Jefferson M Fish. Skeptic. Volume 25, Issue 1, Winter 2020.

Early in my career as a professor of clinical psychology, I explored relaxation, hypnosis, placebo (and other expectancy effects), along with various forms of social influence, in helping people to deal with their psychological problems. When therapists use these interventions, clients often experience various degrees of alteration in their conscious experience. For example, in response to hypnotic suggestions, a client may experience the therapist’s voice as far away and having deep meaning, and may change his or her behavior. Two different kinds of explanations are offered for the therapeutic change:

1. Hypnotic suggestions lead the client to enter an altered state of consciousness, and this “hypnotic state” enables the client to change his or her behavior, or;
2. A variety of factors—the therapeutic relationship, the client’s motivation to change, the expectancy of change associated with the magical aura of hypnosis, the appropriateness of the therapeutic suggestions, and so forth—lead to the behavior change, and the client’s altered experience, called a “hypnotic state” is an epiphenomenon. That is, the other factors cause the change, and the altered experience is merely a byproduct. Of course, the novelty and dramatic qualities of the altered experience may well contribute to the motivation for change—but the alteration in conscious experience itself, in this explanation, is irrelevant to the change.

In the course of becoming a psychologist, I not only read about various forms of therapy, and related phenomena like hypnosis and relaxation, and received supervised training in them, but I also made a point of experiencing them as a client or subject. I wanted to understand the phenomena subjectively as well as objectively.

So it was that, nearly 40 years ago, I read a number of books and articles about meditation and attended a residential meditation workshop that lasted about a week. Following the workshop, I practiced a form of meditation focused on my breathing for several months, before I gave it up as too boring.

For the rest of my academic career I pursued other interests, unrelated to meditation. Then, about 20 years ago, I began developing some age-related aches and pains, and I hit on the idea of learning the Wu form of Tai chi—a long series of slow movements that takes about 15 to 20 minutes to complete that began as a Chinese martial art, but is also practiced for its purported health benefits and as a form of meditation. The health benefits, as I understand the rationale, stem from the movements directing and using the flow of Chi (life force/vital energy).

As a Western scientist, I am skeptical about the existence of Chi; but the effects of the Tai chi system on balance and coordination are much easier to accept. Keeping my body moving seemed to have a positive effect on some joints (though not necessarily better than the effect of some other form of exercise or physical therapy), and—who knows—maybe there are other positive health effects.

It certainly doesn’t hurt one’s mental health to take a break from everyday stresses for a few quiet minutes of slow movements. The calmness and focused attention, required to remember where you are in a long sequence of movements, tend to give you a respite from other concerns.

Then there is the placebo effect. The placebo effect is a real and substantial psychological effect. For the many treatments experimentally shown to be ineffective or only marginally effective, the placebo effect is all there is; and even for effective treatments, the placebo effect is often comparable in magnitude to the treatment effect, thus doubling treatment efficacy. Those who believe that Tai chi or meditation might have positive, or wonderful, or even miraculous effects, are likely to profit more from it than are skeptics. Of course, overblown expectancies can backfire when they are not realized—but that is a matter for a discussion about placebo rather than meditation. (Full disclosure—my first book, published in 1973, was titled Placebo Therapy: A Practical Guide to Social Influence in Psychotherapy. It argued in part that a large proportion of the positive effects of therapy are due to client expectations; and that rather than trying to control for or eliminate placebo effects, therapists should attempt to maximize them.)

Another relevant explanation for the effects of meditation, stemming from the social psychology theory of cognitive dissonance, is the effort justification hypothesis. Basically, effort justification argues that people tend to overvalue outcomes that they put effort into achieving. In the case of the Wu form of Tai chi, it took me two years of once-a-week classes, plus nearly daily practice, to master the form. It would seem like a foolish waste of a lot of time and effort if I were to stop practicing it. Hence, it is easy to believe that Tai chi must be good for me. (For the last few years, my practice has diminished to about once a week—in part to keep from forgetting the form. This is an example of effort justification in action.)

