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Sunday, July 5, 2015

Spiritual statins? Health IT, meet Mindfulness IT

Add one more to the current "mobile apps" craze. In my current hardcopy New Yorker:

The Higher Life
A mindfulness guru for the tech set.


THRIVE, yet another TED-style ideas conference offering mental and spiritual rejuvenation to the business world. It was organized by the “Morning Joe” co-host Mika Brzezinski and the new-media mogul Arianna Huffington, and conceived, Huffington said, to correct a problem that she had perceived in herself and other harried strivers. According to the event’s Web site, “The relentless pursuit of the traditional measures of success—money and power”—had resulted in an “epidemic of burnout”: stress-related illnesses, relationship problems. In addition to frantically pursuing the traditional measures, it was time to introduce a “ ‘Third Metric’—a combination of well-being, wisdom, wonder, and giving.”

THRIVE’s speakers included women with expertise in the first two metrics: Katie Couric, Tory Burch. But a keynote address was delivered by a Third Metric expert: Andy Puddicombe, a forty-two-year-old British meditation teacher. Puddicombe trained as a Tibetan Buddhist monk before creating an iPhone app called Headspace, which teaches meditation and mindfulness techniques. Since 2012, when the app launched, Headspace has been downloaded by three million users. Among its acolytes are Richard Branson, who put the company’s meditation exercises on Virgin Airlines flights, and the Seattle Seahawks. The Times has written that Puddicombe is “doing for meditation what someone like Jamie Oliver has done for food.”

...For several years now, the overlapping worlds of business and self-help have been abuzz about mindfulness meditation. (In February, an executive coach opined in the Harvard Business Review that mindfulness “is close to taking on cult status in the business world.”) The World Economic Forum, in Davos, opens with daily meditation sessions; Fortune 500 companies like General Mills, General Motors, and Target offer their employees contemplative programs, embracing Huffington’s message that enlightenment need not be at odds with the pursuit of profit. Goldman Sachs and the Dana-Farber Cancer Institute have bought bulk subscriptions to Headspace for their employees.

As with many contemporary trends, Silicon Valley was there first. Meditation was one of the habits that seeped from San Francisco’s counterculture into its hacker culture. For years, its high priest was Steve Jobs, a Zen enthusiast. These days, it’s Chade-Meng Tan, a Google engineer who, in 2007, helped create Search Inside Yourself, a “mindfulness-based emotional intelligence” course that has since been taken by thousands of the company’s employees. Tan told David Gelles, the author of “Mindful Work,” that Google’s program represents “the fourth turning of the wheel of the dharma.” Eastern spirituality seasons much of today’s techno-utopianism. HBO’s “Silicon Valley” includes a C.E.O. who consults a guru and says things like “I don’t want to live in a world where someone makes the world a better place than we do.”

Silicon Valley’s interest in meditation is, in some respects, adaptive. “We’re at the epicenter of being stimulated with digital stuff,” Mamood Hamid, a venture investor at Social Capital, told me. “Five years ago, it was just e-mail. Now if you’re not on Twitter, if you don’t know how to use social, you’re a Luddite. And then you add the Apple Watch that’s going to be giving you notifications every five minutes—text messages, e-mails. It’s going to drive you insane.” Stewart Butterfield, the C.E.O. of Slack, noted that this is a fate that awaits us all. “I feel like we’re in the early stages of a species-level change with devices,” he told me.

All of this has led to a strange but perhaps inevitable oxymoron: digital therapy. A new class of app has emerged on iPhone screens, promising to relieve the mental afflictions—stress, distraction—that have been exacerbated by its neighbors. A venture-funded company called Big Health is developing a suite of cognitive-behavioral-therapy apps. (Its first product, Sleepio, treats insomnia.) And though Hamid considers Headspace to be the best mindfulness-meditation app, in terms of its “content and sophistication,” there are many others, including buddhify, which collects data via daily “mood check-ins”; Calm, which offers meditation exercises set to soothing nature scenes; and Insight Timer, which provides Tibetan bell sounds. Huffington has an app, too, called GPS for the Soul.

