East is East and West is West, and never the twain shall meet. —Rudyard Kipling (1889)
Mindfulness-Based Compassionate Living by Erik van den Brink and Frits Koster, published by Routledge, is a thin volume of great wisdom on mindfulness and how it can be used to enhance one’s compassion for oneself. According to the authors, mindfulness involves learning to be more aware of life as it unfolds moment by moment, even if these moments bring us difficulty, pain, or suffering. Compassion requires both sensitivity to our own and other’s suffering and the courage to deal with it. Erik van den Brink is a Dutch psychiatrist trained in the United Kingdom who has extensive experience in mindfulness-based and compassion-focused approaches to mental health. Frits Koster is a Vipassana meditation teacher and studied Buddhist psychology for 6 years as a monk in Southeast Asia. The authors are well placed to write this book and their understanding and self-compassion are evident on every page. The layout is attractive, and the references are extensive and highly relevant.
As a psychiatrist brought up in the East, who received his training in psychiatry in the West, I have personally experienced the dismissive attitude of the Western sciences to the concepts that are described in this book. I remember reading an article in the New York Times a few years ago that described the opposition by neuroscientists to an invitation to the Dalai Lama to give the keynote address at their convention. To offer a balanced review, I invited my colleague Dr Robert Barris, who teaches alternative medicine to medical students and residents in my program, to join in this exercise.
We wondered why the concept of mindfulness has been gaining ground lately in medicine, and the answer is easy. The training of physicians in the United States is a long drawn-out process that requires great dedication, hard work, and self-sacrifice. As we know, having empathy is a prerequisite for any successful clinical encounter. However, an extensive survey among US physicians showed that approximately 40% of respondents experience symptoms of burnout, which is considerably more than the general population. This exhaustion results both in job dissatisfaction and poor quality of care and makes the physician more prone to making medical errors. Many studies also show a significant empathic decline during medical school and in residency. Another large American study showed that more than half of medical students met the criteria for burnout, which was associated with more unprofessional conduct and fewer professional altruistic values. Is our education system failing our students? On the other hand, participation in teaching mindfulness programs has shown a remarkable positive impact on participant’s quality of life, their stress tolerance levels, and their capacity for self-compassion. Double-blind control research among therapists in training shows that they help not only themselves but also their clients by meditating regularly. Therefore, is teaching the caregivers skills in self-care through mindfulness training much overdue?
The book consists of 3 parts. Part 1, “Approaches to Suffering,” has 6 chapters that introduce the reader to the theoretical concepts. This chapter is an elegant effort to appreciate both Western scientific and Eastern Buddhist approaches to wellness and personal growth. The 2 differing systems are compared and contrasted with the use of the foundational axioms of Buddhist psychology: The Four Noble Truths. Western science and medicine use an external methodology wherein objective measures and quantifiable cause and effect data can be utilized in devising treatment strategies. The caveat is that this runs the risk of robbing the individual of their direct tapping into deep interior resources and wisdom, their personal inner healer. Rather than disempowering the individual, the contemplative and introspective mindfulness practice makes each directly and intimately involved in their well-being. And yet, Western medicine has yielded remarkable successes in the eradication or cure of many diseases and suffering, and the East has been open and embracing of wisdom derived from scientific methodology. Ultimately, a model is offered as “marriage between East and West,” with an appreciation of the best of both worlds and where heavy overlap and common ground can be integrated.
In a chapter called “Modem Myths,” the authors debunk many modem myths in Western medicine and science, namely, the myth of being able to control disease, the myth of specific remedies for every ailment, the myth of dependence on health care professionals, and the myth of the freedom from values of research results. In the chapter “Causes and Remedies,” they see many similarities between various causes of human suffering, as proposed by Buddhism, psychoanalysis, first- and second-generation behavior therapy, and third-generation therapy based on mindfulness. In a chapter named “Research,” the authors review correlational, interventional and noninterventional studies that have been done to investigate the efficacy of mindfulness programs in reducing human suffering. The "Neurobiology of Compassion" is a fascinating section of the chapter on research, which offers insights into the neurobiology of mindfulness. The authors end this chapter on research with the conclusion that “insights from Inner Science (Eastern) that have been generated over 2500 years are in fact being increasingly supported by Outer Science (Western). Research into the practice of compassion is still in infancy but rapidly growing.”