Finally, there is the possibility that some benefits might accrue from Tai chi as a form of meditation. The Wu form is a long, repetitive sequence of movements, always performed in the same manner. While going through the movements, you are supposed to maintain focused attention on your body as it moves through space. This, of course, is impossible; but when you realize that your mind has wandered, you are supposed to bring your attention back to the task at hand. This sequence—repetitive task/focused attention/mind wandering/return attention to task—is pretty much a definition of meditation.

Vipassana Meditation

Last year, well into my retirement from academia, I decided to give meditation another try. At the time, I had been impressed by three books written by the historian Yuval Noah Harari: Sapiens, Homo Deus, and 21 Lessons for the 21st Century. The last book has a final chapter on meditation. Harari struck me as a clear thinker, able to formulate fundamental questions and cut through the fog of irrelevance to produce significant insights; and he did so without losing his ironic sense of humor. He labeled himself as an atheist, and yet attributed much of the clarity of his thinking to the practice of Vipassana Meditation (VM), a Buddhist technique. I had some skepticism about his meditation claim. He is an Israeli, for whom English is a second language; and yet he has a Ph.D. from Oxford. So I am inclined to believe that he was a clear thinker before he began meditation. Still, I thought, if I’m going to try meditation again, why not VM?

So, near the end of 2018, I took the 10-day residential course at a meditation center in rural northwestern Massachusetts. I drove up a day early and stayed at a nearby motel, to be sure I could reach the center despite slow-moving traffic on snow-, sleet-, and ice-covered dark roads, accompanied by threats of more snow. Having to endure hours of tense driving turned the trip into something of a quest—”if I’m going through this, before even entering on a daunting ten-day experience, VM must be really terrific to justify the effort.”

Before leaving, I deliberately read very little about VM because I wanted to approach the experience with fresh eyes. Expectations have a strong effect on how we perceive and react to experiences, and I wanted to minimize that effect, recognizing that doing so might set me up for unexpected insights, positive and/or negative.

Here is an example of avoiding preparation and the insight it brings. More than 50 years ago, a fellow Ph.D. student and I did our clinical psychology internships at a university medical center in California. We decided to take the California Psychological Inventory without reading up on it, so as to ensure a valid test result. We were very different people, with very different personalities, so we were startled to see that we had very similar personality profiles. When we went to the test manual and looked up the standardization data, we discovered that our profiles were not only similar to each other—they were similar to those of a sample of psychology students. So, we discovered that, while we thought we were quite different when compared to each other, it turned out that we were actually quite similar when compared to Californian psychology students-in-general.

In this case, in my self-imposed naivete, I thought I was going to a meditation center—a place where they teach different forms of meditation, the way a fitness center has different kinds of equipment, and different kinds of classes like Pilates, Zumba, and aerobics. I was signing up for VM, instead of one of the other forms of meditation. How wrong I was. On arrival, I discovered that I was at a Buddhist meditation center, complete with a Pagoda. The Pagoda was off limits (until we were introduced to it at the end of the course) giving it an aura of forbidden fruit. The center made clear that it was about teaching the technique of VM, a technique that could be practiced by members of any religion or no religion, and it did not proselytize. At the same time, it was obviously a Buddhist center.

The 10-day course was an introductory one, opening the door to all kinds of follow-up courses at related centers in the U.S., India, and other countries, ranging in length from a day to a month or longer. If you wanted to further your understanding and practice of VM, there was no way of doing so without furthering your understanding of Buddhism of the variety being taught at Vipassana centers. From my point of view, the more you were to do so, the more you would become a Buddhist in practice (and a member of a VM community), even if you did not label yourself as such.

Once the course begins, there is no contact with the outside world. Students observe absolute silence until the last day—no talking, gestures, or other forms of contact with one another; and, even at the communal vegetarian meals in the dining halls, eye contact is minimized. Each student has an individual room, used only for meditation, personal hygiene, and sleep. Counting both individual and group meditation sessions, compliant students are spending about 10 hours a day meditating.

During the entire period there is a strict separation of the sexes. The women’s rooms and dining hall are separate from those of the men. Group instruction and meditation take place in a large hall, with women on one side and men on the other, with access from separate entrances. Students sit on meditation mats, though chairs and/or cushions are available for those, like me, whose age and/or medical problems make meditating on the floor unsustainable. There were about 150 students, evenly divided between men and women.

