与内观的关系
The Relationship between Mindfulness (meditation) and Psychoanalysis
Randall H Paulsen, MD Both mindfulness and psychoanalysis are disciplines of cultivating
self-knowledge.They should not be mistaken or substituted for each other,
but they can support each other.Mindfulness includes many forms but
consists of being present in the moment and being aware of one's physical
and mental experience in the moment. It is practiced often alone, with
intermittent sessions with a teacher and in group retreats. Psychoanalysis
was first developed by Sigmund and has been continually revised in the
past 100 years. It is both a science of human psychological life and a
therapeutic practice to help alleviate human suffering and facilitate growth
and development. What follows is a series of reflections about the
relationship between the two disciplines.
Here are three lists to keep in mind, or perhaps return to, as you read
through these reflections. There is a list of similarities, a list of
differences, and then four evocative quotes that we will turn to at the
conclusion.
The things that mindfulness and psychoanalysis may be said to share:
1. Growth in self-knowledge by practicing a discipline of focusing
attention on certain aspects of present-moment experience.
2. Trying to minimize the judgmental qualities in self-observation.
3. Emphasizing a physicality to the practice of awareness, that is, the
movement of breath, physical sensations, emotional currents, and sensory
awareness.
4. The use of a structural and temporal framework for the practice of
attention – a cushion in meditation, a couch in psychoanalysis. Both
practices rely on a set period of time on a daily or almost daily basis.
5. Both practices exist at the interface between neuroscience and
subjective experience. They seek examination and proof as medical truths,
and they provide disciplined paths for personal and spiritual growth.
The differences between mindfulness and psychoanalysis:
1. A one-person framework vs. a two-person framework.
2. Psychoanalysis relies on transference, where the subject redirects
feelings to an observing therapist; mindfulness relies on a relationship
with a teacher who guides the work of the self observing the experience of
the self.
3. Psychoanalysis uses explicit knowing (saying, listening, use of
metaphor and perception), while mindfulness employs implicit knowing
(noticing, categorizing, non-verbal), that is, noticing where the mind goes.
Evocative phrases:
1. “You have to acquire a sense of self before you can lose a sense of
self.” Jack Engler, psychotherapist and vipassana meditator in Cambridge,
Mass.
2. “Mr. James Duffy … lived at a little distance from his body.” James
Joyce, The Dubliners
3. “One acquires a sense of a center by being centered upon.” Hans Loewald, a psychoanalyst.
4. "Wisdom tells me I am nothing. Love tells me I am everything.
Between the two, my life flows." Nisargadatta Maharaj
If we think of learning from contemplation, we can picture the person
sitting on a meditation cushion as one paradigm. We can picture the other
paradigm as a person lying on a couch with a second person sitting in a
chair at the head of the couch listening carefully both to the stated
experience of the person on the couch, and to his/her own experience as
he/she listens.
Mindfulness: The Person on the Cushion
The person on the cushion is alone with him or herself (although they may be in a group of people sitting on cushions). Their eyes are closed or downcast, letting in light but not focusing on visual things. They are following the direction to “observe the breath.” They do this for a pre-set period of time at regular intervals on a daily basis or many times a day in a retreat setting. By intending to focus on the physical experience of the breath the person’s conscious awareness is drawn into their physical body, its involuntary capacity for rhythmic activity to support life, and, most importantly, the present moment. This practice sets up a dualism within the experience of the person. On the one hand there is the intention to focus awareness on the breath. On the other hand there are the myriad thoughts, sensations, and emotions that draw the attention away from the breath. The instructions are to observe and take note non-judgmentally of the thoughts, images, and sensations that took the mind away, and then to gently guide the attention back to the rhythmic experience of the breath. Even very experienced mindfulness practitioners like Pema Chodron (who’s CD “Getting Unstuck” provides a vivid description of a Tibetan Buddhist concept of SHENPA, which is very friendly to psychoanalysis) say that they never cease to work with this back and forth.
Mindfulness is thus the practice of trying to follow the breath, and to
take serious note of where the mind goes, and then what it takes to bring it
back to the breath. This practice, greatly simplified here, on a daily
basis can begin to increase one’s ability to be present, to be “awake” (as
the Buddha said) to the texture of life, in all its up and down, sad and
happy, full and empty, fleeting and timeless moments. Doing this with an
innocence – a “beginner’s mind” – without striving for a particular state,
without harshness or self-criticism, with compassion for one’s very
experience, ethically, patiently, steadfastly, whether one feels like it or
not, can have an effect on the function of the brain, the level of stress,
the amount of “craving,” and the sense of dissatisfaction with life.
