Full Catastrophe Living

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 Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness is a book by Jon Kabat-Zinn, first published in 1990, which describes the mindfulness-based stress reduction (MBSR) program. Kabat-Zinn describes scientific research showing the medical benefits of mindfulness-based interventions (MBIs), and lays out an approach to mind-body medicine emphasizing the depth of the interconnections between physical and mental health. The book has been called "one of the great classics of mind/body medicine", and has been seen as a landmark in the development of the secular mindfulness movement in the United States and internationally.

Full Catastrophe Living grew out of the work of the University of Massachusetts Medical Center's Stress Reduction Clinic, founded in 1979 by Jon Kabat-Zinn. The purpose of the Clinic was to "serve as a referral service for physicians and other health providers, to which they could send medical patients with a wide range of diagnoses and conditions who were not responding completely to more traditional treatments, or who were and not feeling satisfied with their medical treatments and outcomes."  MBSR aimed to help patients by providing a relatively intensive training in mindfulness meditation and mindful hatha yoga.

This was meant to serve as an educational (in the sense of inviting what is already present to come forth) vehicle through which people could assume a degree of responsibility for their own well-being and participate more fully in their own unique movement towards greater levels of health by cultivating and refining our innate capacity for paying attention and for a deep, penetrative seeing/sensing of the interconnectedness of apparently separate aspects of experience, many of which tend to hover beneath our ordinary level of awareness regarding both inner and outer experience.

Kabat-Zinn composed Full Catastrophe Living with aim of capturing "the essence and spirit of the MBSR curriculum as it unfolds for our patients", while at the same time articulating "the dharma that underlies the curriculum, but without ever using the word ‘Dharma’ or invoking Buddhist thought or authority, since for obvious reasons, we do not teach MBSR in that way." Kabat-Zinn recalls his desire for the book to "embody... the dharma essence of the Buddha’s teachings" in a way that was "accessible to mainstream Americans", and to avoid "as much as possible the risk of it being seen as Buddhist, ‘New Age,’ ‘Eastern Mysticism’ or just plain ‘flakey.’"

The second edition refines the meditation instructions and descriptions of mindfulness-based approaches found in the first edition, and also reflects the "exponential" growth of scientific research into mindfulness and its clinical applications in the two decades after the book was first published. The title Full Catastrophe Living is derived from the film Zorba the Greek, in which the title character says, in response to being asked whether he has ever married, "Am I not a man? Of course I've been married. Wife, house, kids... the full catastrophe". 

According to Kabat-Zinn: Zorba’s response embodies a supreme appreciation for the richness of life and the inevitability of all its dilemmas, sorrows, traumas, tragedies, and ironies. His way is to “dance” in the gale of the full catastrophe, to celebrate life, to laugh with it and at himself, even in the face of personal failure and defeat. In doing so, he is never weighed down for long, never ultimately defeated either by the world or by his own considerable folly.

Kabat-Zinn defines defines mindfulness as "the awareness that arises by paying attention on purpose, in the present moment, and non-judgmentally", while noting that "when we speak of mindfulness, it is important to keep in mind that we equally mean heartfulness... It is a more-than-conceptual knowing. It is more akin to wisdom, and to the freedom a wisdom perspective provides." He emphasizes that mindfulness involves accessing within ourselves capacities that we in fact already possess, "finding, recognizing, and making use of that in us which is already okay, already beautiful, already whole by virtue of our being human—and drawing upon it to live our lives as if it really mattered how we stand in relationship to what arises, whatever it is."



While stressing that "mindfulness has its own internal logic and poetry", he suggests that scientific research showing its beneficial effects for health and well-being may provide extra incentive to follow the MBSR curriculum. Kabat-Zinn begins by laying out what he sees as the foundational attitudes necessary for mindfulness practice - non-judging, patience, beginner's mind, trust, non-striving, acceptance, and letting go. 

 Kabat-Zinn emphasizes the non-instrumental nature of mindfulness practice, as in his explication of "non-striving": "Almost everything we do we do for a purpose, to get something or somewhere. But in meditation this attitude can be a real obstacle. That is because meditation is different from all other human activities. Although it takes a lot of work and energy of a certain kind, ultimately meditation is a non-doing. It has no goal other than for you to be yourself. The irony is that you already are. This sounds paradoxical and a little crazy. Yet this paradox and craziness may be pointing you toward a new way of seeing yourself, one in which you are trying less and being more. This comes from intentionally cultivating the attitude of non-striving."

Kabat-Zinn then lays out the basis for his approach to health and healing, emphasizing the concepts of "wholeness" and "interconnectedness". He summarizes this approach, which he associates with mind-body and integrative medicine, as follows: "Perhaps the most fundamental development in medicine over the past decades is the recognition that we can no longer think about health as being solely a characteristic of the body or the mind, because body and mind are not two separate domains—they are intimately interconnected and completely integrated. The new perspective acknowledges the central importance of thinking in terms of wholeness and interconnectedness and the need to pay attention to the interactions of mind, body, and behavior in any comprehensive effort to understand and treat illness. This view emphasizes that science will never be able fully to describe a complex dynamical process such as health, or even a relatively simple chronic disease, without looking at the functioning of the whole organism, rather than restricting itself solely to an analysis of parts and components, no matter how important that domain may be as well."

Kabat-Zinn goes on to lay out the extensive scientific evidence for the close interconnection between mental and physical processes, examining the impact that attitudes such as optimism or pessimism, self-efficacy, hardiness, sense of coherence, and anger can have on physical conditions including cancer and heart disease. He also extends the concept of wholeness to stress the intimate interconnectedness of all living and non-living phenomena, approvingly quoting a letter from Albert Einstein stating that the human sense of being "something separated from the rest" is "a kind of optical delusion of consciousness".

Kabat-Zinn then lays out a range of scientific evidence relating to the psychological and physiological effects of stress, then goes on to describe how mindfulness practice can alleviate these effects. Drawing on the work of Richard Lazarus and Susan Folkman, he defines psychological stress in terms of the relationship between a person and their environment, which in this case is perceived as taxing or threatening. Kabat-Zinn examines both the prevalence and the deleterious effects of chronic stress within modern societies, noting that many of the automatic stress reactions common to human beings are poorly adapted to the types of problems modern people most often face.

He writes: "Health can be undermined by a lifetime of ingrained behavior patterns that compound and exacerbate the pressures of living we continually face. Ultimately, our habitual and automatic reactions to the stressors we encounter, particularly when we get in the habit of reacting maladaptively, determine in large measure how much stress we experience. Automatic reactions triggered out of unawareness—especially when the circumstances are not life-threatening but we take them that way all the same—can compound and exacerbate stress, making what might have remained basically simple problems into worse ones over time. They can prevent us from seeing clearly, from solving problems creatively, and from expressing our emotions effectively when we need to communicate with other people or even understand what is going on within ourselves.... A lifetime of unconscious and unexamined habitual reactivity to challenges and perceived threats is likely to increase our risk of eventual breakdown and illness significantly."


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