All Vipassana Meditation discourses and sessions are led by audio and video recordings of S. N. Goenka, a Burmese-Indian man who died in 2013. A male assistant teacher sits on an elevated seat facing the male students, and a female assistant teacher, similarly elevated, faces the female students. At the end of each session, students with questions may line up on the floor in silence, with their feet pointed away from the assistant teacher, and may approach him or her, on their knees, to ask brief questions, in a low voice, to clarify whether they understand what was said or whether they are practicing the technique properly. Other questions—such as what it means to an American to have to approach an elevated seated authority on one’s knees to ask a question—are out of order, since they distract from the single focus of the course—learning the technique of Vipassana meditation.

The meditation technique itself is claimed to have originated about 2,500 years ago with Siddhartha Gautama, the Buddha (Enlightened One), in Myanmar (formerly Burma), and to have been preserved intact over the generations. This claim adds to the credibility of the technique, and hence to positive expectations about its effectiveness. On one hand, the claim is irrelevant because VM has whatever positive and negative effects it has, regardless of its origin. On the other hand, since the Buddha’s teachings were passed down through oral tradition for centuries before being written down, it is unlikely that VM as practiced today is unchanged from its original form.

Of the world’s major religions, Buddhism is the one with the greatest natural appeal to psychologists because it is actually a psychological system for feeling good and being good—with no concept of a deity or an afterlife. As the Dalai Lama famously said, “If science proves some belief of Buddhism wrong, then Buddhism will have to change.” This is an admirable statement that other religions would do well to imitate, and Buddhist monks have cooperated with scientists, for example, by meditating while undergoing an fMRI brain scan. Then again, I haven’t heard of any beliefs of Buddhism that have changed thus far. (In addition, while we were meditating in Massachusetts, Buddhists in Myanmar were committing genocide [or politicide, or ethnic cleansing] against the Rohingya Muslim and Kachin Christian minority groups, raising questions about the religion’s ability to get people to do good.)

Here is a brief summary of my understanding of Goenka’s presentation of Buddhist philosophy and its relationship to Vipassana meditation:

• Reality exists in the present, which is fleeting (less than a millisecond). The past no longer exists, and the future does not yet exist.
• Meditation focuses on what is happening in the present, as we experience it in our thoughts and bodily sensations, and thus meditation puts us in touch with reality.
• Our attachments and aversions cause us to suffer. Attachments—things, experiences, relationships that we want—make us suffer because we do not have them; and, when we have them, attachment to them makes us suffer because we fear losing them. Aversions—unpleasant things, experiences, and relationships—also make us suffer.
• Meditation helps us to experience all sensations as fleeting, such as pleasure and pain, or attachments and aversions, and this loosens their grip on us and helps to free us from suffering.

In the videos, Goenka presents himself as an ordinary person, making a point of being clean shaven and wearing everyday Western/Indian clothes—implicitly contrasting himself with the exotic appearances of Indian gurus who were his contemporaries, such as Maharishi Mahesh Yogi and Rajneesh. Interestingly, though, his biography does contain some parallels to that of Siddhartha, a prince who grew up with the best education available, and was protected in his youth from the misfortunes of the world, until he was shocked by them as an adult, after which he chose the life of an ascetic and religious teacher. His privileged upbringing offered him the freedom, prestige, skills, and advantages to pursue and spread his ideas. Goenka grew up in a rich family, with its attendant education and advantages, and was a successful businessman until failed medical treatments for severe migraine headaches led him to seek relief through, and ultimately dedicate his life to, Vipassana meditation.

Goenka begins and ends meditation sessions with some chanting in Pali, the language of Buddha from 2,500 years ago. Key Buddhist words and concepts in Pali are scattered throughout his presentations, making the initiate feel that “If I want to understand what I’m doing, I’ll have to learn what these terms mean and get deeper into the philosophy.” Also, while Arabic, Hebrew, Latin, and Pali were at one time everyday languages in which people said things like “It looks like rain,” or “Stop fighting with your brother,” in the current American context they take on special meaning as the languages of Mohammed, Moses, the early Christian church, or Buddha. That is, they come from a faraway place and a magical, long-ago time, when miracles happened, and the laws of physics were periodically suspended. In addition, at some points, many of the students would chant along with Goenka. We learned, at the end of the course, that about half of those present were “old students,” who had taken the course one or more times, perhaps along with other courses. Their chanting made the new student feel left out in comparison to those who knew and could participate with the specialized vocabulary. Thus, the course contained multiple implicit group pressures, along with the pressure of effort justification to pursue VM further.