At THRIVE, Puddicombe brought up the health benefits sought by some meditators—better sleep, lower blood pressure—before getting to the heart of the matter: attention. He cited a 2010 Harvard study about mind-wandering: “Forty-seven per cent of our life is spent lost in thought. Distracted!” If we meditate a lot, “it’s almost like there’s a little more room, a bit of space in the mind.”...
Interesting article, a fairly long read. Worth your time, spike in the dubiety meter notwithstanding.
...As technologies for studying the brain have improved, a new field of inquiry has emerged, sometimes called contemplative neuroscience, which examines the effects of meditation on the brain. The preliminary findings of the studies are reported breathlessly: recent headlines in the Times include “MEDITATION FOR A GOOD NIGHT’S SLEEP” and “EXERCISING THE MIND TO TREAT ATTENTION DEFICITS.” Headspace, which employs a chief medical officer, Dr. David Cox, has a promotional pamphlet that relates an array of “Quantifiable Positive Outcomes of Mindfulness Training.” These range from “stress and anxiety reduction” to “immune function,” “compassion,” and “heart health.” When it comes to psoriasis, Headspace notes, referring to a paper co-authored by Kabat-Zinn, “the meditators’ skin cleared around four times faster than the non-meditators.” This can make meditation seem like a wonder drug: Adderall, Prozac, and Proactiv rolled into one.

While it’s true that a recent metastudy found that mindfulness meditation produces effects that are equivalent to those of antidepressants, scientists caution that the research is in its early stages. Most of the studies are pilot studies, and many lack an “active control”—a kind of meditative sugar pill, to guard against the placebo effect. (Headspace is considering developing a fake meditation app.) Bias can cloud the results, too. As one review put it, wryly, “Many researchers are enthusiastic meditators themselves.” Kerr, the neuroscientist, said that if you join “a mindfulness group or get an app like Headspace, you should not assume that your depression will magically lift or your skin will clear up.”

Many Buddhists don’t love the wonder-drug version of meditation, either. They are bothered by the way that it has come to be adaptable to any goal, from training marines to picking investments. (A Reuters article called “Meditation and the Art of Investment” quotes Ray Dalio, of the hundred-and-seventy-billion-dollar hedge fund Bridgewater Associates: “Meditation more than anything in my life was the biggest ingredient for whatever success I’ve had.”) David McMahan, the scholar, pointed out that in Buddhism mindfulness doesn’t quite work that way: “You are supposed to be mindful of something: the teachings of the Buddha!” The teachings of the Buddha are not always warm and fuzzy, nor would they play well at a corporate retreat. The most important precept, after all, is the universal truth of suffering...
Yeah. I am reminded of a small volume I read over and over again while sitting by my dying daughter's bedside in Brotman Medical Center in Culver City in 1998 during the last few months of her life.

DESPITE THE BUDDHA’S own succinct account of his awakening, it has come to be represented (even by Buddhists) as something quite different. Awakening has become a mystical experience, a moment of transcendent revelation of the Truth. Religious interpretations invariably reduce complexity to uniformity while elevating matter-of-factness to holiness. Over time, increasing emphasis has been placed on a single Absolute Truth, such as “the Deathless,” “the Unconditioned,” “the Void,” “Nirvana,” “Buddha Nature,” etc., rather than on an interwoven complex of truths. 

And the crucial distinction that each truth requires being acted upon in its own particular way (understanding anguish, letting go of its origins, realizing its cessation, and cultivating the path) has been relegated to the margins of specialist doctrinal knowledge. Few Buddhists today are probably even aware of the distinction.

Yet in failing to make this distinction, four ennobling truths to be acted upon are neatly turned into four propositions of fact to be believed. The first truth becomes: “Life Is Suffering”; the second: “The Cause of Suffering Is Craving”— and so on. At precisely this juncture, Buddhism becomes a religion. A Buddhist is someone who believes these four propositions. In leveling out these truths into propositions that claim to be true, Buddhists are distinguished from Christians, Muslims, and Hindus, who believe different sets of propositions. The four ennobling truths become principal dogmas of the belief system known as “Buddhism.” 

The Buddha was not a mystic. His awakening was not a shattering insight into a transcendent Truth that revealed to him the mysteries of God. He did not claim to have had an experience that granted him privileged, esoteric knowledge of how the universe ticks. Only as Buddhism became more and more of a religion were such grandiose claims imputed to his awakening. In describing to the five ascetics what his awakening meant, he spoke of having discovered complete freedom of heart and mind from the compulsions of craving. He called such freedom the taste of the dharma...

AN UNAWAKENED EXISTENCE, in which we drift unaware on a surge of habitual impulses, is both ignoble and undignified. Instead of a natural and noncoercive authority, we impose our will on others either through manipulation and intimidation or by appealing to the opinions of those more powerful than ourselves. Authority becomes a question of force rather than of integrity. 

