Kind Recognition

I can’t remember a Winter season in Silicon Valley with such sustained cold. 2/22 usually means Spring-like conditions; white plum blossoms dropping and pink cherry blossoms shyly peeking out. Yet, today plum blossoms cling tightly to branches and nary a pink flower can be found. I want warmth but my weather app shows only rain and cold for the next 10 days.

Each day I am reminded how much the engine of human internal experience runs on expectation and assumption. This now must mean that before. Incorrect. This now is merely what is occurring. And that occurrence often lacks connection to what has been or what will be. Yet, moment to moment the human brain is wired to habitually make probabilities certainties, unknowns knowns.

So much of human suffering can be boiled down to that basic misapprehension, its flawed mentation, and all the incessant efforting we do to make it so. Believing an internal illusion of knowing what can’t be known and predicting with an accuracy the human brain utterly lacks, is foolish and oh so human. And of course, we believe the mind’s limited, distorted narratives of certainty will be replicated in real life. Hardly ever is that borne out to be true.

When human functioning evolves to a point where producing heedless internal suffering become the default, alleviating that suffering becomes a necessity.  Tibetan Buddhist teacher Dzogchen Ponlop says that the most powerful medicine we can offer for suffering of any kind is simply kindness. And I would add clear knowing. Recently, a patient who finally understood they had been lost in delusional thinking, was asking me how to calm a disturbed mind. I wrote the following equation on a sticky note: clarity + compassion =  a calm mind.

That formula gives rise to what I call kind recognition. “Adding kindness to recognition helps us soften into and receive ‘this is hard.’ When life is truly distressing, relying solely on mindfulness may feel harsh or sterile or may activate existing habits of disassociating or disconnecting from experience. Kind recognition begins by recognizing what has arisen; for the fact of its arising cannot be altered. What comes next is the ‘ow!’ of it. The key becomes allowing ourselves to receive the ‘ow!’ with openheartedness and then remaining open to distressful thoughts and feelings that follow. Kind recognition builds our capacity to meet distressful feelings and difficult circumstances with less blame, shame and avoidance. It also promotes the cognitive-affective responsiveness needed to remain engaged, empowered and able to make skillful choices” (Miller, 2014)*.

Kind recognition is similar to distress tolerance but different. It is not an effort to escape, change or avoid distress, rather the capacity to welcome distress with openheartedness and wisdom. A good example is: all things come and go, including painful and pleasurable experience. That recognition can in and of itself lessen a reactive mind insisting distress will never end and needs to be ignored, avoided or ended. Such efforts most often lead only to harmful choices and behaviors.

I have posited that much of the diagnoses listed in the DSM could be viewed as outcomes of internally-driven efforts to end painful experience. And that would be very human. It is merely the severity of distortion and reactivity that morphs everyday human suffering into a mental health issue.

*Miller, Lisa Dale. Effortless Mindfulness: Genuine Mental Health Through Awakened Presence“. Routledge 2014.

Graduating Psychotherapy

“I’ve graduated!” Most mental health professionals would not expect a patient to utter this proclamation at the end of therapy. Yet I have heard it more than once. The first time I was a bit taken aback as even I was lacking appropriate context for this framing. At the time I remember inquiring, “What about your accomplishment feels like graduating?” Their answer was so simple. “I have learned so much and radically changed because I have embraced this knowledge and use the skills in my daily life. I am still me, and yet, I am a me I could not have imagined being before I started this work. Therapy was not school but it feels like I have earned a degree!”

Though I don’t agree, psychoeducation is often considered separate from the therapy itself. I have always been a big fan of educating patients as part of the therapeutic process. Getting them excited about knowledge I have worked so hard to gain. Wisdom from biology, neuroscience, social science, psychology, and contemplative science is often as much of an ‘ah-ha!’ moment producer as directly perceiving mind, or landing firmly in embodied presence, or experiencing how goodness, kindness, openheartedness melt away anxiety, depression, loneliness and meaninglessness. It is all part of delivering an integrated package of resources for symptom alleviation and awakening.

Completing therapy fully equipped to meet life’s challenges with intelligence, humility, flexibility and inner strength is the aim. If accomplishment of that goal that feels like graduation I am all for it!

Intersubjectivity and Interdependence

Recently, a colleague shared the following, “I am more and more tuned into the reality of separateness, gradations, distinctions. I think we are being hoodwinked by this idea of universal oneness. This feels particularly true when working with patients, where I find most significant change occurs from investigating distinctions and details.”

While I agree that in-depth exploration is critical for insight, contrasting that process with notions of universal oneness rings hollow for me. And that common mistake may simply be due to widespread misinterpretations of ‘oneness’; most especially the Buddhist concept of emptiness or interdependent co-arising. Although emptiness is a concept, therapeutic dynamics provide a real-time example of how interdependent co-arising actually manifests in human experience.

The Intersubjective School of Psychoanalysis hypothesized an intersubjective field continually mediating bidirectional knowing between psychotherapist and patient. Intersubjectivity enables a psychotherapist to empathically use their entire psychophysical system to receive and mirror a patient’s cognitive-affective-somatic material. That form of empathy or therapeutic attunement, is the primary process through which a patient feels known. So, although a psychotherapist may deliberately direct patient inquiry, intersubjectivity tells us that both parties are equal participants and influencers in the therapeutic container’s ebb and flow.

Acknowledging that apparent interdependence does not discount or negate the appearance of two separate participants. Each exists from their own side in a relationship of mutual influence. Nagarjuna, the progenitor of the Middle Way School of Indian Buddhism argued that emptiness rests on two principles: (1) things/selves in the world appear nominally, and (2) because of their impermanence, interdependence and insubstantiality, these entities lack any essential (svabhāva) nature.

