MEDITATION

MEDITATION . The terms meditation and contemplation are applied to a variety of manifestations throughout the historical and cultural geography of world religions. Meditation and contemplation are used in English to translate a number of specialized terms in several different languages. Attention will be paid here to the etymologies of these terms in English, so that the reader may determine the suitability of their application to foreign terms. Some general categories through which meditative and contemplative systems can be described will be introduced.

Confusion sometimes arises when the words meditation and contemplation are used interchangeably. However, a working distinction between the two terms can be suggested. Meditation is considered preparatory and contributory to the achievement of contemplation. Meditation involves concentration, the narrowing of the focus of consciousness to a single theme, symbol, catechism, or doctrine, yet it remains cognitive and intellectual. Meditation is usually rumination on a particular religious subject, while contemplation is a direct intuitive seeing, using spiritual faculties beyond discursive thought and ratiocination. In the felicitous phrase of Richard of Saint-Victor, a Christian theologian of the twelfth century, "Meditation investigates, contemplation wonders."

The English word meditate comes from the Latin meditari. Meditari connotes deep, continued reflection, a concentrated dwelling in thought. Contemplation is derived from the Latin cum ("with") and templum ("a consecrated place"). Frequently, contemplation is itself a spiritual state and serves as the end of an ascetic quest. Particularly in the monotheistic traditions of Judaism, Christianity, and Islam, this state is sometimes considered tantamount to the beatific vision bestowed upon the individual through the grace of God. This distinction between meditation and contemplation will serve for an examination of the following materials, but the reader should bear in mind the difficulty of translating these concepts from one language and culture to another.

As for the morphology of the theories and practices indicated by the terms meditation and contemplation, it may be useful to mention some categories of spiritual discipline. Meditation leading to contemplation can be apophatic. Involved here is an emptying procedure, in which the individual systematically removes from consciousness any content that is not the object of the quest. In Christian mysticism, this type of path is referred to as the via negativa; it is also an important technique in Buddhism.

Other forms of meditation and contemplation may be termed cataphatic. In this type of practice, a specific image, idea, role, or deity is held in the mind's eye. The object of the individual is to assimilate, or to participate in some way with, the chosen object. Apophatic forms of meditation tend to be more speculative, cognitive, and intellectual, at least in their early stages. They tend to be centered in the mind. Cataphatic forms of meditation and contemplation, on the other hand, tend to be more emotional and devotional. They tend to be centered in the heart. In what follows, meditation and contemplation represent a continuum, with different systems and traditions illustrating shifting perspectives within a descriptive framework that opposes the apophatic and speculative to the cataphatic and affective.

Western Traditions

The practice of prayer has always held a central place in the Western traditions of Judaism, Christianity, and Islam. Although prayer may devolve into meditation and even into contemplation, these are more directly the concerns of the mystical and, in many instances, the monastic dimensions of these traditions.

Judaism

Meditation and contemplation in the Jewish tradition acknowledge the centrality and authority of the Hebrew scriptures. Reading and interpreting the Torah require concentration and discursive meditation. This meditation led to the development of commentary, such as the Mishnah and the Talmud, and schools came into being that fostered an experiential approach. Heavily influenced by gnosticism and Hellenism, this movement is referred to as heikhalot mysticism. Ascetical practices culminated in a contemplative ascent of the soul through seven heavens to reach its final home in a state of beatitude. The final state is viewed as one in which the mystic stands before the throne of God and sees and hears directly. There is no experience of mystical union, and God remains "wholly other." This tradition remained essentially cataphatic and nonaffective, although the symbolism of the ascent and the attainment of ecstatic consciousness is characteristic of Jewish contemplation.

A more immanentist approach to the contemplation of God developed within the Hasidic tradition. One can trace here the influence of Philo Judaeus, a Jewish philosopher of the first century ce who later was to have an important influence on Christianity. In Hasidic contemplation, the transcendent majesty of God is preserved by making the object of contemplation the shekhinah, or the spirit of the living God. God can be contemplated directly only at the end of the world, or the Day of Yahveh. The Jewish contemplative almost always retains a sense of the distance between himself and God. The quest ends not with mystical union but with a sense of adhesion (or being joined) to God, which is short of an actual union.

The qabbalistic school from the thirteenth century onward produced some major developments in the Jewish meditative and contemplative tradition. A major exponent of this school was the Spaniard Avraham ben Shemuʾel Abulafia. He developed a meditative technique designed to release the individual from bondage to the sensible forms and images that one must deal with in everyday life and that delimit the soul. Meditation is an avenue through which the soul can come to apprehend more than the forms of nature. Abulafia looks for a means to deautomatize the human faculties from the normal preoccupation with daily events. He seizes upon a system of meditation based on the Hebrew alphabet. The letters of the alphabet are sufficiently abstract so as not to preoccupy the mind with any specific meaning, but concrete enough to supply an object of intense focus and concentration. The letters of the alphabet are regarded by the meditator as constituents of the holy name of God. The meditator is instructed to combine and recombine the letters of the alphabet without any attempt to form words, thereby constructing a kind of nonrepresentational mystical logic. Such exercise produces interior freedom and detachment from natural objects and prepares the adept for the final achievement: the pure contemplation of the divine name.

Christianity

Meditation and contemplation, particularly within monastic circles, reached a high degree of differentiation and sophistication in the Christian tradition. The practices of the early church took form in an atmosphere influenced by Hermetic literature and the philosophy of Neoplatonism. Syncretic in nature, the Hermetic books present the theme of a mystical ascent to the knowledge of God. This important image (found also in Jewish mysticism) becomes central to the mysticism of Christianity. The idea of an ascent from the many to the One is taken over from the thought of the Neoplatonist Plotinus. Plotinus describes four movements in the ascent to divine knowledge: (1) purgation in the practice of virtue; (2) the development of thought beyond sense perception; (3) the transcendence of thought in the achievement of union; and (4) the final absorption in the One. In the Christian circles of third-century Alexandria, these non-Christian ideas came to be absorbed into the tradition and to exert an important influence. Two important figures of this development were Clement and Origen.

For Clement, meditation led to the apprehension of the intelligible realities and then, through gnosis as a gift of Christ, to hidden spiritual realities. Reflective reading of, and meditation on, the scriptures in order to discern this hidden meaning was important. Within this metaphorical framework, Origen introduces the symbol of a contemplative marriage between the soul and the Logos (Christ).

Anchoritism, or withdrawal into the desert, was a form of spirituality in the early church that gave full rein to ascetic and meditative practices. Disengagement from the concerns of ordinary life provided a favorable atmosphere for the awakening of the spirit to the word of God. The austere life of the desert could produce a deep, inner quiet and was conducive to a life of continual meditation on the scriptures in an attempt to hear the word of God and to ascend the ladder of perfection through grace.

Within this context, as early as the third century, a life of constant prayer developed as an ideal for the anchorite. The beginnings of the prayer of the heart, or the Jesus Prayer, are found here. The Jesus Prayer is an apothegm translated as "Lord Jesus Christ, Son of God, have mercy on me." The first reference to this prayer comes from the seventh century. The practice of the Jesus Prayer became important in Eastern Orthodox spirituality and in the development of the movement known as hesychasm. Meditation came to be seen, in a movement away from Neoplatonism, as more properly centered in the heart rather than in the mind. Control of breathing and the fixation of the gaze were important ancillaries to the constant repetition of the apothegm. This tradition has survived down to the present day in its major center on Mount Athos, in Greece.

The sixteenth and seventeenth centuries in the Roman Catholic church were a period of rationalization and the systematization of meditative and contemplative processes. This movement looked back to a medieval interest in the methodology of meditation developed among the Franciscans. A major figure in this movement was Bonaventure (1217–1274). In his De triplici via, he gives an exemplary statement for Western Christianity on the three processes of meditation: purgation, illumination, and union.

Ignatius Loyola (1495–1556), the founder of the Jesuits, wrote a treatise entitled Spiritual Exercises, in which he outlines a progression in meditative practice. His notions of meditation may not be so exalted as others, but his methods are of interest insofar as they involve cataphatic visualization techniques that bear some resemblance to Hindu and Buddhist practices. For example, Ignatius's fourth method requires that the practitioner choose a specific image, such as the passion or the resurrection of Jesus, and apply each of the five senses to that image. Thus, through seeing, hearing, smelling, tasting, and touching, the image is vivified in the consciousness of the meditator.

Teresa of Ávila (1515–1582) was a member of the Carmelite order. In her Autobiography, she narrates her meditative experiences and describes a period of spiritual desiccation followed by a series of ecstatic experiences. Teresa describes the latter in sexual images and draws upon the symbolism of the bride and the bridegroom, a symbolism that dates back at least to the time of Origen. In the Autobiography she catalogs degrees of meditation, using the symbolism of the husbandry of plants. She compares discursive meditation to watering the garden, bucket by bucket; recollection is analogous to the use of a water wheel, and quiet, to springs of water. Union is compared to a drenching rain.

Teresa's contemporary and fellow Carmelite, John of the Cross (1542–1591), modified the three ways of meditation developed by Bonaventure. Purgation is retained but illumination is replaced, using the bridal imagery, with betrothal, and union with spiritual marriage. Both Teresa of Ávila and John of the Cross describe a stage in contemplation referred to as the "dark night of the soul," an experience of alienation and isolation preparatory to illumination through the grace of God. This theme continues a long-standing tradition of a vision of God that includes the perception of darkness.

A major figure of the French church involved in codifying meditation was Francis of Sales (1567–1622). In his Introduction to the Devout Life, he teaches a five-step meditation. The preparatory stage of meditation involves three steps: (1) placing one's self in the presence of God, (2) praying for divine assistance, and (3) imagining a scene from the life of Jesus. The second step builds on the first through identification with those images that most affect the practitioner. In the third step feelings generated in the second are converted into acts of understanding and will. The fourth step involves thanksgiving and offering up the results of the meditation as a sacrifice, and petition for the putting into practice of the insights gained. The fifth step is the development of the "spiritual nosegay" or the preparation of some content of the meditation to sustain one in daily affairs.

Islam

The prophet Muḥammad (b. 570) considered his prophecy to be a continuation and reaffirmation of the Judeo-Christian tradition. The word islām means "submission" in Arabic; thus a Muslim is one who submits. Islamic theology emphasizes the transcendent majesty and unity of God. Humanity is considered to exist face to face with this transcendent majesty without intercessors. Humans are not expected to try to share the secrets of God.

In the more orthodox forms of Islam, daily prayer (ṣalāt ) is one of the obligatory observances. Usually this prayer is conducted communally. Although it is also recommended that a Muslim perform dhikr, or remembrance of God, these practices are external formalities and not necessarily related to contemplation and meditation in the present sense.

By the eighth century, strict Muslim orthodoxy began to be challenged by Sufism, the generic term for Islamic mysticism. The Ṣūfī movement favored an interiorization and esotericization of the basic institutions of Islam. The orthodox religious attitudes of fear and obedience before the transcendence of God changed in Sufism to an attitude of ecstatic love of God and hope of union with him through a transcendence of the phenomenal self. Meditative and contemplative practices became an important part of this quest, and dhikr became a constant practice of the presence of God.

Ecstasy is the goal of the Ṣūfī path, and dhikr, in an expanded and intensified form, becomes a means to the goal. Techniques familiar in other traditions such as control of the breath, visualization of sacred words, and repetition of sacred phrases were adopted as important means to this end. The goal is termed fanāʾ, or annihilation of the lower self, which enables God through his grace to bestow on the mystic the rapture of union with him.

