| | I have recently had a lot of exposure to the world of Clinical Mindfulness (CM), which generally and stereotypically involves PhD/MS/MD-types who have very little experience in meditation, lots of exposure to the world of clinical mindfulness research (which generally ignores or discounts what we here would call basic attainments, not to mention high attainments) and movements such as the Mindfulness-based Stress Reduction traditions, but they are teaching meditation practices to lots of people/patients, some of which will actually get into interesting territory, with the big trouble generally starting if and when some cross the A&P, and now find themselves in territory the PhD/MS/MD-type doesn't recognize, as they have never been there.
This has caused a whole ton of thoughts about how to bridge the gap between "them" and the technology, skill sets, paradigms, and expertise of "us", the Hardcore Dharma (HD) people, realizing that some may fall into both camps (you have my sympathy), or, failing that, at least offer some service or support or something to those who have been thus affected.
The problems are vast, and a short list here being:
1) massive ignorance on both sides: we have no idea what the CM people are doing, what they are teaching, that there are so many of them teaching so many people, what language, techniques and concepts they use, and the CM people have little to no idea that what they are doing seems like kindergarden to us, and dangerous kindergarden, as it can lead to the A&P and the rest without guidance or, worse, with bad guidance. They have no idea what we know and do and consider normal and expected, and this ignorance is massive, deep and nearly reflexive. Simultaneously it is hard for some of us on this side to not automatically dismiss the CM world as being like the worst stripped down mush regardless of the fact that they really do help some people.
2) massive egos: they are quite certain they are doing the latest and greatest, they have degrees, training, certifications, and are paid well. We have massive direct experience and amazing abilities, ancient techniques, deep lineages, and the like. Our badges are unrecognizable to the other side, and theirs seem meaningless to us.
3) massive terminological barriers: we tend to use obscure dharmic terms based on ancient Indian languages, and they tend to use obscure medical terms based on ancient Mediterranean languages. Theirs seem superficial and woefully inadequate for "real practice" to us, and ours seem like some New Ager's pipe dream babble to them.
4) massive paradigm barriers of various sorts: they don't believe the stuff we do is possible, and we don't generally realize that the doses they use, which we would generally think of microscopic, can actually do useful things for some people. They like fMRI's and p-values, and we can just go: "Yeah! that was this (insert "weird" term for attainment here)!" and we feel comfortable with that and think it is normal.
How to bridge these things?
I can imagine a group of people writing the Hardcore Dharma Manual for Clinical Mindfulness People, using their terms and making up Greco-Latin equivalents to the Sanskrit and Pali terms we throw around so easily, with DSM-style diagnostic criteria, as well as recommended therapies based on presenting symptoms.
I can imagine referral services, groups of accomplished HD practitioners who have somehow established themselves as resources that practicing CM clinicians could send their patients to if they met certain defined criteria based on having certain key experiences, such as rapturous vortex-like energetic phenomena followed by profound panic, etc, which they would be likely to misdiagnose and not handle as well as someone who knew that territory would (my unscientific biases being obvious here), sort of like a more refined version of the Spiritual Emergency Network that I believe is now defunct but functioned for some period. How would one get certified to be one of these referral services in a way that people who are used to PhD's and other letters could make sense of? Could you bill insurance companies for it? Liability coverage? Covering Board? Standards of Care? Diagnostic Criteria? Agreed on methods of treatment? Treatment clinics/retreat centers? JHACO certification? ;)
Just as in emergency medicine there are little urgent cares and little community emergency departments all over, and there are a few large University/Community Level-One Trauma Centers/Heart/Stroke/Tertiary Care Centers, just so there are a lot of clinical mindfulness teachers and only a few people with great depths of meditation competence. In this way, it would make sense if the little CM centers could realize that there were times to refer people to the specialized HD groups for those patients who got into what to them would be the really weird/complex stuff and for us would be the bread and butter of what we do every day. If we could provide clear criteria when referral would make sense and a way to identify the places/persons to refer them to in some way that became accepted as normal, that would be amazing.
When my mind goes down that thought-track and tries to imagine how this could actually manifest in the world, what paradigms, institutions, regulations, structures, committees, boards, business models, and the like would actually happen and what they might look like, it is easy to get overwhelmed by the challenges, but that doesn't mean it can't be done, it would just take a strong and capable group and a lot of time.
I thought I would throw this out there to see what people might think of all of this. I think that the stuff we do here has the capacity to help people if it could be packaged right, and by right I mean a way that translates it while maintaining the depths of its power and scope as it currently stands at the very least.
The day when the A&P has an ICD9/10 code, we will have arrived. Imagine all the things that would have to change for that to happen! Daunting and yet, it is hard not to dream of things like this, as they seem so obvious and normal from this vantage point.
I think that this, done well, could have massive practice implications for a very large number of people, and actually would be hard to have it done worse than it currently is.
Any takers?
Daniel |