For example, take the device you are reading this blog on. If it was self-existing, it could not be broken down into its parts—cover, screen, content, matter, particles, quantum information and so on. It is no more than a so-called object, interdependently linked to nominal parts similarly lacking any essential nature. Though the device does have conventional or relative existence, it also cannot be found to ultimately exist separately from its myriad parts.

Similarly, though the therapeutic dyad includes two separate beings, the therapy itself is an intersubjective, co-created process. Co-creation widens the menu of possible perspectives and makes possible successful interventions that decrease systemic reactivity and increase capacity for in-depth inquiry. Mutual influence and co-creation till the soil that yields embodied awareness and cognitive-affective-somatic openness. Such that self-fixation and its concomitant feelings of separateness fall away; and along with it the oh, so ubiquitously harmful distorted notions of self and world. Clearing those obscurations of mind is not only the optimal path to less cognitive-affective-somatic distress, but also increased tolerance and connectedness with all other beings.

Meditation is not an antidote.

If you think meditation alone will ‘cure’ the deleterious characteristics of humanness, like anger, violence, greed, hatred, fear and bias… think again. These qualities arise from an experientially shared, all-pervasive perceptual feeling of separateness—I am inside, everyone else is outside.

Cutting through that misapprehension requires both conceptual training and contemplative practices for cultivating cognitive-affective quiescence and profound insights into what is known in Buddhist philosophy as the Three Marks of Existence—impermanence, unsatisfactoriness, and not-self.  Most clinical and non-clinical applications of mindfulness teach meditation devoid of information about the way in which humans misapprehend the Three Marks of Existence, and how this mistaken perception becomes the proximate cause of all forms of human suffering.

Let me be absolutely clear. Noticing 1) how thoughts come and go; 2) how much time we mentally spend in the past and future; 3) cultivating compassion; 4) and that basic physical pain is worsened by mental anguish about painful stimuli—all these insights will decrease cognitive-affective symptoms, which makes them appropriate Western psychological interventions. However, when ‘Buddhist-derived’ mindfulness meditation practices are offered as a means to attain happiness and/or reduce distress, those meditators remain largely unaware of the root causes of their suffering.

The main reason Buddhist psychology does not view symptom relief as an end goal is because non-suffering is ultimately an outcome of the fearless pursuit of non-delusion. That pursuit includes the recognition of and liberation from two basic causes of human suffering—our deluded belief in a substantive, separate self; and our deluded belief that happiness is conditioned upon comfort, certainty and security.

In the Tibetan Buddhist tradition that perceptual distortion is called, innate reification, which is viewed as largely unconscious; functioning at a very basic level of cognitive processing. The pervasive and assumptive nature of innate reification is a primary obstacle to direct realization of how all perceptual phenomena (including the self) interdependently co-arise moment-to-moment. Separate self-existence is illusory. But that illusion makes harming doable—particularly the false perception that harming another does not simultaneously also harm the harmer. Imagine how different the world would be if all human beings recognized how intimately connected they are to all other beings through their thoughts, words and deeds.

Because this profound insight into reality is not a predetermined outcome of meditative practice, it must be pointed out directly. Clear conceptual understanding proceeds and fortifies accurate perception of reality. Experiencing the Three Marks of Existence and cutting through the perceptual distortion of innate reification requires both concentration meditation and analytical meditation practices. Just practicing mindfulness and compassion is not enough. Concentration meditation alone is not enough. Conceptual understanding is not enough. Going beyond antidotes requires all of these together.

World Mental Health Day

It seems dis-ease predominates the world stage at this time. Whether it is whiplash from 2.5 years of pandemic, the ongoing Russian war on Ukraine, or mounting climate disruption catastrophes, an air of dread permeates the current world mental health landscape.

In 2014 I coined the phrase genuine mental health and set out in a rather dense textbook to explicate what that might be and how to facilitate it in psychotherapy. I still hold to the premise that human minds are innately capable of humility, wisdom, compassion, and great insight. And I remain committed to offering patients targeted, clinically-appropriate contemplative practices for cultivating these states and building states into traits.

Eight years later the landscape of mental health interventions seems more murky, sensationalized, and as Yaden, Potash and Griffiths recently described in JAMA Psychiatry more subject to hype-cycles. Psychedelics and cannabis are big medical business now and clinical research on effectiveness is slower than business-led exaggerated claims of efficacy. Substances are remarkably unpredictable in how a given human will react. And with the growing number of cannabis-induced psychosis reports (that industry refuses to address) I remain skeptical of the long-term transformative capacity of these methods.

And it’s not just the interventions, diagnoses as well have expanded to include almost any form of human suffering—particularly PTSD or trauma. Difficult or painful human experience is not by definition traumatic. Prior disposition and level of cognitive-affective-physical disorganization in a receiver’s system usually determines if a given painful experience will be traumatic or not. A great example is discussed in my previous blog post on overcoupling. Humans are a tremendously adaptive and resilient species by nature. Most of us can withstand high levels of challenge and some of us greet it with joy and anticipation!

My prescription for World Mental Health Day is a plea for each of us to take up the mantle of humane, respectful conduct and communication in all of our interactions with others—regardless of whether they are friend, foe or stranger. Kindness is not enough. Holding in thought, word and deed a commitment to non-harming is critical in a world of increasing global disturbance.

Equally important is the compassionate recognition that every human has their own form of human suffering; me included. None of us is perfect. Reflecting on our own imperfection and recognizing the power every one of us has to awaken to genuine mental health, will rescue our world from its current path of intensified suffering and harm.