The Ṣūfīs developed sacred dance as a technique for the induction of ecstasy. The turning and whirling movements of the dance accompanied by hypnotic music and chanting of poetry bypassed the intellectual faculties and created a trancelike state of centeredness and concentration. The Mevlevi order of Ṣūfīs founded by Jalāl al-Dīn Rūmī institutionalized this practice as the foundation of its worship.

Eastern Traditions

Sophisticated psychologies and techniques of contemplation and meditation were developed within the spiritual traditions of India and China. These traditions, which antedate the beginning of the common era, developed independently until the introduction of Buddhism into China in the first century ce. Thereafter, India's techniques of meditation strongly influenced Chinese religious thought.

India

A concern for meditative asceticism, which runs through Indian religious history, can be traced as far back as the Indus Valley civilization of the third millennium bce. Artifacts recovered from this civilization can be interpreted as representing individuals or deities in meditative attitudes.

Yoga

An early systematization of meditative technique is found in the Yoga Sūtra of Patañjali, dating from the third century bce. Patañjali defines yoga as "the cessation of the modifications of the mind." This statement forms the basis of much of pan-Indian spirituality. The Yoga system is one of the classical darśana s, or "viewpoints," of Indian philosophy. The object of meditation and other ascetic practices is to still the mind and the emotions with which the individual usually identifies. When this is accomplished, consciousness can reflect the pure absolute spirit (or puruṣa ), which is the principle of consciousness itself. Realization of the puruṣa as one's true and ultimate identity brings with it release (mokṣa ) from the tendency to identify with temporal experience.

The mind (citta ) in Yoga philosophy is considered to be the repository of saṃskāra (the root impressions of past deeds). These impressions are stored from present and past lives in unconscious layers of the psyche and, in turn, produce binding proclivities, good and bad habits, and all forms of limited vision and false identification, which modify and determine a person's life in the unenlightened state. The unenlightened mind is modified by its past ignorant experience and in turn perpetuates such modifications into the indefinite future. (This is the pan-Indian doctrine of karman, which becomes axiomatic for much of Indian spirituality.) Hence the importance of causing the modifications of the mind to cease so that the pure unconditioned spirit may become manifest in meditation.

A primary object of Yoga discipline is to bring the mind into a state of one-pointedness or intense concentration. Moral and ethical abstinences and observances form the first two limbs of an eightfold prescription for attaining this state. A comfortable posture (āsana ) is recommended, especially one that enables the practitioner to keep the spine correctly aligned and one that can be comfortably held for protracted periods of time as the mind becomes abstracted from the body. Breath control (prāṇāyāma ) is then recommended, since states of breathing and states of consciousness correspond closely to each other. A calming and quieting of the breath produces a corresponding calming and quieting of the mind.

As concentration deepens, the next limb of Yoga, pratyāhāra (withdrawal of the senses from their objects), contributes to a further interiority. The next step is dharaṇa, or the concentration of the mind on a single object. This is followed by dhyāna, or the achievement of an uninterrupted nonverbal current of consciousness focused on the meditative object. The eighth and last limb of this meditative program is samādhi, in which the goal of complete cessation of the modifications of the mind is achieved, and a transcendent awareness of one's ultimate identity as puruṣa, or unconditional spirit, is attained. In this state of ecstasy, the normal ego sense and the experience of a dichotomy between subject and object is overcome. Yoga discipline in a variety of forms becomes an important ingredient in several Indian spiritual traditions and religions, including Jainism, various forms of Hinduism, and Buddhism.

Hinduism

Hinduism is a generic term used to refer to a variety of religious manifestations within the Indian subcontinent and other areas subject to Indian influence. In the early history of Hinduism, a stage referred to as Brahmanism, there was a movement away from the practice of exoteric ritual and toward meditative interiority and realization. As the tradition developed, Hindus came to be divided into three main sects: the Vaiṣṇava, the Śaiva, and the Śākta.

Vaiṣṇavism. The Vaiṣṇavas, worshipers of the god Viṣṇu and his many incarnations, developed a form of active, affective, and cataphatic meditation in which chanting, singing, and dancing were used to induce transic absorption into the deity. Perhaps the most popular incarnation of Viṣṇu is the deity Kṛṣṇa, whose worship is bhakti ("devotion"). In addition to performances of chanting and dance, a devotee was expected to remain ever mindful of his object of devotion. In turn, the deity extends his grace and love to the devotee. In both Vaiṣṇava and Śaiva forms of theistic meditation, the emotions are given a much freer rein than in the more abstract classical Yoga system. Transmutation of the emotions through devotion to Viṣṇu, Śiva, and their avatāra s became popular and had a far-reaching effect on Indian art and literature.

Devotional theism borrowed some of its elements from Sanskrit poetics. The term bhāva, which refers to an intense personal emotion in poetic theory, was adapted by the Vaiṣṇavas to refer to the meditative attitude that a devotee assumes toward Kṛṣṇa. There are four types of contemplative mood, determined by the form of relationship with the deity. These range from a relationship to Kṛṣṇa as supreme deity, as friend, as brother, and, perhaps most importantly, as lover. A devotee's chosen bhāva was to be cultivated through meditation, chanting, and dance until he experienced himself as the friend or lover of Kṛṣṇa. Continual absorption into these various roles enabled the adherent to experience the love and the personality of the deity.

Śaivism and Śaktism. The devotees of Śiva developed their own forms of contemplative worship. One is the growth of a cult dedicated to Śakti, the female consort of Śiva. Śakti is the active female energy of the universe in contradistinction to the passive contemplative energy of Śiva himself. Śaktism became an important part of the Tantric manifestations of Hinduism. Tantric Hinduism developed several techniques of meditation, including the use of the yantra. A yantra is a geometric diagram that represents an abstract form or manifestation of a deity. Deities are essentially formless in their own nature but are thought to manifest themselves in a movement from the subtle to the gross, in the forms of sound, the geometric forms of the yantra, and the mūrti (or sculpted) image. A yantra is a series of triangles, squares, and circles emanating from a central point, which serves to focus the mind of the meditating yogin.

Visualization of a sculpted or painted form of the deity became important in Tantric meditation. The object was to achieve a high degree of absorption in the outward form so that it could be reproduced in complex detail within the mind of the meditator. When this stage was reached the outward form could be dispensed with. The general goal of Tantric meditation is the complete unification of the body, speech, and mind of the Tantric yogin with the body, speech, and mind of his chosen divinity. Mantra s, symbolic sounds or phrases for the sound form of the divinity, were used in this practice. Mudrā s were used in meditation also as symbolic gestures of the hands and body representing various stages of the unification process.

In kuṇḍalinīyoga, the macrocosmic Sakti is further identified, within the microcosm of the human body, as kuṇḍalinī. Kuṇḍalinī literally means "coiled" and refers to the visualization of Sakti as an energy within the body in the form of a sleeping serpent. This energy is associated with a meditative physiology of the subtle body of the human. The meditator visualizes six vital centers called cakra s placed along the spine from its base to the crown of the head. The cakra s are connected to each other by a central vein with two lesser veins, or channels, on either side. The object of the meditation and physical exercises of this form of Tantric yoga is to wake the latent energy of Śakti coiled at the base of the spine and to cause it to enter the central vein. As kuṇḍalinī ascends and is drawn upward through meditation, it energizes the six cakra s until it reaches the topmost cakra, where it is reunited with Śiva. At this point the body of the yogin and the body of the cosmos are resolved into the primal unity.

Buddhism

Buddhism is a tradition that seeks to penetrate the veil of appearances and social conditioning and, through meditative insight, to achieve a vision of the truth of reality. This vision leads to liberation from the round of karmic cycles and the achievement of ultimate freedom in nirvāṇa. Nirvāṇa is the goal of Buddhist ascesis subsumed under the term bhāvana, or meditation. Bhāvana has two secondary objectives: the first is the achievement of śamatha, or calm; the second is vipaśyanā, insight or higher vision.

As a foundation for other Buddhist meditation practices, a monk starts with the practice of mindfulness (Pali, sati). This practice is basic to both śamatha (Pali, samatha ) and vipaśyanā (Pali, vipassanā ) and can be used for both calming and higher vision. The practice of mindfulness, or total awareness, takes place in four main areas: the body itself, the sensations, thought, and mental objects. Mindfulness of the body begins with the observation of breathing. Strict attention is paid to inhalation and exhalation, note being taken of the duration of each as the practitioner becomes aware of this usually unconscious activity. Such concentration involves narrowing of the mind's focus. The effects of mindfulness of breathing include a refined awareness of the entire body and a sense of tranquillity.

Mindfulness of the body is next applied to a monk's postures and movements. Every bodily action is performed with complete awareness and consciousness. This discipline brings into awareness bodily activity, which normally goes on beyond the conscious level. As activities are performed, mindfulness tranquilizes, calms, and controls the body; mindfulness can then proceed with an examination of the constituent parts of the body, external and internal, and a breakdown of the body into its primary physical elements. These practices break up any tendency to identify with the body.

Mindfulness is then applied to the sensations that are discerned as pleasant, unpleasant, or neutral. In a continuing progression, from the gross to the more subtle, mindfulness is then applied to the mind, or thought itself, and its objects. Attention is paid to each thought as it occurs, whether it is with or without such factors as passion, hatred, delusion, or freedom. The objective is detachment and a loosening of the tendency to identify with any factors of experience. With the achievement of detachment, the monk has an increased ability to respond actively to the actual circumstances of life.

Through concentrative attention, a monk sees the momentary quality of life, and sees that a moment of experience arises based on temporary causes and conditions. The monk thus can see the real nature of experience, which had previously been obscured by incorrect mental fabrications and the false projection of permanent identity on a transient stream of moments.

The Buddhist śamatha practices are associated with dhyāna, or the achievement of meditative absorption. Dhyāna practice continues the work of mindfulness into an even greater experience of detachment, one in which contact with the normal content of worldly experience is gradually attenuated and almost altogether eliminated. The dhyāna s (absorptions) are as follows: four absorptions with form, four absorptions without form, and finally the cessation of conception and feeling. These stages represent a gradual elimination of the verbal, discursive, and affective contents of the mind. They lead a monk gradually out of the world of sense-based experience to a new, detached interior dimension. These stages are increasingly independent of the external world and signify a developing autonomy on the part of the monk. The monk is no longer bound by the accidental and chaotic sensory stimuli of the world of ordinary experience or by intellectual concerns, and begins to acquire the power of turning away from the "given world" and toward the ability to "create" an interior world of attenuated, simplified, and peaceful content. This is the meaning of śamatha, the calming of the contents of consciousness, and the attainment of release from subjection to external circumstances.

Calming, transic absorption and insight are important features of Buddhist ascesis; they continue to be fundamental in both Hīnayāna and Mahāyāna schools. The Vajrayāna, or Tantric form of Buddhism, also developed elaborate visualization meditations in which carefully delineated images of deities, or maṇḍala s, were reproduced with great exactitude within the mind of the meditator. The Tantric form of Buddhist meditation became firmly established in Tibet.

China

Contemplation and meditation have held a position of high importance in Chinese religious traditions. This is particularly true of the indigenous Daoist tradition and the various schools of Buddhism imported from India.

Daoism

Daoism in its early literary form (here referred to as "classical Daoism") and its later offshoot, which is usually termed "Neo-Daoism," are usually thought of as the primary province of contemplation in the Chinese indigenous tradition.