This mindfulness practice often requires guidance, instruction,
participation in workshops, retreats, and belonging to a group, which sits
regularly. A teacher is helpful both in encouragement and in recognizing
some of the obstacles to regular practice. But the experience is centered
on regular intervals of focusing the attention on the breath. This is a
solitary experience. It need not always be still. Many meditation
practices include movement such as walking, tai chi type movements, yoga
postures, and breathing. Once a person has acquired an ability to train the
attention, to work with this back and forth between mental activity and
observing breath, the practice of mindfulness can be taken increasingly into
all the reaches of one’s life from doing the dishes, to writing, to driving,
to swimming, walking, or even listening to patients in psychoanalysis.
At first people are struck by the loneliness of the meditation
practice. But gradually it is possible to become aware that you are keeping
yourself company. If you can strengthen the discipline of self-awareness,
you can develop a compassion for yourself. You can also begin to construct
awareness of certain levels of mental psychological life. For example you
can begin to develop an awareness of the push-pull of emotional reactions to
thoughts, memories, and feelings. Certain experiences you like and want to
pull them toward you. Other experiences you do not like and want to push
them away from you. Seeing this layer of reactivity to the content of the
mind begins to bring awareness into the operation of the lived process
inside you. You become aware not only of the contents, but also of your
reaction to the contents.
The Tibetan Buddhist concept of shenpa is often translated as
“attachment,” but as Pema Chodron tells us, the word shenpa is closer to
what we mean by getting “hooked.” In Western terms we speak of getting
“hijacked” (Daniel Goleman in Emotional Intelligence) by an emotion. If we
have built up a discipline of being able to stay in awareness, to keep our
focus intact, we can see ourselves getting hooked and we can resist the urge
to give in to it completely. We can imagine the consequences of
surrendering completely to an emotion, see its origins, and keep it in the
realm of contemplation. We can decide how much to put it into action, or
into communication. For example, if a loved one wounds us with a slight, or
worse, a betrayal, we can reflect. We can become aware of our pain, hurt,
and anger. These are all forms of suffering. We can say, (as Thich Nhat
Han advises), “My darling, I suffer, and I do not understand why you did (or
said) what you did.” This kind of process opens up communication. But it
takes great self-discipline to be able to first contain the shame of
betrayal, then to put it into words to the very person who has wounded you
(my darling, I suffer). And then to put forth the question, the quandary,
“I do not understand.” This an open question that demands an answer. All of
these relationship skills, and self-awareness capacities can come from this
meditative awareness of the reactivity in your self.
You also can begin to observe the shifts in mood from one day, one week,
one hour to the next. This awareness of mood can then be included in your
understanding of how the world looks to you at this moment. You can begin
to include the effect that your mood has on your perceptions. Your own
house, your little place where you meditate, can look beautiful and spacious
at a time when you are in a good mood, or it can look small and dingy when
you are depressed. You notice the shift in perception, the way your mood can
be part of how you construct your experience.
Psychoanalysis: The Person on the Couch with Another Person Listening
These examples of the accumulation of self-awareness through the
practice of contemplation also provide a bridge to how we might think of
psychoanalysis as a two-person practice of mindfulness. There are several
basic building blocks that we should list as we turn our attention from
mindfulness toward psychoanalysis.
1. People who sit in close proximity engaged in a structured interaction
can sense how the other person is feeling at the moment. Current
psychoanalysis refers to this as intersubjectivity.
2. One of the basic ways that human beings grow and form a sense of the
world is through their attachments to other human beings: child and parent,
husband and wife, student and teacher, friend and friend, analyst and
patient.
3. The way we perceive current relationships is largely determined by our
histories and past relationships. That is, if close relationships have
largely been predictable and trustworthy, our approach to future
relationships will tend to be trusting. If our intimate relationships have
been seductive, exploitative, or traumatic, we will tend to experience
others in new experiences as if they are going to treat us similarly.
4. The human brain is capable of great change throughout the life cycle. This capacity for brain growth is enhanced by conditions of low stress,
opportunities for self-reflection, and by the participation of a skilled
guide.
5. The optimal condition for changing an ingrained habit of relating to
others is when the relationship with the guide feels as if it is a
repetition of the past; the difference is, however, the conscious process of
observing that familiarity with the guide, and the understanding that the
guide is functioning as a “ghost” of the past. This is called
“transference.” As the ghostlike quality dissipates through the
psychoanalytic dialogue, the guide is seen more clearly. This is called
“working through” of the transference.