Vipassana Meditation and Psychoanalysis

After days of practicing increasingly focused forms of breathing meditation, and with my accompanying feeling of anticipation bordering on impatience, in the final part of the course we got around to Vipassana Meditation itself. The technique involves focusing your attention bit-by-bit on the sensations in your entire body, beginning at the top of your head and gradually proceeding down to the tips of your toes, and back to your head again.

When I discovered that this is what we had been leading up to for days, my initial reaction was one of exasperation: Is this really what I’ve been devoting all this time and effort to learning? The reason for my reaction is that the VM instructions mirrored, practically word-for-word, a relaxation induction I began using with clients in therapy nearly 50 years ago (though I didn’t use the toes-to-head return instructions). In retrospect, it is hardly fair to criticize VM for imitating a 50-year-old technique, when it claims to be 2,500 years old. I decided to calm down, and see where Goenka would go with the technique, and it was indeed different from the way I had used it in therapy.

Relaxation training first became an important therapeutic technique at the beginning of the behavior therapy movement in the 1950s, when Joseph Wolpe used it to treat phobias with his technique of systematic desensitization. Once deeply relaxed, the client vividly imagines the least fearful scene along a phobic dimension until it is no longer disturbing, and then moves on to the next, slightly more upsetting one. In teaching clients to relax deeply, Wolpe would have them tense, hold, and then relax muscles in one part of their body after another, eventually encompassing the entire body. Deep relaxation was usually a novel experience for individuals, adding to the credibility of the technique.

But therapists soon began wondering whether the tense-hold-and-relax sequence was really necessary, or whether merely going through the body and attending to each area would be sufficient. After all, we will movements (like reaching for a glass on a shelf), not muscle contractions (we don’t will contractions in the various muscles of our shoulder, arm, hand, and fingers to reach the glass). Leaving out the tensing and relaxing of muscles both sped up the relaxation process, and eliminated clients’ counterproductive wondering, “Am I doing this right?” This is because there is no wrong way to attend to a part of your body and see what, if anything you experience.

It turned out that the goal in VM of focusing on the sensations in your body is not deep relaxation—though that might be a side effect—but instead it primarily involves focusing attention ever more intently on the bodily sensations themselves, and in accepting with equanimity the distracting thoughts that arise in the process. From some things the teacher said, VM practitioners appear to accept a rationale for its purported effectiveness that parallels the thought and even language of classical psychoanalysis. For example, as a VM website states, “Ten days is certainly a very short time in which to penetrate the deepest levels of the unconscious mind and learn how to eradicate the complexes lying there.” This assumes, controversially, the existence of the following psychological entities and healing process: a multilevel unconscious mind, complexes that exist therein, and the eradication of those complexes through meditation, a process that takes a long time.

Here are some parallels between VM and classical psychoanalysis. In psychoanalysis, the client is instructed to say everything that comes into his or her mind, no matter how unimportant, embarrassing, or upsetting, and whether a thought, image, or any other experience. The analyst, a highly trained and highly paid listener, occasionally points out patterns in what the client says. Of course, putting one’s entire stream of consciousness into words is impossible, and when the client falls silent or otherwise deviates from the task, it is called resistance, and the analyst directs the client to return to the task of free association.

One possible explanation for the hypothesized (as opposed to proven) effectiveness of psychoanalysis can be found in the psychological phenomenon of extinction. That is, upsetting experiences in the past are associated with unpleasant feelings (fear, anger, sadness), so we learn not to think of them or distort them (aversive conditioning—referred to as repression and defense mechanisms respectively by psychoanalysts). The only way to free oneself from the effects of aversive conditioning is through the process of extinction—like Pavlov’s dog repeatedly being presented with the tone, but without the food, until it no longer salivates to the tone. Hence, it is possible that by expressing one’s free associations in the non-threatening situation of psychoanalysis, where there are no negative consequences for doing so, the negative emotions associated with the thoughts will extinguish.