Laozi (seventh century bce?) and Zhuangzu (365–290 bce?) are the two main figures of classical Daoism. Since their existence as historical figures is questioned, here they shall be referred to only by their works, now known as the Laozu (or Dao de jing ) and the Zhuangzi. These two books contain the early formulation of the Daoist worldview and ethos. In Daoism there is a contrast between the superficialities of conventional reality and the insight achieved by the Daoist sage. The task of Daoist contemplation is to move from a partial and self-centered view of things to a holistic view of the cosmos and its spontaneously functioning dynamism.

The Dao is the primary object of contemplation and meditation in the Daoist tradition. It is the ultimate principle beyond phenomenal manifestations and yet within which all phenomenal manifestations are brought forth and undergo change. The first chapter of the Dao de jing emphasizes the ineffability of the true Dao:

The Dao (Way) that can be told of is not the Eternal Dao;
The name that can be named is not the eternal name.
The Nameless is the origin of Heaven and Earth;
The Named is the mother of all things. (Zhan, 1963, p. 139)

The Dao is the substratum that remains when all verbal and physical phenomena are discarded. Awareness of the Dao can be reached through apophatic contemplation and meditation, that is, only through direct meditative experience. In order to attain inner illumination, the Daoist sage has to follow a way of unknowing, of abandoning learning in favor of looking directly into himself. Real education for the Daoist, in the phrase of Zhuangzu, is "sitting and forgetting."

Buddhism

From the time when Buddhism entered China from India and Central Asia around the first century bce, the Chinese were exposed to a bewildering variety of Buddhist teachings. The major Indian schools were represented, including the Madhyamika (Sanlun) and the Yogacara (Faxiang). Another school that developed in China, the Tiantai, promulgated an elaborate meditative regime based on a variety of scriptural sources. The Huayan school developed a teaching and meditative discipline that led to a vision of the harmony of totality and the mutual interpenetration of all things.

Two schools of Chinese Buddhism, the Chan and the Jingtu (Pure Land school), developed different understandings of meditation practice, a difference often referred to as that between "self-power" and "other-power." "Other-power" refers to a reliance on the grace of a deity for the achievement of salvation, an idea characteristic of the Pure Land school. The idea behind this emphasis is that human beings are not strong enough to bring themselves to nirvāṇa through their own meditative practices. Paradoxically, an adherent of this school is advised to call on the name of the saving deity (Amitabha; Chin., Omituo Fo; Jpn., Amida) with an undivided mind, thus constituting a mantralike form of apophthegmatic practice. Meditation in the "other-power" schools tends toward the affective and cataphatic.

"Self-power" schools, like Chan (Jpn., Zen) Buddhism, are more austere and apophatic. The word chan is a transliteration of the Sanskrit term dhyāna, which means "meditation" or "contemplation." The Chan school emphasized "self-power" and sitting in formless meditation. Because of its exclusive emphasis on meditation, Chan developed an iconoclastic attitude toward other forms of religious observance. In Chan, personal enlightenment through intense meditation was the goal, and nothing was allowed to stand in the way of this pursuit, not even the religious and doctrinal trappings of Buddhism itself.

In Chan monasteries, meditation occupied a major part of the daily routine. Formal meditation usually took place in a separate building erected for the purpose and was supervised by a senior monk. Attention was paid to details of technique, including posture in the lotus position, with an erect spine, and the achievement of comfort and relaxation therein. Chan meditation focuses on the process of breathing, leading to a gradual withdrawal from external stimuli. A monk is instructed simply to observe the thoughts, feelings, and visions that may come into consciousness, and let them pass away of their own accord. When a monk is successful in detaching from both external and internal stimuli, the result is an experience of stillness and emptiness. This breaks up the tendency to identify with the body and mind and provides a new perspective on ordinary experience, marked by detachment, equanimity, and freedom from a sense of the ego as a reference point for experience. This is a realization beyond doctrine and beyond words themselves. The semilegendary founder of Chan in China, Bodhidharma, is said to have described Chan as "a special transmission outside the scriptures; no dependence on words and letters; direct pointing at the mind of man; seeing into one's own nature and the attainment of Buddhahood."

See Also

Alphabets; Attention; Breath and Breathing; Dhikr; Eremitism; Mantra; Mudrā; Mystical Union in Judaism, Christianity, and Islam; Mysticism; Nianfo; Postures and Gestures; Samadhi; Via Negativa; Yantra; Yoga.

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Frederic B. Underwood (1987)

MEDITATION

In common usage, the word meditation approaches the meanings of the Indian Buddhist term dhyĀna (trance state): a shift in awareness typically carried out intentionally, in silence, and while holding the body in a static position (most characteristically sitting with legs crossed). Various practices of dhyāna are associated with notions of sainthood, wisdom, serenity, and extraordinary mental powers, such as the abhijnĀ (higher knowledges). Additionally, the term suggests mental and bodily discipline, and is associated with systematic methods of self-cultivation, and with monastic or eremitical lifestyles.

Generally, Buddhist theories of meditation propose that the core of these practices consists in achieving a state of deep calm and concentration, called samādhi, which in turn can give rise to, or serve as the foundation for, a clear and accurate view (vipaśyanā) that discerns the real from the unreal. Furthermore, perfect calm and concentration can give rise as well to extraordinary visions and marvelous powers.

Wondrous powers arise when the mind is "concentrated, pure, translucent, spotless, free of trouble and confusion, supple." For instance, "from [one's] own body arises another body that has the constituents and shape of a material body but is made of mind. [And one] applies and directs this mind to the acquisition of wondrous powers…. Although [this person is] one, he becomes many, or having become many becomes one again; he becomes invisible, and then visible again" (Dīghanikāya 1, 77–78).

And, the perfect calm of a concentrated mind leads to extraordinary levels of knowing—especially an insight into reality that liberates the meditator from the bonds of duḤkha (suffering). "He applies and directs this mind to that insight that comes from knowledge. He discerns clearly: 'my body is made of matter, … produced by a father and a mother, and continually renewed by boiled rice and juicy foods, … it is subject to decay, wear, dissolution, and disintegration. This consciousness of mine too depends on that body, is bound up in that body'" (Dīghanikāya 1, 76). With this, the meditator knows the reality of the four noble truths: This is suffering; this is the origin of suffering; this is the cessation of suffering; and this is the path leading to the cessation of suffering (Dīghanikāya 1, 83).

The literate elites generally regard as more estimable this second fruit of meditation: insight into the nature of reality and liberation from the bonds of suffering and rebirth. Nonetheless, meditation remains a practice for embodied beings, and is also valued for its putative transformative power on the world of embodiment.

The body

Insofar as the meditator assumes bodily postures that are considered to be those of the Buddha himself, in particular sitting cross-legged in the traditional lotus posture, the act of meditation is, in a manner of speaking, the actualization of the goal of meditation: to become like the Buddha. One is advised to "sit on a soft, comfortable seat," and to assume "the cross-legged posture," appropriately called "the posture of the Buddha Vairocana," or the half-lotus posture. Then, other aspects of body and mind need to conform to the ideal icon of a Buddha: (1) eyes neither open nor closed, and aimed at the tip of the nose; (2) body erect, without slouching or becoming too stiff; (3) mindfulness turned inward; (4) shoulders level; (5) head [erect] without bending [the neck] forward, backward, [or wavering] to either side, the nose in line with the navel; (6) teeth and lips [only] lightly closed, the tongue resting on the gums of the upper teeth; (7) breath inaudible, neither heavy nor too rapid, breathing in and out slowly and effortlessly (Kamalaśīla, First Bhāvanākrama). These instructions, written in the eighth century c.e. for a Tibetan audience, would not differ substantially from the instructions given to beginners in other Buddhist traditions.

Other postures may acquire a similar significance, whether they are explicitly linked to the technique of meditation or not. Thus, walking meditation reflects the gait and demeanor of the awakened, and monks are sometimes asked to sleep in the recumbent position of the Buddha in nirvĀṆa, while they remain mindful of death and liberation.

Some traditions expressed the connection between body and meditation more concretely by locating certain religious experiences or stages of meditation in different parts of the body. Such conceptions were central to the so-called Tantric tradition, especially in India, although the idea also has East Asian manifestations. In this meditation theory, several "spiritual nerve centers" (cakras) map out the interface between body and meditative experience. As many as eight and as few as five cakras are located along the spinal column, on what traditional anatomy regarded as two veins or pathways for spiritual energy. In the process of meditation this energy (conceived sometimes as a kind of fluid) was forced up or down these veins, concentrating alternatively in each one of the cakras: from the lowest in the area of the genitals or the sphincter, through the area of the solar plexus, the heart, the larynx, the eyes, and the crown of the head. Generally, the concentration of energy on the top cakra was regarded as the culmination of the meditation process, although each cakra had a distinct spiritual value.

A less technical location of meditation in the body occurs in the practice of mindfulness meditation, where the main exercise consists in cultivating a clear awareness of one's body, its breathing, its movements, its functions and feelings. In the Chan tradition, likewise, there is a common rhetoric of the body not only in an emphasis on proper posture, but also in the notion that nonconceptual thought is located in the belly (Japanese, hara), not in the head.

The body as object of meditation

The human body itself can become the object of meditation. Classical Indian texts describe various ways to think about or mentally analyze the body into its parts and processes. Some advise the meditator to sit next to a corpse and reflect on the meditator's own mortality, on the fragility and corruption of the body, and on the impossibility of discovering a permanent self in one's own material frame. This meditation is known as "cultivating the impure" (aśubhabhāvanā) because a greater part of the practice consists in understanding that the living body shares the foul nature of the rotting corpse. The practice continues in isolated pockets in TheravĀda countries, where monks now may have to visit a public hospital and sit in the morgue with the bodies of the unidentified and the indigent. The more common practice is to keep a skeleton or a skull in the monastery as a prop to aid in what may be termed "a reflection on one's self," vicariously using someone else's body to imagine one's own as the object of meditation.

In Tibet this tradition resonated with a number of local practices. In areas where the dead are disposed by exposure, a traditional meditation on the corpse was possible and occasionally practiced. But more characteristic of Tibetan Buddhism is the practice of gcod (chöd), a complex sequence of both performative and meditative actions meant to provoke various experiences of bodily dissolution. The meditator, instructed by an experienced master who knows the proper invocations and protective prayers, imagines himself being devoured by demons in a variety of settings called "feasts." In a "red feast," for instance, the body is visualized as being dismembered and cut up into bloody fragments, which are then offered to flesh-eating demons. A "white feast" transforms each part of the body into an idealized, pure part of a universe that will delight the gods. The new sanctified body becomes ambrosia and feeds benevolent deities.

Transforming the body into a spiritual body by ritual or meditation is a central notion in the Tantras. For instance, the ritual use of symbolic hand gestures, called mudrĀ, sacred "seals," serve as a unifying principle for the transformation of the person through artistic representation, ritual performance, and meditation. Although many of these are even today common Indian hand gestures, they are regarded as the gestures of the Buddha himself, their association with the Buddha being confirmed by their appearance in Buddhist icons, and by the attribution of "secret" or mystical meanings the gestures.

Ritual acts, ritual frames

The theme of embodiment can also be used as a heuristic in understanding the connection of meditation to ritual. Most meditation practices occur within some sort of ritual or symbolic frame, and follow very

specific instructions. In most cases meditation sessions are planned, prepared, and adorned, and thus tagged, in predictable fashion, as "proper meditation," or "meditation like that of the Buddha." Meditation sessions are usually seen as an integral part, if not the culmination, of a religious life that includes moral preparation and doctrinal definitions of what one should expect. Apart from the expectations of doctrine, ethical values, and cultural habits, Buddhist meditations are also usually announced and framed by ritual activities.