Instead of presenting himself as a savior, the Buddha saw himself as a healer. He presented his truths in the form of a medical diagnosis, prognosis, and treatment. If you have a pain in your chest, you first need to acknowledge it. Then you will go to a doctor for an examination. His diagnosis will both identify the cause of pain and tell you if it is curable. If it is curable, he will advise you to follow a course of treatment. Likewise, the Buddha acknowledged the existential condition of anguish. On examination he found its origins to lie in self-centered craving. He realized that this could cease, and prescribed the cultivation of a path of life embracing all aspects of human experience as an effective treatment.

WHILE “BUDDHISM” SUGGESTS another belief system, “dharma practice” suggests a course of action. The four ennobling truths are not propositions to believe; they are challenges to act. 

There is a passage in Alice’s Adventures in Wonderland in which Alice enters a room to find a bottle marked with the label “Drink Me.” The label does not tell Alice what is inside the bottle but tells her what to do with it. When the Buddha presented his four truths, he first described what each referred to, then enjoined his listeners to act upon them. Once we grasp what he refers to by “anguish,” we are enjoined to understand it— as though it bore the label “Understand Me.” The truth of anguish becomes an injunction to act. 

The first truth challenges our habitual relationship to anguish. In the broadest sense, it challenges how we relate to our existence as such: our birth, sickness, aging, and death. To what extent do we fail to understand these realities and their implications? How much time is spent in distraction or oblivion? When we are gripped by a worry, for example, what do we do? We might struggle to shake it off. Or we try to convince ourselves that things are not the way they seem, failing which we seek to preoccupy ourselves with something else. How often do we embrace that worry, accept our situation, and try to understand it? 

Anguish maintains its power only as long as we allow it to intimidate us. By habitually regarding it as fearful and threatening, we fail to see the words etched on it by the Buddha: “Understand Me.” If we try to avoid a powerful wave looming above us on the beach, it will send us crashing into the sand and surf. But if we face it head-on and dive right into it, we discover only water. 

To understand a worry is to know it calmly and clearly for what it is: transient, contingent, and devoid of intrinsic identity. Whereas to misunderstand it is to freeze it into something fixed, separate, and independent. Worrying about whether a friend still likes us, for example, becomes an isolated thing rather than part of a process emerging from a stream of contingencies. This perception induces in turn a mood of feeling psychologically blocked, stuck, obsessed. The longer this undignified state persists, the more we become incapable of action. The challenge of the first truth is to act before habitual reactions incapacitate us...

Batchelor, Stephen (1998-03-01). Buddhism without Beliefs (pp. 4-8). Penguin Publishing Group. Kindle Edition.
I found this book quite sustaining during those most difficult of days.
WHEN ASKED WHAT he was doing, the Buddha replied that he taught “anguish and the ending of anguish.” When asked about metaphysics (the origin and end of the universe, the identity or difference of body and mind, his existence or nonexistence after death), he remained silent. He said the dharma was permeated by a single taste: freedom. He made no claims to uniqueness or divinity and did not have recourse to a term we would translate as “God.” Gautama encouraged a life that steered a middle course between indulgence and mortification. He described himself as an openhanded teacher without an esoteric doctrine reserved for an elite. Before he died he refused to appoint a successor, remarking that people should be responsible for their own freedom. Dharma practice would suffice as their guide. 

This existential, therapeutic, and liberating agnosticism was articulated in the language of Gautama’s place and time: the dynamic cultures of the Gangetic basin in the sixth century B.C.E. A radical critic of many deeply held views of his times, he was nonetheless a creature of those times. The axioms for living that he foresaw as lasting long after his death were refracted through the symbols, metaphors, and imagery of his world. 

Religious elements, such as worship of the Buddha’s person and uncritical acceptance of his teachings, were doubtless present in the first communities that formed around Gautama. Even if for five hundred years after his death his followers resisted the temptation to represent him as a quasi-divine figure, they eventually did so. As the dharma was challenged by other systems of thought in its homeland and spread abroad into foreign cultures such as China, ideas that had been part of the worldview of sixth-century-B.C.E. India became hardened into dogmas. It was not long before a self-respecting Buddhist would be expected to hold (and defend) opinions about the origin and the end of the universe, whether body and mind were identical or different, and the fate of the Buddha after death. 