In parallel fashion, a possible explanation for the hypothesized (as opposed to proven) effectiveness of meditation may also be found in the psychological phenomenon of extinction. That is, it is possible that by experiencing one’s spontaneous upsetting thoughts and related bodily sensations in the non-threatening situation of meditation, where there are no negative consequences for doing so because the meditator is alone, the negative emotions associated with the thoughts will extinguish. Furthermore, both free associating in psychoanalysis and body scanning in VM lead individuals to develop distance from their fantasies (rather than giving them excessive weight) by viewing them as “just a thought.” In psychoanalysis, one views them as just one more free association, and in VM one views them as just one more distraction from the meditation task.

From this point of view, an advantage of psychoanalysis is that you have a trained, if expensive, analyst to keep you on track and point out aspects of your associations you might not have noticed. A disadvantage is that, out of embarrassment or other negative emotion, you might not express all of your thoughts. An advantage of meditation is that you are spared the embarrassment (and cost) of sharing your spontaneous thoughts with another person; but a disadvantage is that you might avoid attending to them without someone to bring you back on track. In this sense, meditation can be seen as a poor person’s psychoanalysis.

Another possible explanation for the hypothesized (as opposed to proven) effectiveness of meditation can be found in considering the Buddhist philosophy conveyed in Goenka’s discourses as a kind of cognitive therapy. That is, it is possible that being persuaded to let go of attachments and aversions could be the effective ingredient, and the subjective experiences during meditation, while serving a motivational function, could be non-causal epiphenomena (as in the above explanation for hypnosis).

Finally, there are a variety of questionable body psychotherapies (unsupported and/or contradicted by research), which assert that painful experiences and emotions are expressed in unpleasant bodily sensations, and that dealing with the bodily sensations in some way will heal the associated pain. These therapies may include massage and other forms of poking and prodding the body with the intention of releasing supposed repressed material trapped in the musculature or body armor. There are quite a few of these therapies: Wilhelm Reich’s Vegetotherapy (going back to the 1930s), Rolfing (popular at the Esalen Institute in the 1960s), and others. VM does seem implicitly to accept the assumption of the bodily manifestations of emotion-laden events, though it deals with them as with all other bodily experiences, by an equanimous acceptance of them as transitory.

Sex and Gender

The strict separation of male and female students during the VM course is similar to that found, both in worship services and elsewhere, in Orthodox Judaism, Coptic Christianity, Islam, and other ancient religions. The VM rationale was that the separation prevents sexual attraction from distracting students from meditation.

Traditional societies are hierarchical, and Asian ones are particularly so (e.g., approaching the assistant teacher on your knees). They are also patriarchal, and maintain strong control over women’s sexuality. It was only in the second half of the 20th century, with the introduction of the birth control pill, that women were finally able to control their own fertility—allowing them to separate sexual expression from pregnancy and childrearing. So, in its failure to recognize the 21st century social reality, the VM rationale for separating the sexes seemed anachronistic to me. When we were told the rationale for separating the sexes, my first reaction was, “What about gays?” But, more penetratingly, during a Q & A session at the end of the course, another student asked, “What about individuals who don’t identify as either male or female?”

Furthermore, while Goenka was leading us through Vipassana Meditation, with a message to focus ever more clearly on the sensations in ever smaller areas of our body, and to attend to the entire body, he omitted the genitals. To me, it was as if we were to view ourselves as Ken and Barbie dolls. Perhaps the rationale was to avoid students getting distracted from the task of focusing attention by their conflicted feelings about sex. Perhaps it was to avoid potential lawsuits. In any event, it seemed to me that, for VM, sex was a taboo, or at least tainted topic.

Health

I wouldn’t be surprised if practitioners of VM experience positive health effects; but I don’t think that those effects should be attributed to meditation. For example, prior to the course, I used to have a glass or two of wine with dinner two or three times a week. Now it is more like two or three times a month. Goenka advises students not to use alcohol or other mind-altering substances; and in fact the reason for my diminished use of alcohol is that the accompanying buzz interferes with the concentration needed to meditate.