A long tradition of preliminaries associated with meditation rituals survives in various forms in East Asian and Tibetan practice. Custom, as well as ritual manuals, helped consecrate ritual practices as diverse as cleaning and adorning the place of meditation, setting up an altar or image, offering flowers and perfumed water, and framing the period of meditation with ancillary rituals, such as the sevenfold act of worship or the invocation of protective deities. In fact, meditation and ritual often form a web of activities that includes not only ostensible silent meditations and publicly performed ceremonies, but also activities such as chanting, recitation, and circumambulation that hold an ambiguous status between ritual and meditation, mechanical reading and deep reflection.

Special meditations are also sometimes regarded as preliminary or preparatory exercises. For instance, the Tibetan tradition often recommends the practice of the sngon'gro (ngöndro, preliminaries), which are divided into two types. The first is that of the four "outer preliminaries," which often serve as a standard or common meditation for the nonspecialist. This set of four consists of meditations of the "recollection" type, with reflection on the following four topics: the value of human rebirth, impermanence, the vicissitudes of karma (action), and the suffering of living beings. The second type is formed by the five "inner preliminaries," which are construed as purificatory activities, each neutralizing or counteracting the effects of one of the major passions. Thus, pride is countered by taking refuge and performing ten thousand prostrations, jealousy by cultivating the aspiration to awaken for the sake of all living beings (the bodhicitta), hatred by reciting the hundred-syllable mantra of Vajrasattva, craving by a maṆḌala offering, and delusion by visualizing one's teacher as identical with one's protective deity (a practice called guru-yoga).

Mental culture

The above reflections are not meant to minimize the significance of meditation as a technology of self-cultivation meant to affect mental states and traits, as well as the content of mind. India scholastics canonized an early schema (perhaps pre-Buddhistic) that saw meditation as combining two kinds of mental exercise. One exercise, dhyāna proper, involved techniques for the cultivation of calm (śamatha) and concentration (samādhi), and was the main ground for extraordinary powers, yet, by itself, it could not lead to liberation. The other, the exercise of the cognitive faculty (jñāna) in an act of accurate perception (darśana), involved the practice of calm, clear-minded observation (vipaśyanā) and the cultivation of discernment (prajñā).

Most Buddhist meditation theories consider both aspects of meditation necessary in the pursuit of liberation, but argue that correct insight is the uniquely Buddhist component in this joint practice. Nonetheless, techniques of calm and techniques of discernment often overlap. The abhidharma, for instance, tended to group together certain techniques and objects of meditation that were seen as primarily means toward the development of concentration, but could be used as props for discernment. Many of these lists are in fact mixed groupings of objects, styles, and states of meditation. One such inventory, explained by Buddhaghosa in his Visuddhimagga (Path of Purity), lists forty "fields" of cultivation of meditation (each is a kammaṭṭhāna, working ground). The list includes heterogeneous categories, such as a hierarchy of meditative states (the four dhyānas), object-states (e.g., the boundless states or brahmavihāra), general objects (e.g., material or corporeal objects), and particular object-tools of meditation (that is, objects designed specially as aids to meditation).

Buddhaghosa's summary is thus a heterogeneous list describing various technical dimensions of meditation. For instance, among the "object-tools" of meditation are the all-inclusive or total objects, usually identified by their Pāli name kasiṇa. This device is a simple visual object that can become the single, neutral object of attention. For instance, a red kasiṇa is a circle of red sand or clay that is spread out on the ground before the meditator, who then focuses on it until he is able to displace all thoughts from the mind except the image of the red circle. The meditator continues the practice until he is able to keep in his mind the red circle even when he is away from the actual external kasiṇa. The outcome is regarded as a state of perfect calm and concentration that can serve as a foundation for special psychic powers or as a preliminary to insight meditation.

The mind: practices of recollection. Like meditation techniques and objects, meditative states cannot be easily classified as objects or states, processes or supports for sustained attention, nor can they be easily distinguished into states of serenity, processes of observation, or moments of insight. For example, the practice of mindfulness (smṛti) can be used emblematically for concepts that encompass concentrated mental calm, as well as insightful observation, and that likewise straddle the distinction between object, process, and goal.

Broadly understood, mindful recollection includes a spectrum of mental states and exercises that the tradition conceives as "memory" or "bringing to mind" (the literal meaning of smṛti) and that overlap with practices of watchful recollection (anusmṛti). As a superordinate term smṛti refers broadly to three related practices: (1) vigilance with regard to one's own demeanor and behavior, (2) bringing to mind (recalling) and keeping in the mind (retaining) a prescribed object of meditation, and (3) constantly directing one's attention toward, and keeping in awareness, a prescribed object, especially the processes of one's body and mind.

The first usage, watching one's own behavior, arguably fits better in a discussion of the rules of monastic conduct and consists primarily of an effort to remain constantly aware of one's own demeanor, bodily posture, tone of voice, gaze, and so on, with a view to keeping mind and body (thoughts and senses) calm and restrained. This dimension of practice is totally ignored in Western accounts of Buddhist meditation but is amply described in classical literature under the rubrics of saṃvara (self-restraint) and śikṣā (training practices). Although often found as an integral part of monastic practice, its importance is suggested by both its pervasiveness on the ground and by influential classical treatments in works like ŚĀntideva's BodhicaryĀvatĀra or the Xiaozhiguan attributed to Zhiyi, the systematizer of the Chinese Tiantai school.

Recollection practices of the second type (recalling and retaining prescribed objects of meditation) may be divided heuristically into the recollection of ideas, the recollection of sensory images, and the evocation of affective states. In the classical Indian practice ofanusmṛti (recollection), the meditator is required to bring to mind one of six different ideal subjects: the Buddha, his teachings (dharma), the community of his noble disciples (saṅgha), good moral habits, generous giving, and heavenly beings (deva). The meditator first brings to mind the traditional description of the chosen topic, then reviews discursively the good qualities associated with the subject of meditation.

A practice that is not explicitly called smṛti, yet involves a systematic bringing to mind or an evocation of affect is "abiding in sublime abodes" (brahmavihāra, also called "boundless states"). Four such states are prescribed: benevolence, compassion, joy, and equanimity. In one of the most common forms (recommended and practiced in Theravāda circles) the meditator begins by developing thoughts of benevolence toward a person to whom the meditator is indifferent, then toward a friend, then an enemy, and finally all sentient beings, infusing the whole universe with feelings of benevolence. The meditator then proceeds to develop the other three feelings in the same manner.

A third type of smṛti, commonly known as "mindfulness practice" or "attention to mindfulness" (smṛtyupasthāna; Pāli, satipaṭṭhāna), may be called "mindfulness proper." It is the "recollection" or bringing to mind of bodily and mental states, and of the conditions to which these states are subject. Once "recollected" they are held in attention and observed with clear awareness.

Tradition prescribes four objects of mindfulness: body, sensations (bodily feelings), mind (thought and stream of consciousness), and dharmas (doctrinal truths and doctrinal ideas). However, tradition has it that all four are encompassed by the sole practice of "mindfulness of breathing" (ānāpanasmṛti), which can be undertaken in preparation for, or in conjunction with, the practice of the other four. One may argue that mindfulness proper is a type of insight practice (vipaśyanā), insofar as calm awareness is a requisite for keen observation. Observation is usually formulated as follows: "What is my body doing?" or "What is my mind doing at this moment?"

At the end of the nineteenth and the beginning of the twentieth century, several Buddhist monks from Myanmar (Burma) set out to reform the practice of Buddhist meditation. Leading figures like Ledi Sayadaw (1856–1923) and Sayagyi U Ba Khin (1889–1971) objected to what they perceived as an excessive emphasis on meditation as samādhi, that is, technically, as mental withdrawal and spiritual power. They proposed a putatively more direct meditation in which mindfulness was the primary technique and insight the ultimate goal. This, they felt, had been the teaching of the Buddha himself.

Presented in a variety of forms, this basic approach came to be known as "mindfulness" or "insight" (or by the original Pāli terms, satipaṭṭhana and vipassanā). The prototypical practice was mindfulness of breathing, but other forms of mindful awareness and recollection were emphasized. Insight meditation lent itself to lay practice, and soon came to satisfy the aspirations of the new secular, middle-class audience that appeared in modern Southeast Asia, and of young Western disciples who came to Asia in search of the dharma.

The mind: calm and insight. Contemporary advocates of mindfulness/insight methods regard such practices as distinctive or self-contained practices, as suggested in canonical texts like the Satipaṭṭhāna-sutta (Majjhimanikāya 1, 55–63). However, the most common scholastic position in classical times was to suppose that one needed techniques for making body and mind supple and malleable, serene and focused, as a basis for mental culture.

In this context, the word samādhi denotes a family of techniques shared by other religious systems of India, but normative Buddhist literature generally regards these techniques as preparatory or foundational, and not as aims in themselves. Although, in practice, many even today pursue states of samādhi for their own sake, the higher, normative goal is insight, which is believed to lead to liberation from suffering and from the cycle of rebirth.

Insight is not a simple "looking" or "seeing," but rather a review of reality or truth. Insight is therefore not easily separated from doctrine and doctrinal reflection. The classical Indian tradition sometimes accepts the possibility that there can be insight without the cultivation of serenity. An integration of both is not a given, and it is neither simple nor necessary, yet most traditions acknowledge the need for both, even when one is emphasized more than the other. Generally, the theoretical integration is based on two assumptions: that a preparatory calming of the mind will allow for clear insight, and that the objects used as the foundation for calm can also be used as objects of investigation by means of insight. The goal of insight is discernment or clear understanding (prajñā), and this discernment would never arise without the cultivation (bhāvanā) of insight accompanied by the cultivation of perfect calm and concentration.

Meditation in Mahāyāna

Most Buddhist currents and religious groups in India—whether they were identified as nikāya (so-called mainstream Buddhist schools) or MahĀyĀna communities—tended to model meditation on elements found in a common pool of practices. These corresponded in their rough outlines to the techniques summarized in the formula of the forty kammaṭṭhāna, and they are also found in practice manuals (so-called yogācāra or yogāvacāra manuals). Sometimes these recommendations were incorporated into larger treatises on doctrine and practice, like the encyclopedic Yogācārabhũmi attributed to AsaṄga.

Thus, Mahāyāna meditation in India followed some variants of the common background of practices found in non-Mahāyāna traditions. Mahāyāna texts recommend, for example, the practice of the boundless states, the meditation on the corpse (aśubhabhāvanā), and mindfulness practices. Many of these practices were transported to Mahāyāna regions outside India in versions that seldom differed significantly from the accounts found in the Indian texts we possess.

Nevertheless, a number of innovations occurred in Mahāyāna, in India and beyond. Emphasis on ŚŪnyatĀ (emptiness) led some Mahāyāna authors to criticize the notion that the corpse was impure or foul (aśubha), arguing that it was better to conceive of it as empty of both substance and characteristics. In the same vein, the classical meditation on mental states (citta), which had earlier focused on a clear distinction between mental states that are good or healthy (kuśala) and those that are noxious or unhealthy (akuśala), shifted according to Mahāyāna dialectic, and the meditator asked himself whether his own thoughts, good or bad, could be located anywhere: "Where did they come from, where will they go, where are they located, inside of me, outside, or somewhere in between?"