One important theme that joins psychoanalysis with the practice of
mindfulness is contained in the word: reverie. Bion states it as the
therapist approaching the patient “without memory or desire.” Reverie can
be defined as awake awareness of inner and other process, intact connection
to physical, preverbal, visual, emotional, and verbal (metaphoric)
information. It is the capacity for reverie in the psychoanalyst, which
provides the container in which psychoanalysis can occur. This capacity for
compassionate, attentive reverie – in the face of such emotions as pain,
distress, trauma, and shame – provides a basic medium for growth in analytic
patients.
But reverie itself is not enough to foster growth in the psychoanalytic
paradigm. There are two other elements. One is provided by what the
patient says from his/her experience. And the third element is provided by
what the analyst says from his/her experience of what the patient is saying,
what he/she thinks is going on between the two of them, and what he/she is
sensing from the patient. These statements of the analyst may also contain
perceived connections, possible meanings, and the noticing of interruptions,
shifts, or links between various moments in the dialogue. A day of
psychoanalytic practice is like a series of two-part meditations, where the
analyst allows him/herself to be filled with undigested bits from the mental
world of the patient. These bits (an idea from Wilfred Bion) are not only
contained but also mentioned, noted, talked about, “processed” in the
dialogue between analyst and patient. The digestion does not only occur in
the pot of mindfulness within the analyst’s reverie. It also occurs in the
recognizing efforts of the analyst’s statements and the patient’s reactions
to those statements. Sometimes the patient will resist the emerging memory,
awareness or understanding. The analyst and patient will need to work with
this natural tendency to fight off new insights or painful realizations. The
process becomes a conversation with a high degree of attentiveness on the
part of both the analyst and the patient. Thus, the unconscious becomes
conscious in several ways. Some elements of the experience of the past are
seen for the first time. Some capacity for reflection, for “staying” (Pema
Chodron’s word) with the painful experience as it is recounted, or even
re-experienced on the couch, may literally increase over time in the
interaction. This is a process of becoming more “awake” through growth in
the interaction (numbers 3,4, and 5 above).
I once asked my analyst what insight he had into what I had said. “Insight,” he said, “that’s your department.” This occurred in a context
where I felt held in his containing presence, his occasional questions and
reflections. But it also prevented me from placing the responsibility for
my learning on his head. In his reverie state he made a place for my out
loud, verbal and nonverbal meditative musings. His attention, combined with
a gentle refusal to take the wheel of my life provides both nourishment for
my coming into wakefulness, and an insistent recognition of my ability to
learn meaningfully from my own relayed experience. In this brief example
from my experience, I am describing a kind of “growing up” in the
psychoanalytic relationship. Then I experience a kind of relationship
between the analytic growth, which has become part of who I am as a person,
and the meditation practice, which I have been practicing over many years
now. As I practice meditation, yoga, mindful walking, and doing, I find
that my capacity for reverie with my patients, for reverie with myself, is
getting better, broader, and more stable. I keep finding new reserves for
staying vital, calm and attuned for the next patient – and the next. And
this, in turn, feels like a way to renew my connection to the developmental
growth and self-knowledge that occurred in my own psychoanalysis.
Evocative Statements
“You
have to acquire a sense of self before you can lose a sense of self.”
Jack Engler, psychotherapist and vipassana meditator in Cambridge, Mass
There is a great deal of discussion in the meditation/mindfulness
community about the wisdom of this statement. Partly this debate stems from
the fact that mindfulness is based on a goal of transcending the Self, or
transcending Ego, as it is often referred to. Ego, as a word, and as a
concept, means two very different things to a meditator and to a
psychoanalyst. In mindfulness, or Buddhism, the Ego is seen as source of
suffering, of selfishness, greed, and craving. This form of self should
fade during the days, months and years of a disciplined mindfulness
practice. In psychoanalysis this kind of self would be called “narcissism”
– preoccupation with greed, and insecurity masked by pompous, selfish,
judgmental, impatient, heartless behavior. If we align the mindfulness term
ego with the psychoanalytic term narcissism, then the two disciplines can be
said to have the same goal: the diminishment of this kind of self which
promotes unhappiness and suffering in the person, in their family, and by
extension, in the world.
When we use the term ego in the psychoanalytic sense we are talking
about functions of a human being. A healthy ego is self-aware,
compassionate, able to observe self-experience, to care for the body, and
for others. One important example to understand Jack Engler statement
occurs in the instance of great trauma, either in childhood, or disaster, or
war. When a human being is subjected to trauma, one primary coping strategy
is to dissociate, to “send the self away.” A victim of childhood abuse will
describe “watching it happen as if I was on the ceiling, outside my body.” This is a damaged self. Such people suffer greatly in the world, in their
relationships. If they suddenly find themselves in a meditation class,
being asked to pay close to attention to their breathing, they may bolt for
the door in a state of great panic. Remember the reference to “undigested
bits of experience.” This person suffers from this and finds their way into
psychoanalytic treatment, perhaps feeling suicidal, or “not knowing who they
are.” They may need some time in psychoanalytic treatment to develop ways
of living with memories and feelings that don’t involve disconnecting. They
become ready to inhabit their body, as it were. They have acquired a “sense
of self” and that may make it possible for them to begin a mindfulness
practice that provides a practice of being on more intimate terms with their
present moment experience.
