychotherapist detail these histories of talk therapy to those seeking purely secular treatment?
And what religious studies scholarship can most contribute to this conversation is the insight that, to a strikingly larger extent then we may anticipate, the same claims of religious roots can actually be made about every segment of our contemporary U.S. culture. We can still see the outline of the cross on the walls of hospitals and schools where they once were affixed and our system of government was founded on Protestant assumptions about values and ideals that a particular group of land-holding men of European descent then sought to adapt into universal, not-religious principles. How should this history be approached by doctors, professors, and senators? As I will discuss more in the second part of this post next month, what we ultimately face here are immense questions about how to define the term "religion" itself. However, we may take for granted that there are spheres of life that are not-religious, that are “secular"; their histories are often all but forgotten. And, to be sure, for many, this is also the case with mindfulness practices.
In graduate training programs today, countless clinicians are instructed in the use of mindfulness practices by teachers who themselves may have little or no notion of their purportedly Buddhist origins. The now multiple generations of psychotherapists who only know “mindfulness” as a purely secular treatment intervention surely cannot be accused of an unethical duplicitousness. And it is unclear that such therapists would be interested in a debate about mindfulness’ true origins when faced with suffering people who are often in desperate need of care.
But, as I will say more about in my next post to Therapy and Buddhist Traditions, none of this releases practicing therapists from the ethical obligation to consider these questions (whether informed consent is the best rubric for describing them or not). Furthermore, perhaps the problem goes beyond only the history of mindfulness practices. Next month, we will explore whether mindfulness practices still carry a religiosity with them and whether acquiring informed consent for their use requires disclosing what some believe are “religious or spiritual effects.”
Hickey, W. S. (2019). Mind Cure: How Meditation Became Medicine. Oxford University Press.
Kabat-Zinn, J. (2011). Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemporary Buddhism, 12(1), 281-306.
Sharf, R. H. (2015). Is mindfulness Buddhist?(and why it matters). Transcultural psychiatry, 52(4), 470-484.
Sperry, L., & Stoupas, G. (2017). Incorporating mindfulness in secular and spiritually oriented psychotherapy: Ethical concerns. Spirituality in Clinical Practice, 4(2), 152.
Stratton, S. P. (2015). Mindfulness and contemplation: Secular and religious traditions in Western context. Counseling and Values, 60(1), 100-118.