Śāntideva describes in his Bodhicaryāvatāra a psychologically complex meditation on no-self and compassion that became a classic in Tibet and has been admired in the West for almost a century. The meditation has two parts: identification of self with others, and reversing roles between self and others. In the first part, the meditator explores the boundaries of the self and the preconceptions that make us set such boundaries. For instance, one is to reflect on the fact that suffering is the same in all beings, so that our natural impulse to avoid suffering makes more sense as a desire to protect all living things from suffering than in any selfish desire to protect ourselves at the expense of others.

In the second part of the meditation, Śāntideva imagines another person, one who is less fortunate than he is. Then he assumes the role of this other person and imagines this person looking back at Śāntideva first with envy, then reproaching him for his pride and for his insensitivity in regarding the less fortunate as inferiors, instead of as the only reason for his existence, for only those in pain justify one's existence since service to others is the only meaning of the Buddhist's life.

A group of texts written approximately a century later, Kamalaśīla's three Bhāvanākramas, also describe uniquely Mahāyāna practices. These three essays borrow extensively from the Yogācāra tradition. The second essay establishes clearly a uniquely Mahāyāna use of the boundless states (āpramāṇya) as a way to generate the great compassion that will motivate the meditator to seek the awakening of a buddha. The same texts also summarize meditations on emptiness that progress from an abhidharmic analysis of matter, through a yogācāra analysis of mind and its contents, and culminate in a state of samādhi that is devoid of any conceptual contents (ānimittasamādhi). The latter state is the gateway to the liberating knowledge that is nondual (advayajñāna).

Tantric practices

The Buddhist textual and ritual traditions that are usually called Tantric expanded on some of the practices outlined above and adopted practices that may have been autochthonous to the localities where Tantra grew roots. The typical Tantric meditation session is a pastiche or a stratified event, in which elements from different periods and currents of the tradition intermingle. Such a session, called a sādhana (realization, empowerment) is typically a mixture of evocation and visualization overlaying a classical Mahāyāna liturgy.

Three characteristics of Tantric meditation stand out in a sādhana; two of them are evident to an outside observer, one is apparent only to the practitioner. First, meditation exercises can take the form of complex liturgies. These are ritual events that may or may not include meditation proper, since often the representation or performance of the liturgical process is considered as effective as, equivalent to, or inducive of events internal to the practitioner. Yet, silent, private meditation may incorporate these ritual elements as inner, or mental, rituals. The dividing line between a meditation embedded in a ritual and a liturgy meant to display publicly the structure and power of the meditation is often blurred.

Second, one cannot escape the obvious emphasis on the senses that pervades Tantric practice. Sight is both stimulated and used by a number of multicolored props, offerings, and ritual implements, and by the maṇḍala (a graphic representation that in part maps out the ritual and any internal processes of meditation). The sense of smell is stimulated by the frequent use of incense and flowers. The ear is involved through recitation and through the focusing of the ritual and the meditation on specific ritual formulas and "mystical" formulas (mantras) and syllables (bījas).

The third characteristic is less palpable. Tantric liturgical-meditative events are often presumed to depend on or to induce an inner sensory process in the practitioner. This process is sometimes called "visualization," since instructions often ask the meditator to "see" something in his or her heart or mind. This object is to be retained in the mind for a prescribed time, to the exclusion of everything else, and serves some of the functions of the kasiṇa.

Although some Western observers have questioned the meaning of these instructions, it seems clear that the practitioner is being asked to view something in the mind. Whether this is at all possible is not as critical as understanding that many people think it is possible. Once the picture is in the mind one can look at it, view it, and contemplate it; or one can become one with the object.

The inner process is also called sādhana, and it may be construed as a "realization" because it implies that the vision is, or should be made to become, something that is real or that can be appropriated or incorporated into one's person. The meditator, for instance, is asked to perceive mentally, in his own heart, the first vowel, A, which gradually turns into the orb of the moon. In the middle of this moon he should see a lovely blue lotus. On the filaments of this lotus he will see the spotless orb of a second moon, upon which appears the yellow seed-syllable (bīja) Tāṃ. Thereupon, the meditator sees rays of light issuing from this yellow seed-syllable, and this mass of rays destroys the darkness of the world's delusions, illuminates all the endless worlds that exist in the ten directions, and gathers the numberless, measureless families of buddhas and bodhisattvas from the whole universe, bringing them before the meditator.

Such visualizations often lead to meditations of the insight type that we have seen before: The mental picture of a buddha, for instance, is examined by asking questions regarding the substantiality of the image, and of the buddha it represents.

The evocation of deities in contexts that shade off from simple invocation to visualization, and from apotropaic and propitiatory prayer to meditations of identity, was especially popular among Tibetan Buddhists. It is sometimes called deity yoga in the West, in accordance with a free English translation of the Tibetan term lha'i mgnong rtogs ("realization" or "actualization" of the deity). In a deity-yoga sādhana, the meditator invokes and visualizes the physical appearance (including shape, sound, and smell) of his or her own meditation deity (the chosen or assigned object of meditation), which is also the person's main protective deity, the "chosen" tutelary deity (yi dam; Sanskrit, iṣṭadevatā). As a step into higher meditations the practice is indistinguishable from a basic sādhana, but as a devotional practice it is perhaps the most popular of all meditations in circles that follow Tibetan traditions of meditation. A meditation of this type is the nyungne (bsnyung gnas), which is especially popular among the laity and is devoted to the bodhisattva of compassion, Avalokiteśvara. This ritual meditation is usually carried out during the days celebrating the birth, enlightenment, and death of the Buddha. The nyungne is a twoday fasting retreat for laypersons, led by a monk. Although the primary objective appears to be strengthening the vows and precepts of the bodhisattva and the invocation of Avalokiteśvara's compassionate assistance, the model for the liturgy is still that of a deity-yoga sādhana inviting the bodhisattva to make himself present before and inside the meditator.

Another form of Tantric practice, a syllable or a full phrase (of the mantra genre), recited aloud or mumbled, becomes the focus for the development of concentration and insight. These Sanskrit syllables often represent sacred presences, and by extension embody and therefore invoke and appropriate them (that is, fuse or exchange the identities of meditator and deity).

In Japanese Tantric practice, as modeled, for instance, in the Shingon tradition, the syllable hrī is taken to represent the name, person, and presence of AmitĀbha. When the syllable is drawn or recited, the believer presumes that the Buddha Amitābha has been invoked or, better yet, that he is present. The set of all syllables, and therefore of all buddhas, bodhisattvas, and deities, is contained in the primary vowel sound A. This syllable is regarded as the origin and essence of all syllables, and hence of all language and everything

constructed and generated by language. Its invocation therefore brings forth not an individual buddha, but the totality or essence of what is real (dharmadhātu).

Tantric meditation blends the themes and instruments of ritual, sound, and language, combining them with the ideas of serenity and insight, all in a process rooted in a conviction that deities can be made manifest before or assimilated into the meditator. This is then not only meditation of speech, but also meditation of visual imagery; yet it is also a technique for inviting holy, ideal beings to come, as guests, before the meditator, and then gradually share their identity with that of the meditator. Additionally, this identity is usually reduced to the emptiness of all things, which is, paradoxically, what is ultimately real, stable, and foundational.

Other uses of the word

Belief in the transformative power of word and syllable is not limited to Tantra. A different sort of invocation is found in the practice of calling on or calling out the name of the Buddha Amitābha. Indian notions of the sacred name found fertile ground in East Asia, where they tended to cluster around the cult of this buddha in particular, whose invocation has become synonymous with Buddhist devotionalism.

In China, where the East Asian tradition has its roots, one may chant either the name of the Buddha Amitābha or the equivalent of the Sanskrit expression "homage to the Buddha Amitābha" (namo 'mitābhāya buddhāya; Chinese, namo Amito-fo), which has been turned into a sacred name or "the Name." The recitation is conceived as devotion or devotional surrender, but can also be conceived as meditation embedded in traditions of mental culture and moral-ascetic cultivation. In the latter function, the recitation may be part of a visualization exercise in which the meditator imagines or images the paradise of Amitābha, the Pure Land.

Traditional understandings of meditation on the name include conceiving of it as concentrated wish or devotion, as meditation on the true name or essence of the Buddha, or as an aid to visualizing Amitābha's Western Paradise. Additionally, the recitation of the sacred name has been used as part of Chan meditation practice.

The Chan use of language in meditation is less explicit that it is in Tantric tradition, as the Chan tradition claims to have access to an experience that is nonconceptual and free from the boundaries of language. Yet important strands of the tradition claim that this nonconceptual mode of being is achieved through a peculiar use of words. Although ostensibly the ultimate meaning of Chan is "an independent transmission that is outside doctrinal teaching, and does not rely on words," Chan has had much to do with words, and has developed a specialized language of the unspoken and the ineffable.

The Chan traditions (chanzong, or Zen in contemporary Western parlance) began to develop an approach that was described as a method of no-method, but which was in fact a radical method, using a rhetoric of iconoclasm and paradox. The tradition conceives enlightenment as already present in the mind, or, rather, as the mind itself being already enlightened and therefore requiring no cultivation, no meditation. Some strands of the tradition argue accordingly that method and meditation are superfluous; truth must be grasped directly, without mediation; delusion and suffering are nothing but a mistake, and if one abandons the mistake, the true mind manifests itself. Such extreme statements perhaps were put into practice among a limited circle of disciples and for a short time during the Tang dynasty (618–907 c.e.), but, in theory, this rhetoric remained in the tradition as an ideal description of Chan.

Be that as it may, the most characteristic Chan use of language developed in the Song dynasty (960–1279 c.e.) and is known in the West as the kŌan—borrowing the Japanese pronunciation (kōan) of the Chinese gong'an. The term refers today to a key word or phrase used as the pivot or focus for meditation and believed to be derived directly from the words of ancient masters. The key phrase is usually found in an anecdotal or legendary exchange between disciple and master. These dialogues are known as "question and answer" (Japanese, mondō; Chinese, wenda) and are for the most part presented as vignettes of incidents or anecdotes of dialogues from the lives of great Chan masters. The incident or exchange was regarded as a "public case" (the meaning of gong'an), hence a "court precedent" embodying the wisdom of the greatest judges of what is true enlightenment, that is, the great meditation masters of the past. The master's "verdict" or judgment was the key phrase (huatou) in the anecdote.

In the Japanese Rinzai tradition, the meditator memorizes the anecdote with its key phrase (both called kōan in common parlance) and uses the phrase as the focus of concentrated attention. In China, Korea, and Vietnam, it is common to reserve the cases for study, reflection, commentary, or debate, and make the focus of meditation a more general or all-encompassing question, such as: "What is it?" "Who is it?" "Who is reciting the sūtras?" In this phrasing, the it and the who are the focus of concentrated attention.

Whatever the assigned question might be, the meditator is expected to cultivate undistracted awareness of the kōan during sitting meditation and then "take it with him wherever he goes." This is reminiscent of the kasiṇa exercise, in the sense that the person is expected to become one with, and think of nothing but, the object of meditation.