“Mr. James Duffy … lived at a little distance from his body.” James
Joyce, The Dubliners
One general impression people have of psychoanalysis is that it is very
heady, very intellectual, and focused on thoughts, interpretations, and
meaning. This view overlooks how much the actual practice of psychoanalysis
is grounded in an awareness of the body. Freud states, “The Ego is first
and foremost a bodily Ego.” When I began my own psychoanalysis, I was
pleasantly surprised to hear my analyst describe the basic instructions as
follows: “Try to say whatever comes to mind: thoughts, feelings, memories,
dreams, perceptions, and bodily sensations.” Thus the analysis included a
focus on bodily experience, which could include moments of being “out of
body” as in dissociation. This grounds the analytic dialogue in the present
moment, and it lays the framework for James Duffy to, perhaps, decrease the
distance between his subjective experience and his body.
Likewise, mindfulness bases its approach on attention to the physical body. The rhythm of the breath is a felt, physical medley of sensations. The
dialogue in meditation between attention to the breath, and the noticing of
where the attention was taken off to is a conversation across that
“distance” that James Duffy lived from his body. By including an emphasis
on refraining from judgment, the practice of mindfulness makes room for
those who begin with a sense of great difficulty sitting still, or attending
to physical phenomena. Walking meditation, yoga postures, tai chi
movements, and many others attempt to provide ways for restless, dissociated
people to begin to enter a conscious relationship with their bodies. As
stated above, some traumatized people may require a period of
psychoanalysis, or supportive group work, or even medication (SSRI’s can be
very useful in calming a traumatized nervous system) before they feel safe
enough to fully enter an attentive conversation with their own interior
physical experience.
“One acquires a sense of a center by being centered upon.” Hans Loewald,
a psychoanalyst
This presents another angle on the importance of secure attachment between a
person and their caregiver. Daniel Siegel (The Mindful Brain) who has
studied attachment theory (a branch of study within psychoanalysis of the
process of connection in early human life) with Peter Fonagy and others
points out the relationship between mindfulness practice (meditation) and
human needs for secure attachment. On the journey of meditation, one
begins to form a more enduring sense of attachment to one’s basic existence.
Psychoanalysis, in Hans Loewald’s view, provides an opportunity for patients
to resume their own development. Because human beings, from cradle to
grave, are profoundly equipped for relationships, the framework of an
attuned, listening analyst coupled with the patient who seeks relief from
suffering can be seen as a dyad which is analogous to a child and a
caregiver. Because the patient lies on the couch (metaphorically as well as
actually) their attention and expressed experience of the relationship is
freed from too much pre-occupation with the reality of the analyst. It is
profoundly different from a conversation with a friend. It is more like a
friendly (or sometimes not so friendly) conversation with one’s ghosts. The
analyst participates in this by having prepared his/her self (by their own
extensive analytic work on themselves) to be a flexible participant in this
re-creation of traumas, unmet needs, abandonments, seductions, and amnesia. The process is often stalled. Sometimes the search for understanding feels
more like a search for a lost child. And the patient sometimes does not
feel so much “figured out” as they feel “found.” They acquire a “center by
being centered upon.”
"Wisdom tells me I am nothing. Love tells me I am everything. Between the
two, my life flows." Nisargadatta Maharaj
Both psychoanalysis and mindfulness, as disciplines of human awareness, have
to make room for the lifelong ebb and flow between reason and desire,
between thought and body. It is not conducive to a full and honest view of
human life to pretend that this constantly flowing relationship between love
and wisdom is ever over, at a standstill, or resolved. The awareness, which
is cultivated in mindfulness, needs to be a compassionate awareness, with
room to observe the urges of the heart. The consciousness, which is
cultivated in psychoanalysis, needs to include some work on conflicts, which
prevent one from honest expression, from taking risks and stands. The
experience of shame keeps the self hidden and restricts one’s ability to
fully participate in life. By reconnecting with an attentive other there
can be a freeing of one’s flow, of one’s effort to understand and to love. Freud’s best hope for psychoanalysis was that it would help people in their
“work and love.”