Part 2 takes the reader through the full mindfulness-based compassionate living program and its practices. The course consists of 8 sessions with extra “silent practice” sessions between. Mindfulness practice itself can indirectly yield transformative changes in virtuous character traits such as compassion, generosity, and equanimity. Outcome measures in programs such as mindfulness-based stress reduction and mindfulness-based cognitive therapy have shown this to be so. However, the authors wanted to take things to the next level, exploring whether a direct and deliberate 8-week program Mindfulness-Based Compassionate Living in cultivating compassion would be efficacious. A critical caveat that the authors stress is that the cultivation of compassion cannot be forced and that the similar attitude of mindful nonstriving would be an essential precondition. Virtuous character traits such as these have always been part of us, perhaps from the moment we were born; however, they are too often dormant, unrecognized, and lying just beneath the surface. The Mindfulness-Based Compassionate Living program can be seen as a methodology to giving space for the manifestation of the virtue of compassion with an attitude of nonstriving allowing.
“Kindness” or the “Kindness Meditation-Yourself” are in fact adaptations and variants of the traditional Buddhist meta loving-kindness meditation practice. There is a strong emphasis on nurturing our inner self-soothing bodily system. For there to be any possible expression of compassion to the other, the bedrock needs to start with a foundation of self-directed compassion and self-directed kindness. Ultimately, the feeling of compassion is neither artificial nor contrived; rather, it emerges almost effortlessly and spontaneously from the inside out.
The final part of this book offers relevant information, specifically for professionals to support their clients individually or in a group. They describe 3 perspectives in mindfulness psychotherapy, which are mindfulness-oriented therapy, mindfulness informed therapy, and mindfulness-based therapy. In all of these approaches, they discuss how the therapist can help these clients help themselves through these practices.
The book begins with multiple endorsements, and the relevance of each is doubtful. We found the beginning chapters rather cluttered and slow moving. We suggest that in any future editions of this book these endorsements be removed and the book start with the introduction. The book is valuable and can stand on its own merits. The second issue is more substantial concerning the typical Western notion that Buddhists thought is a sine qua non with all Eastern thought, and such a conceptualization does injustice to other Eastern religions such as Hinduism, Jainism, Daoism, and others. Mindfulness practices and yoga are an integral part of the Hindu Samskara (way of life), as well as the other religions of the East. A discussion of the reasons for the Western practice of associating mindfulness practices almost exclusively with Buddhism, which exists in much of the mindfulness literature, is beyond the scope of this review. Suffice to state that Buddhism originated from Hinduism; for example, the Buddhist concept of Nirvana is a derivative to the Hindu concept of Moksha. Furthermore, Gautama, a Hindu prince, is generally credited with having created Buddhism. Incidentally, the title “Buddha” is much like the title of the Pope; there may be many Buddhas in the long, convoluted history of Buddhism in Southeast Asia and various other parts of the world. Besides, not all schools of Buddhism are nonviolent, as was shown in the recent history of Sri Lanka, Myanmar, and Tibet. However, this brief discussion, which some may say is not germane to the book under review, is made to clarify a misconception about major Eastern religions. Nevertheless, Buddha, through his enlightenment and his teachings, showed the world a way out of its suffering.
In conclusion, the authors Erik van den Brink and Frits Koster have done an enormous service to the field by writing a book that describes the state-of-the-art knowledge of mindfulness. We recommend this book to anyone who is interested in the Eastern mind healing practices, examined in the context of Western scientific methods of inquiry. Also, the neuroscientific basis of mindfulness and the comparison to cognitive behavior therapy and psychoanalysis are extremely helpful. One also learns the areas of commonality and possible collaboration between East and West, thus countering the pessimism and fatalism contained in the famous lines of Kipling, which is the title of our review.
Nyapati R. Rao, MD
Robert Barris, MD
Nassau University Medical Center
East Meadow, NY
The authors declare no conflict of interest.