But the exercise also develops insight because the phrase becomes an object of inquiry as part of the question formulated in the kōan (e.g., "What is this?") The answer has to be nondiscursive: a gesture or a sound, or perhaps even the right unquestioned and unreflective word. A common reply is an interjection. Among the interjections, some have become classical answers on the same plane with other sayings of the great masters. One such word is ho! (Japanese, katsu!), a Chinese monosyllabic expression indicating a sharp scolding or sarcastic surprise. The Chan master Can of Boyun Wuliangsi states,

Throughout the twenty-four hours of the day, walk with your key phrase (huatou), stand with your key phrase, sit with your key phrase, lie down with your key phrase. Your mind should feel just like a thorn bush, so you cannot swallow such notions as "person," "self," "delusion," etc. Whether you are walking, standing, sitting, or lying down, turn your entire body into a ball of doubt…. Then, upon hearing some sound or seeing some shape or color, most certainly you will shout, "Ho!" This single sound takes you to the end. (Taishō 2024, vol. 48, 1100a2–7)

The system remained permeable to various influences from the literature and philosophy of the countries in which kōan were used. For instance, beginning with the Ming dynasty (1368–1644), Pure Land recitation was often used as a kōanlike topic. Master Zhiji advised,

Recite the name of the Buddha Amitābha once, or three, or five, or seven times. Then turn back silently and ask yourself, "Where does this recitation of the name of the Buddha arise?" Or ask yourself, "Who is this reciting the name of the Buddha?" If you have doubts, simply have doubts …. Investigate it carefully, inquire into it thoroughly. (Taishō 2024, vol. 48, 1102b18–23)

The practice of Zen meditation, although idealized sometimes as a path of lonely self-discovery, requires constant coaching, prodding, and questioning by a qualified Zen master. In the Japanese Rinzai Zen tradition, interactions between the disciple and the meditation instructor take place in private interviews known as sanzen (Zen practiced by visiting) or dokusan (private visit). The interview can be frightening to the novice because the master traditionally sits on a cushion with his teaching rod lying at his feet, in a dark room, with a single candle illuminating the room from behind the master's back. The disciple must bow before the master and immediately give or demonstrate his understanding of the meditation exercise. Any exchange taking place in dokusan is considered secret because it is believed to embody transmission from mind to mind.

Although tradition sometimes suggests that all kōans ultimately have the same meaning, it is not uncommon to organize kōans in graded or step-wise presentations, or to prescribe them for different purposes (including the healing of specific diseases). Collections composed mostly during the Song dynasty also generated much debate as to the meaning of kōans and the proper explanation or "answer" to the riddle implicit in the fact that a kōan cannot have a "discursive" meaning.

In Japan, approximately after the seventeenth century, kōans were systematized into a curriculum of Zen training that included, for instance, traditional correct answers to the kōans. The plan also incorporated some kōans of Japanese origin, such as the famous, "What is the sound of one hand," attributed to Hakuin Ekaku (1686–1768). The disciple is expected to come up with the correct answer to a given kōan, which will then be accepted or rejected by the master. Once the answer is accepted, the master assigns a different kōan. The rigidity of the system and a number of abuses were often criticized, the most thorough and devastating criticism coming at the beginning of the twentieth century.

The contexts of meditation

What we conceive as "Buddhist meditation" may involve a spectrum of beliefs and practices embedded in both the private and the public lives of Buddhists. Moreover, as outlined above, meditation practice and doctrine, inner meditation processes, and external ritual overlap significantly and reinforce each other.

Unlike ritual, meditation is, in practice, open-ended and subject to missing its ultimate goal, even when technically correct. To express it differently, meditation is supposed to have a transformative effect, but in actual practice, the effect may come about gradually, imperfectly, or not at all. Both the experience of the struggle, the failures and frustrations, and the pragmatic quest for the right technique, time, and intensity of practice are topics worth exploring.

The full range of meditation includes many experiences. We have noted already some of the more abstract: notions of truth, polemical and philosophical insights, and the experience of preparation, retreat, or ritual frames. But, as a personal journey, meditation meets many obstacles: a person's frustration with meditation; sleepiness or overexcitability during meditation; physical pain, fatigue, or discomfort; and the disappointment of making no progress. For people who practice meditation these obstacles are equally important experiences. Sometimes they are either commented upon in meditation instruction, or used for meditation itself.

Needless to say, meditation, like other aspects of the religious life, also has its social contexts and its interpersonal correlates. In its social contexts, meditation can have many meanings and functions. Similarly, the goals of meditation can vary considerably even in the lifetime of one individual. Such goals may be associated with traditions of hygiene, health, and healing, or with those of wonder-working. Meditation is also often closely associated with the visionary quest, the quest for visions of hidden or distant worlds, heavens and hells. It is also associated with ascetic practices, withdrawal, or escape. In all of these functions the tendency is to see meditation as essentially the concentration of spiritual power.

Buddhists can, and often do, appeal to the experience of meditation as a justification or a foundation for their beliefs, values, and practices, regardless of their willingness or capacity to actually practice meditation. But it is also true that many Buddhists see meditation as a value in itself, as an ideal that may be difficult to achieve, too difficult for most of us, but nevertheless as a spiritual discipline that represents the highest accomplishment that a human being is capable of achieving. A Buddhist expressing this second view of meditation can also consider meditation as essentially a practice, something to be done or accomplished, and therefore, as something that is not merely a belief or an ideal.

See also:Bodhi (Awakening); Chan School; Nenbutsu (Chinese, Nianfo; Korean, Yŏmbul); Psychology; Vipassanā (Sanskrit, Vipaśyanā); Yogācāra School

Bibliography

Beyer, Stephan. The Cult of Tārā: Magic and Ritual in Tibet. Berkeley, Los Angeles, and London: University of California Press, 1973.

Beyer, Stephan V., ed. and trans. The Buddhist Experience: Sources and Interpretations. Encino, CA: Wadsworth, 1974.

Beyer, Stephan V. "The Doctrine of Meditation in the Hīnayāna" and "The Doctrine of Meditation in the Mahāyāna." In Buddhism: A Modern Perspective, ed. Charles S. Prebish. University Park: Pennsylvania State University Press, 1975.

Blacker, Carmen. "Methods of Yoga in Japanese Buddhism." In Comparative Religion: The Charles Strong Trust Lectures, ed. John Bowan. Leiden, Netherlands: Brill, 1972.

Blofeld, John. The Tantric Mysticism of Tibet: A Practical Guide. New York: Dutton, 1970.

Blofeld, John Eaton Calthorpe. Mantras: Sacred Words of Power. London: Allen and Unwin, 1977.

Bronkhorst, Johannes. The Two Traditions of Meditation in Ancient India. Stuttgart, Germany: Verlag, 1986; 2nd revised edition, Delhi: Motilal Banarsidass, 1993 (mistakenly identified as "first edition" on the copyright page).

Cleary, Thomas. Stopping and Seeing: A Comprehensive Course in Buddhist Meditation by Chih-I. Boston: Shambhala, 1997.

Conze, Edward, ed. and trans. Buddhist Meditation. London: Allen and Unwin, 1956.

Gómez, Luis O. "Prayer: Buddhist Perspectives" and "Spirituality: Buddhist Perspectives." In Encyclopedia of Monasticism, Vol. 2, ed. William M. Johnston. Chicago: Fitzroy Dearborn, 2000.

Griffiths, Paul J. "Indian Buddhist Meditation." In Buddhist Spirituality: Indian, Southeast Asian, Tibetan, Early Chinese, 2 vols., ed. Yoshinori Takeuchi. New York: Crossroad, 1993.

Jamgon Kongtrul Lodro Tayé (Kong-sprul Blo-gros-mtha'-yas). Jamgon Kongtrul's Retreat Manual, tr. Ngawang Zangpo. Ithaca, NY: Snow Lion, 1994.

King, Winston L. Theravāda Meditation: The Buddhist Transformation of Yoga. University Park: Pennsylvania State University Press, 1980.

Kornfield, Jack. Living Dharma: Teachings of Twelve Buddhist Masters. Boston: Shambhala, 1996. Previously published as Living Buddhist Masters, Santa Cruz, CA: Unity Press, 1977.

Minoru Kiyota, ed., assisted by Elvin W. Jones. Mahāyāna Buddhist Meditation: Theory and Practice. Honolulu: University of Hawaii Press, 1978.

Nyanaponika Thera. The Heart of Buddhist Meditation. London: Rider, 1962.

Sharf, Robert H. "Buddhist Modernism and the Rhetoric of Meditative Experience." Numen 42 (1995): 228–283.

Sharf, Robert H. "Experience." In Critical Terms for Religious Studies, ed. Mark C. Taylor. Chicago: University of Chicago Press, 1998.

Sharf, Robert H., and Sharf, Elizabeth Horton. Living Images: Japanese Buddhist Icons in Context. Stanford, CA: Stanford University Press, 2001.

Singh Khalsa, Dharma, and Stauth, Cameron. Meditation as Medicine: Activate the Power of Your Natural Healing Force. New York: Pocket Books, 2001.

Tambiah, Stanley J. "The Cosmological and Performative Significance of a Thai Cult of Healing through Meditation." Culture, Medicine, and Psychiatry 1, no. 1 (1977): 97–132.

Thrangu, Khenchen. The Practice of Tranquility and Insight: A Guide to Tibetan Buddhist Meditation. Ithaca, NY: Snow Lion, 1993.

Vajirañāna, Paravahera (Mahāthera). Buddhist Meditation in Theory and Practice: A General Exposition According to the Pāli Canon of the Theravāda School (1962). Kuala Lumpur, Malaysia: Buddhist Missionary Society, 1975.

Yamasaki, Taiko. Shingon: Japanese Esoteric Buddhism, translated and adapted by Richard and Cynthia Peterson, ed. Yasuyoshi Morimoto and David Kidd. Boston: Shambhala, 1988.

Luis O. GÓmez

Meditation

Definition

Meditation is a practice of concentrated focus upon a sound, object, visualization, the breath, movement, or attention itself in order to increase awareness of the present moment, reduce stress , promote relaxation , and enhance personal and spiritual growth.

Origins

Meditation techniques have been practiced for millennia. Originally, they were intended to develop spiritual understanding, awareness, and direct experience of ultimate reality. The many different religious traditions in the world have given rise to a rich variety of meditative practices. These include the contemplative practices of Christian religious orders, the Buddhist practice of sitting meditation, and the whirling movements of the Sufi dervishes. Although meditation is an important spiritual practice in many religious and spiritual traditions, it can be practiced by anyone regardless of their religious or cultural background to relieve stress and pain .

As Western medical practitioners begin to understand the mind's role in health and disease, there has been more interest in the use of meditation in medicine. Meditative practices are increasingly offered in medical clinics and hospitals as a tool for improving health and quality of life. Meditation has been used as the primary therapy for treating certain diseases; as an additional therapy in a comprehensive treatment plan; and as a means of improving the quality of life of people with debilitating, chronic, or terminal illnesses.

Benefits

Meditation benefits people with or without acute medical illness or stress. People who meditate regularly

have been shown to feel less anxiety and depression . They also report that they experience more enjoyment and appreciation of life and that their relationships with others are improved. Meditation produces a state of deep relaxation and a sense of balance or equanimity. According to Michael J. Baime, "Meditation cultivates an emotional stability that allows the meditator to experience intense emotions fully while simultaneously maintaining perspective on them." Out of this experience of emotional stability, one may gain greater insight and understanding about one's thoughts, feelings, and actions. This insight in turn offers the possibility to feel more confident and in control of life. Meditation facilitates a greater sense of calmness, empathy, and acceptance of self and others.