HISTORICALLY, BUDDHISM HAS tended to lose its agnostic dimension through becoming institutionalized as a religion (i.e., a revealed belief system valid for all time, controlled by an elite body of priests). At times this process has been challenged and even reversed (one thinks of iconoclastic Indian tantric sages, early Zen masters in China, eccentric yogins of Tibet, forest monks of Burma and Thailand). But in traditional Asian societies this never lasted long. The power of organized religion to provide sovereign states with a bulwark of moral legitimacy while simultaneously assuaging the desperate piety of the disempowered swiftly reasserted itself— usually by subsuming the rebellious ideas into the canons of a revised orthodoxy [ibid, pp. 15-16]...
While I've been hip to the fundamentals of Buddhist thought (including the Zen) since the 60's (e.g., via the myriad writings of people like Alan Watts, Baba Ram Dass, etc), I'm not much of a routine practitioner, I must confess. Maybe I oughta buy into the Headspace app and check it out, particularly as I now traverse my own cancer journey. Is it legit? More importantly, even if the answer is "yes," will it stay that way? (Or, is the very question antithetical to Buddhist thought?)
Puddicombe is neutral on the subject of the moral status of money, saying, “It’s our relationship to it and how we choose to use it.” According to Puddicombe, one online critic called him a “very greedy monk.” But if Headspace is to bring meditation to every smartphone owner in the world—and do so better than its competitors—the company can’t afford to be unmindful of its finances. Puddicombe and Pierson say they have been approached by more than fifty investors, including most of the prominent names on Sand Hill Road, the hub of venture capital. They haven’t taken any money yet, but Puddicombe said, in a somewhat resigned tone, that “it’s almost inevitable.”

Mamoon Hamid, at Social Capital, said that, despite his admiration for Headspace, he has decided not to invest. His reason was Puddicombe. He told me, “It’s extremely compelling when a Buddhist monk walks in the door. It’s true to brand. It’s authentic.” But, he said, “at the end of the day, we want to create the biggest company around this concept without being shackled by your Buddhist-monk tendencies.” Headspace has an impressive number of users for a product that has spread almost entirely by word of mouth. But, Hamid said, “in order to get to two hundred million users, you have to break a lot of glass along the way. Your company will change over time, and are you O.K. with that?” In the end, he said, “you have to let go”—the dharma of Silicon Valley.
Puddicombe has no backup plan in the event that Headspace fails to become the Uber of mindfulness...
“at the end of the day, we want to create the biggest company around this concept without being shackled by your Buddhist-monk tendencies.”
Yeah. Precisely the problem. Venture capitalism is overpopulated with avaricious Gresham's Dynamic grifters motivated simply by the pot of honey comprising the next big IPO deal. And, as I've joked before,
"Health care needs an Uber like it needs another Gruber."
Check out the website. Pretty interesting.

World Health Organization definition of Health

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
apropos, very nice site over at U.Cal Davis:

Some excellent work there. We in the U.S. in particular have a lot of room for improvement across the breadth of these fronts, e.g., I am reminded of my May 1st post on "Upstream" issues.
The assertion is made that perhaps 90% of human health is atributable to "upstream" factors outside the clinical care delivery system: genetics (to the extent that they are still considered "outside of care delivery"), lifestyle factors, culture, poverty, pollution, and environmental factors more broadly.

From The Atlantic:

...Davidson and his colleagues ran a simple experiment on eight “long-term Buddhist practitioners” whose had spent an average of 34,000 hours in mental training. They asked the subjects to alternate between a meditative state and a neutral state in order to observe how the brain changed. One subject described his meditation as generating “a state in which love and compassion permeate the whole mind, with no other consideration, reasoning, or discursive thoughts.”

“When we did this, we noticed something remarkable,” Davidson said. “What we see are these high-amplitude gamma-oscillations in the brain, which are indicative of plasticity”—meaning that those brains were more capable of change, for example, in theory, of becoming more resilient. The researchers also found in MRI scans of monks that a region of the brain known as the anterior insula was activated. “Every neuroscientist will have their favorite part of the brain,” Davidson said. The anterior insula is one of his, because it’s where a lot of brain-body coordination takes place. “The systems in the brain that support our well-being are intimately connected to different organ systems in our body, and also connected to the immune and endocrine systems in ways that matter for our health,” he said. The brain scans showed that “compassion is a kind of state that involves the body in a major way.” One example: Davidson and coauthors found in another study that meditation improved immune response to an influenza vaccine—and the subjects were not “professional” Buddhist meditators, but people who had gone through an eight-week training program in mindfulness meditation. And a short “compassion training” course, Davidson and colleagues found in a 2013 study, exhibited more altruistic behavior compared with a control group...



More to come...

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