Since alcohol and other mind-altering substances (especially tobacco) have greater negative effects on health than positive ones, the diminution or cessation of their use is good for health. So the positive effects on health are the result of the changed health related behavior, not of meditation. Thus, if people were to change their behavior with intoxicants to the same degree as meditators, while spending an equal amount of time watching TV instead of meditating, they would probably experience the same positive health effects. In like manner, studies have shown that Seventh Day Adventists have good health because their religion tells them to be vegetarian; but the positive health effects stem from their diet, not their religious beliefs.

The food at the VM course was vegetarian, so any students who had been on the standard American diet might have experienced an improved sense of well-being after 10 days, resulting at least in part from the diet, but which they might have misattributed to meditation. And if they were to continue both meditating and eating plants, and their health continued to improve, they might continue to misattribute all of the positive effects to meditation.

During the course, students agree to “abstain from killing any being.” (This was easy to do in December. Students in the summer might have a hard time not accidentally stepping on an ant or absent-mindedly swatting an insect.) Many vegetarians and vegans choose their diets mainly out of concern for the welfare of animals, while others do so mainly for health reasons. But the effects of diet on health stem from what people actually eat, not from their reasons for doing so.

There may also be positive health effects resulting from the relaxation during VM, in addition to any effects from the cognitive processes of meditation. Some have argued that the calming bodily effects of the relaxation response are the opposite of the stressful effects of the fight-or-flight response. At one point during the course, Goenka pushes relaxation to an extreme by asking students to see if they can remain immobile during the entire hourlong meditation. On the other hand, VM is also the opposite of aerobic exercise; and the health benefits of relaxation have to be weighed against the health liabilities of being a couch potato.

Why Meditate?

In learning VM, and thinking about the psychological and health effects of meditation from a clinician’s perspective, I found myself distinguishing among:

• The social psychological pressures to meditate and/or continue meditating, and to become part of a VM community,
• The placebo/expectancy effects of meditation,
• The persuasive effects of the theoretical and Buddhist rationales for meditating,
• The evidence, if any, for the truth of the rationales, and
• The effects, if any, of the meditation itself.

(These are the kinds of issues one needs to consider in deciding whether to adopt any purportedly life-enhancing practice. For example, one might substitute an “exercise regimen” or a “plant-based diet” for “meditation” in the list, as in: social psychological pressures to exercise, placebo/expectancy effects of exercise, and so forth.)

It has been a year since the course ended, and I have continued meditating twice a day on nearly all days—averaging not a total of two hours per day as Goenka suggests, but more like an hour and a quarter, which is still a significant amount of time. I’ve wondered why I haven’t stopped meditating, and two answers suggest themselves, both of which have parallels with my continued practice of the Wu form of Tai chi. First, since VM is also a long form with multiple steps, it provides a complex task to perform that has maintained my interest in a way that meditation based on breathing alone has not. And second, because VM, like Tai chi, required a lot of time and effort to learn, there is the pressure of effort justification to keep practicing it.

I also have wondered why I chose to start meditating now. I know that people say that when you get old and closer to death you become more spiritual. That may be true for some people, but not for me. The best answer I’ve been able to come up with is curiosity. In my 1996 book Culture and Therapy: An Integrative Approach, I wrote about an experience I had during my last year of doctoral studies:

There was a deli across the street from the university where many of us would buy sandwiches to eat in the lounge. One particular time during the winter several of us walked there together, and since it was so close we didn’t bother to wear coats. As we crossed the street, I thought to myself, “I feel cold.” Suddenly I had a realization: “That’s because it is cold!” With my years of personal therapy and training as a therapist, I had become so attuned to every nuance of my inner world that I had become blind to the most obvious elements of my environment and their powerful determining effect on my experience. This epiphany contributed significantly to my decision to get postdoctoral training  in behavior therapy.

I think it is as simple as that—after a half century of viewing behavior primarily from external sociocultural and behavioral perspectives, I’m indulging my curiosity about looking inward again.