Meditation can be used with other forms of medical treatment and is an important complementary therapy for both the treatment and prevention of many stress-related conditions. Regular meditation can reduce the number of symptoms experienced by patients with a wide range of illnesses and disorders. Based upon clinical evidence as well as theoretical understanding, meditation is considered to be one of the better therapies for panic disorder , generalized anxiety disorder, substance dependence and abuse, ulcers, colitis, chronic pain, psoriasis , and dysthymic disorder. It is considered to be a valuable adjunctive therapy for moderate hypertension (high blood pressure), prevention of cardiac arrest (heart attack ), prevention of atherosclerosis (hardening of arteries), arthritis (including fibromyalgia ), cancer, insomnia , migraine, and prevention of stroke . Meditation may also be a valuable complementary therapy for allergies and asthma because of the role stress plays in these conditions. Meditative practices have been reported to improve function or reduce symptoms in patients with some neurological disorders as well. These include people with Parkinson's disease , people who experience fatigue with multiple sclerosis , and people with epilepsy who are resistant to standard treatment.

Overall, a 1995 report to the National Institutes of Health on alternative medicine concluded that, "More than 30 years of research, as well as the experience of a large and growing number of individuals and health care providers, suggests that meditation and similar forms of relaxation can lead to better health, higher quality of life, and lowered health care costs." A study of health care professionals published in 2002 indicates that the majority of physicians, nurses, and occupational therapists in the United States accept meditation as a beneficial adjunct to conventional medical or surgical treatments.

Description

Sitting meditation is generally done in an upright seated position, either in a chair or cross-legged on a cushion on the floor. The spine is straight yet relaxed. Sometimes the eyes are closed. Other times the eyes are open and gazing softly into the distance or at an object. Depending on the type of meditation, the meditator may be concentrating on the sensation of the movement of the breath, counting the breath, silently repeating a sound, chanting, visualizing an image, focusing awareness on the center of the body, opening to all sensory experiences including thoughts, or performing stylized ritual movements with the hands.

Movement meditation can be spontaneous and free-form or involve highly structured, choreographed, repetitive patterns. Movement meditation is particularly helpful for those people who find it difficult to remain still.

MAHARISHI MAHESH YOGI 1911–

Maharishi Mahesh Yogi is one of the most recognized spiritual leaders of the world. Almost single-handedly, the Maharishi (meaning great sage) brought Eastern culture into Western consciousness. He emerged in the late 1950s in London and the United States as a missionary in the cause of Hinduism, the philosophy of which is called Vedanta—a belief that "holds that God is to be found in every creature and object, that the purpose of human life is to realize the godliness in oneself and that religious truths are universal."

By 1967, the Maharishi became a leader among flower-children and an anti-drug advocate. The Maharishi's sudden popularity was helped along by such early fans as the Beatles, Mia Farrow, and Shirley MacLaine. These people, and many others, practiced Transcendental Meditation (TM), a Hindu-influenced procedure that endures in America to this day.

When the 1960s drew to a close, the Maharishi began to fade from public view. The guru still had enough followers, though, to people the Maharishi International University, founded in 1971. One of the main draws of Maharishi International University was the study of TMSidha, an exotic form of Transcendental Meditation. Sidhas believe that group meditation can elicit the maharishi effect—a force strong enough to conjure world peace.

Generally speaking, there are two main types of meditation. These types are concentration meditation and mindfulness meditation. Concentration meditation practices involve focusing attention on a single object. Objects of meditation can include the breath, an inner or external image, a movement pattern (as in tai chi or yoga ), or a sound, word, or phrase that is repeated silently (mantra). The purpose of concentrative practices is to learn to focus one's attention or develop concentration. When thoughts or emotions arise, the meditator gently directs the mind back to the original object of concentration.

Mindfulness meditation practices involve becoming aware of the entire field of attention. The meditator is instructed to be aware of all thoughts, feelings, perceptions, or sensations as they arise in each moment. Mindfulness meditation practices are enhanced by the meditator's ability to focus and quiet the mind. Many meditation practices are a blend of these two forms.

The study and application of meditation to health care has focused on three specific approaches: 1. transcendental meditation (TM); 2. The "relaxation response," a general approach to meditation developed by Dr. Herbert Benson ; and 3. mindfulness meditation, specifically the program of mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn.

Transcendental meditation

TM has its origins in the Vedic tradition of India and was introduced to the West by Maharishi Mahesh Yogi . TM has been taught to somewhere between two and four million people. It is one of the most widely practiced forms of meditation in the West. TM has been studied many times; these studies have produced much of the information about the physiology of meditation. In TM, the meditator sits with closed eyes and concentrates on a single syllable or word (mantra) for 20 minutes at a time, twice a day. When thoughts or feelings arise, the attention is brought back to the mantra. According to Charles Alexander, an important TM researcher, "During TM, ordinary waking mental activity is said to settle down, until even the subtlest thought is transcended and a completely unified wholeness of awareness..is experienced. In this silent, self-referential state of pure wakefulness, consciousness is fully awake to itself alone.." TM supporters believe that TM practices are more beneficial than other meditation practices. A group of Australian researchers has recently recommended TM as a preventive strategy for heart disease .

The relaxation response

The relaxation response involves a similar form of mental focusing. Dr. Herbert Benson, one of the first Western doctors to conduct research on the effects of meditation, developed this approach after observing the profound health benefits of a state of bodily calm he calls "the relaxation response." In order to elicit this response in the body, he teaches patients to focus upon the repetition of a word, sound, prayer, phrase, or movement activity (including swimming, jogging, yoga, and even knitting) for 10–20 minutes at a time, twice a day. Patients are also taught not to pay attention to distracting thoughts and to return their focus to the original repetition. The choice of the focused repetition is up to the individual. Instead of Sanskrit terms, the meditator can choose what is personally meaningful, such as a phrase from a prayer.

Mindfulness meditation

Mindfulness meditation comes out of traditional Buddhist meditation practices. Psychologist Jon Kabat-Zinn has been instrumental in bringing this form of meditation into medical settings. In formal mindfulness practice, the meditator sits with eyes closed, focusing the attention on the sensations and movement of the breath for approximately 45–60 minutes at a time, at least once a day. Informal mindfulness practice involves bringing awareness to every activity in daily life. Wandering thoughts or distracting feelings are simply noticed without resisting or reacting to them. The essence of mindfulness meditation is not what one focuses on but rather the quality of awareness the meditator brings to each moment. According to Kabat-Zinn, "It is this investigative, discerning observation of whatever comes up in the present moment that is the hallmark of mindfulness and differentiates it most from other forms of meditation. The goal of mindfulness is for you to be more aware, more in touch with life and whatever is happening in your own body and mind at the time it is happening—that is, the present moment." The MBSR program consists of a series of classes involving meditation, movement, and group process. There are over 240 MBSR programs offered in health care settings around the world.

Meditation is not considered a medical procedure or intervention by most insurers. Many patients pay for meditation training themselves. Frequently, religious groups or meditation centers offer meditation instruction free of charge or for a nominal donation. Hospitals may offer MBSR classes at a reduced rate for their patients and a slightly higher rate for the general public.

Precautions

Meditation appears to be safe for most people. There are, however, case reports and studies noting some adverse effects. Thirty-three to 50% of the people participating in long silent meditation retreats (two weeks to three months) reported increased tension, anxiety, confusion, and depression. On the other hand, most of these same people also reported very positive effects from their meditation practice. Kabat-Zinn notes that these studies fail to differentiate between serious psychiatric disturbances and normal emotional mood swings. These studies do suggest, however, that meditation may not be recommended for people with psychotic disorders, severe depression, and other severe personality disorders unless they are also receiving psychological or medical treatment.

Side effects

There are no reported side effects from meditation except for positive benefits.

Research & general acceptance

The scientific study of the physiological effects of meditation began in the early 1960s. These studies prove that meditation affects metabolism, the endocrine system, the central nervous system, and the autonomic nervous system. In one study, three advanced practitioners of Tibetan Buddhist meditation practices demonstrated the ability to increase "inner heat" as much as 61%. During a different meditative practice they were able to dramatically slow down the rate at which their bodies consumed oxygen. Preliminary research shows that mindfulness meditation is associated with increased levels of melatonin . These findings suggest a potential role for meditation in the treatment and prevention of breast and prostrate cancer.

Despite the inherent difficulties in designing research studies, there is a large amount of evidence of the medical benefits of meditation. Meditation is particularly effective as a treatment for chronic pain. Studies have shown meditation reduces symptoms of pain and pain-related drug use. In a four-year follow-up study, the majority of patients in a MBSR program reported "moderate to great improvement" in pain as a result of participation in the program.

Meditation has long been recommended as a treatment for high blood pressure; however, there is a debate over the amount of benefit that meditation offers. Although most studies show a reduction in blood pressure with meditation, medication is still more effective at lowering high blood pressure.

Meditation may also be an effective treatment for coronary artery disease. A study of 21 patients practicing TM for eight months showed increases in their amount of exercise tolerance, amount of workload, and a delay in the onset of ST-segment depression. Meditation is also an important part of Dean Ornish's program, which has been proven to reverse coronary artery disease.

Research also suggests that meditation is effective in the treatment of chemical dependency. Gelderloos and others reviewed 24 studies and reported that all of them showed that TM is helpful in programs to stop smoking and also in programs for drug and alcohol abuse.

Studies also imply that meditation is helpful in reducing symptoms of anxiety and in treating anxiety-related disorders. Furthermore, a study in 1998 of 37 psoriasis patients showed that those practicing mindfulness meditation had more rapid clearing of their skin condition, with standard UV light treatment, than the control subjects. Another study found that meditation decreased the symptoms of fibromyalgia; over half of the patients reported significant improvement. Research by a group of ophthalmologists indicates that nearly 60% of a group of patients being treated for glaucoma found meditation helpful in coping with their eye disorder. In addition, meditation was one of several stress management techniques used in a small study of HIV-positive men. The study showed improvements in the T-cell counts of the men, as well as in several psychological measures of well-being.

Training & certification

There is no program of certification or licensure for instructors who wish to teach meditation as a medical therapy. Meditation teachers within a particular religious tradition usually have extensive experience and expertise with faith questions and religious practices but may not have been trained to work with medical patients. Different programs have varied requirements for someone to teach meditation. In order to be recognized as an instructor of TM, one must receive extensive training. The Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical Center offers training and workshops for health professionals and others interested in teaching mindfulness-based stress reduction. The Center does not, however, certify that someone is qualified to teach meditation. The University of Pennsylvania program for Stress Management suggests that a person have at least 10 years of personal experience with the practice of mindfulness meditation before receiving additional instruction to teach meditation. Teachers are also expected to spend at least two weeks each year in intensive meditation retreats.

Resources

BOOKS

Astin, John A., et al. "Meditation." In Clinician's Complete Reference to Complementary and Alternative Medicine, edited by Donald Novey. St. Louis: Mosby, 2000.

Baime, Michael J. "Meditation and Mindfulness." In Essentials of Complementary and Alternative Medicine, edited by Wayne B. Jonas and Jeffrey S. Levin. New York: Lippincott, Williams and Wilkins, 1999.

Benson, Herbert, M.D. The Relaxation Response. New York: William Morrow, 1975.

Kabat-Zinn, John. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Dell, 1990.

Roth, Robert. TM Transcendental Meditation: A New Introduction to Maharishi's Easy, Effective and Scientifically Proven Technique for Promoting Better Health. Donald I. Fine, 1994.

PERIODICALS

King, M. S., T. Carr, and C. D'Cruz. "Transcendental Meditation, Hypertension and Heart Disease." Australian Family Physician 31 (February 2002): 164–168.

Rhee, D. J., G. L. Spaeth, J. S. Myers, et al. "Prevalence of the Use of Complementary and Alternative Medicine for Glaucoma." Ophthalmology 109 (March 2002): 438–443.

