Science and mindfulness

A short talk on the meeting point of science and contemplative practice, given to a clinical audience. Dr Bakshi traces how mindfulness entered mainstream medicine, and how functional MRI opened questions that neurosurgery had long treated as a closed box. What follows is an edited transcript.

There is real substance behind the trendiness, and that is some of what I wanted to share with you today.

Jon Kabat-Zinn was mentioned this morning. He was a molecular science PhD at MIT in the late 1970s. He happened to go to a lecture much like this one, except that it was five people listening to a Zen master at MIT. He was inspired by it, went off and lived as a monk for four or five years, and learned the Zen philosophy. Then in the early eighties he came back, and he went to the University of Massachusetts internal medicine cancer clinic. He said: your terminal patients, the ones who have nowhere left to go, allow me to work with them on the mental side. What he started there became MBSR, mindfulness-based stress reduction. Most of the papers published since acknowledge his contribution in bringing a spiritual practice into mainstream modern medicine.

It is now reimbursed by Medicare. If you listen to some of his lectures he says, only half joking, that it is really quite funny: we sit in a room and do nothing, and we get paid for it, because it produces results.

Somebody asked this morning whether it works. There is hard scientific data showing that it improves outcomes, reduces stress and aids healing. And in a business sense, you know something is true when the insurance company starts paying for it, because an insurance company takes a very long time to convince.

A lot of this began with the tool we call functional MRI. Ordinary MRI is an imaging technique, and it is static. In functional MRI we run sequences that track where the blood is going. The brain has a system called autoregulation, which means blood flows to wherever the most neuronal activity is happening. So a volunteer lies inside the machine, the scientist asks him to tap his hand, and that area of the brain lights up.

It is almost a living instrument. The early studies were simple: move your hand, move your toe, do some mathematics, feel a sensation on your finger, and we will see which part of the brain lights up.

What is being studied now is a different order of question. Meditation masters are asked to go into the machine and told: now meditate, now stop meditating, and let us see what happens to your brain. There are papers in journals like Nature and Science on the neuroscience underlying compassion. There are psychological studies where subjects must make choices that are moral or immoral, in settings where people have gone as far as ordering the killing of their own colleagues, and functional MRI is used afterwards to ask why they chose as they did, and which part of the brain was working when they chose.

When I was practising neurosurgery a great deal of this was a black box. We did not know what was actually happening in the brain, and consciousness in particular was not open to scientific inquiry. Because of this tool, it now is. To quote a paper: after many years of reticence, scientists are no longer wary of exploring the stream of consciousness.