Schoenberger, N. E., R. J. Matheis, S. C. Shiflett, and A. C. Cotter. "Opinions and Practices of Medical Rehabilitation Professionals Regarding Prayer and Meditation." Journal of Alternative and Complementary Medicine 8 (February 2002): 59–69.

ORGANIZATIONS

Insight Meditation Society. 1230 Pleasant, St. Barre, MA 01005. (978) 355-4378. FAX: (978) 355-6398. <http://www.dharma.org>.

Mind-Body Medical Institute. Beth Israel Deaconess Medical Center. One Deaconess Road, Boston, MA 02215. (617) 632-9525. <http://www.mbmi.org>.

The Center for Mindfulness in Medicine, Health Care and Society. Stress Reduction Clinic. University of Massachusetts Memorial Health Care. 55 Lake Avenue North, Worcester, MA 01655. (508) 856-2656. Fax (508) 856-1977. jon.kabat-zinn@banyan@ummed.edu <http://www.umassmed.edu/cfm>.

Linda Chrisman

Rebecca J. Frey, PhD

Meditation

Definition

Meditation is a practice of concentrated focus upon a sound, object, visualization, the breath, movement, or attention itself in order to increase awareness of the present moment, reduce stress, promote relaxation, and enhance personal and spiritual growth.

Purpose

Meditation benefits people with or without acute medical illness or stress. People who meditate regularly have been shown to feel less anxiety and depression. They also report that they experience more enjoyment and appreciation of life and that their relationships with others are improved. Meditation produces a state of deep relaxation and a sense of balance or equanimity. According to Michael J. Baime, "Meditation cultivates an emotional stability that allows the meditator to experience intense emotions fully while simultaneously maintaining perspective on them." Out of this experience of emotional stability, one may gain greater insight and understanding about one's thoughts, feelings, and actions. This insight in turn offers the possibility to feel more confident and in control of life. Meditation facilitates a greater sense of calmness, empathy, and acceptance of self and others.

Meditation can be used with other forms of medical treatment and is an important complementary therapy for both the treatment and prevention of many stress-related conditions. Regular meditation can reduce the number of symptoms experienced by patients with a wide range of illnesses and disorders. Based upon clinical evidence as well as theoretical understanding, meditation is considered to be one of the better therapies for panic disorder, generalized anxiety disorder, substance dependence and abuse, ulcers, colitis, chronic pain, psoriasis, and dysthymic disorder. It is considered to be a valuable adjunctive therapy for moderate hypertension (high blood pressure), prevention of cardiac arrest (heart attack ), prevention of atherosclerosis (hardening of arteries), arthritis (including fibromyalgia), cancer, insomnia, migraine, and prevention of stroke. Meditation may also be a valuable complementary therapy for allergies and asthma because of the role stress plays in these conditions. Meditative practices have been reported to improve function or reduce symptoms in patients with some neurological disorders as well. These include people with Parkinson's disease, people who experience fatigue with multiple sclerosis, and people with epilepsy who are resistant to standard treatment.

Overall, a 1995 report to the National Institutes of Health on alternative medicine concluded that, "More than 30 years of research, as well as the experience of a large and growing number of individuals and health care providers, suggests that meditation and similar forms of relaxation can lead to better health, higher quality of life, and lowered health care costs …"

Description

Origins

Meditation techniques have been practiced for millennia. Originally, they were intended to develop spiritual understanding, awareness, and direct experience of ultimate reality. The many different religious traditions in the world have given rise to a rich variety of meditative practices. These include the contemplative practices of Christian religious orders, the Buddhist practice of sitting meditation, and the whirling movements of the Sufi dervishes. Although meditation is an important spiritual practice in many religious and spiritual traditions, it can be practiced by anyone regardless of their religious or cultural background to relieve stress and pain.

MAHARISHI MAHESH YOGI (1911–)

Maharishi Mahesh Yogi is one of the most recognized spiritual leaders of the world. Almost single-handedly, the Maharishi (meaning great sage) brought Eastern culture into Western consciousness. He emerged in the late 1950s in London and the United States as a missionary in the cause of Hinduism, the philosophy of which is called Vedanta—a belief that "holds that God is to be found in every creature and object, that the purpose of human life is to realize the godliness in oneself and that religious truths are universal."

By 1967, the Maharishi became a leader among flower-children and an anti-drug advocate. The Maharishi's sudden popularity was helped along by such early fans as the Beatles, Mia Farrow, and Shirley MacLaine. These people, and many others, practiced Transcendental Meditation (TM), a Hindu-influenced procedure that endures in America to this day.

When the 1960s drew to a close, the Maharishi began to fade from public view. The guru still had enough followers, though, to people the Maharishi International University, founded in 1971. One of the main draws of Maharishi International University was the study of TM-Sidha, an exotic form of Transcendental Meditation. Sidhas believe that group meditation can elicit the maharishi effect—a force strong enough to conjure world peace.

As Western medical practitioners begin to understand the mind's role in health and disease, there has been more interest in the use of meditation in medicine. Meditative practices are increasingly offered in medical clinics and hospitals as a tool for improving health and quality of life. Meditation has been used as the primary therapy for treating certain diseases; as an additional therapy in a comprehensive treatment plan; and as a means of improving the quality of life of people with debilitating, chronic, or terminal illnesses.

Sitting meditation is generally done in an upright seated position, either in a chair or cross-legged on a cushion on the floor. The spine is straight yet relaxed. Sometimes the eyes are closed. Other times the eyes are open and gazing softly into the distance or at an object. Depending on the type of meditation, the meditator may be concentrating on the sensation of the movement of the breath, counting the breath, silently repeating a sound, chanting, visualizing an image, focusing awareness on the center of the body, opening to all sensory experiences including thoughts, or performing stylized ritual movements with the hands.

Movement meditation can be spontaneous and free-form or involve highly structured, choreographed, repetitive patterns. Movement meditation is particularly helpful for those people who find it difficult to remain still.

Generally speaking, there are two main types of meditation. These types are concentration meditation and mindfulness meditation. Concentration meditation practices involve focusing attention on a single object. Objects of meditation can include the breath, an inner or external image, a movement pattern (as in tai chi or yoga ), or a sound, word, or phrase that is repeated silently (mantra). The purpose of concentrative practices is to learn to focus one's attention or develop concentration. When thoughts or emotions arise, the meditator gently directs the mind back to the original object of concentration.

Mindfulness meditation practices involve becoming aware of the entire field of attention. The meditator is instructed to be aware of all thoughts, feelings, perceptions or sensations as they arise in each moment. Mindfulness meditation practices are enhanced by the meditator's ability to focus and quiet the mind. Many meditation practices are a blend of these two forms.

The study and application of meditation to health care has focused on three specific approaches: 1. transcendental meditation (TM); 2. The "relaxation response," a general approach to meditation developed by Dr. Herbert Benson; and 3. mindfulness meditation, specifically the program of mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn.

Transcendental meditation

TM has its origins in the Vedic tradition of India and was introduced to the West by Maharishi Mahesh Yogi. TM has been taught to somewhere between two and four million people. It is one of the most widely practiced forms of meditation in the West. TM has been studied many times; these studies have produced much of the information about the physiology of meditation. In TM, the meditator sits with closed eyes and concentrates on a single syllable or word (mantra) for 20 minutes at a time, twice a day. When thoughts or feelings arise, the attention is brought back to the mantra. According to Charles Alexander, an important TM researcher, "During TM, ordinary waking mental activity is said to settle down, until even the subtlest thought is transcended and a completely unified wholeness of awareness … is experienced. In this silent, self-referential state of pure wakefulness, consciousness is fully awake to itself alone…." TM supporters believe that TM practices are more beneficial than other meditation practices.

The relaxation response

The relaxation response involves a similar form of mental focusing. Dr. Herbert Benson, one of the first Western doctors to conduct research on the effects of meditation, developed this approach after observing the profound health benefits of a state of bodily calm he calls "the relaxation response." In order to elicit this response in the body, he teaches patients to focus upon the repetition of a word, sound, prayer, phrase, or movement activity (including swimming, jogging, yoga, and even knitting) for 10-20 minutes at a time, twice a day. Patients are also taught not to pay attention to distracting thoughts and to return their focus to the original repetition. The choice of the focused repetition is up to the individual. Instead of Sanskrit terms, the meditator can choose what is personally meaningful, such as a phrase from a Christian or Jewish prayer.

Mindfulness meditation

Mindfulness meditation comes out of traditional Buddhist meditation practices. Psychologist Jon Kabat-Zinn has been instrumental in bringing this form of meditation into medical settings. In formal mindfulness practice, the meditator sits with eyes closed, focusing the attention on the sensations and movement of the breath for approximately 45-60 minutes at a time, at least once a day. Informal mindfulness practice involves bringing awareness to every activity in daily life. Wandering thoughts or distracting feelings are simply noticed without resisting or reacting to them. The essence of mindfulness meditation is not what one focuses on but rather the quality of awareness the meditator brings to each moment. According to Kabat-Zinn, "It is this investigative, discerning observation of whatever comes up in the present moment that is the hallmark of mindfulness and differentiates it most from other forms of meditation. The goal of mindfulness is for you to be more aware, more in touch with life and whatever is happening in your own body and mind at the time it is happening—that is, the present moment." The MBSR program consists of a series of classes involving meditation, movement, and group process. There are over 240 MBSR programs offered in health care settings around the world.

Meditation is not considered a medical procedure or intervention by most insurers. Many patients pay for meditation training themselves. Frequently, religious groups or meditation centers offer meditation instruction free of charge or for a nominal donation. Hospitals may offer MBSR classes at a reduced rate for their patients and a slightly higher rate for the general public.

Precautions

Meditation appears to be safe for most people. There are, however, case reports and studies noting some adverse effects. Thirty-three to 50% of the people participating in long silent meditation retreats (two weeks to three months) reported increased tension, anxiety, confusion, and depression. On the other hand, most of these same people also reported very positive effects from their meditation practice. Kabat-Zinn notes that these studies fail to differentiate between serious psychiatric disturbances and normal emotional mood swings. These studies do suggest, however, that meditation may not be recommended for people with psychotic disorders, severe depression, and other severe personality disorders unless they are also receiving psychological or medical treatment.

Side effects

There are no reported side effects from meditation except for positive benefits.

Research and general acceptance

The scientific study of the physiological effects of meditation began in the early 1960s. These studies prove that meditation affects metabolism, the endocrine system, the central nervous system, and the autonomic nervous system. In one study, three advanced practitioners of Tibetan Buddhist meditation practices demonstrated the ability to increase "inner heat" as much as 61%. During a different meditative practice they were able to dramatically slow down the rate at which their bodies consumed oxygen. Preliminary research shows that mindfulness meditation is associated with increased levels of melatonin. These findings suggest a potential role for meditation in the treatment and prevention of breast and prostrate cancer.

KEY TERMS

Dervish— A member of the Sufi order. Their practice of meditation involves whirling ecstatic dance.

Mantra— A sacred word or formula repeated over and over to concentrate the mind.

Transcendental meditation (TM)— A meditation technique based on Hindu practices that involves the repetition of a mantra.

Despite the inherent difficulties in designing research studies, there is a large amount of evidence of the medical benefits of meditation. Meditation is particularly effective as a treatment for chronic pain. Studies have shown meditation reduces symptoms of pain and pain-related drug use. In a four-year follow-up study, the majority of patients in a MBSR program reported "moderate to great improvement" in pain as a result of participation in the program.

Meditation has long been recommended as a treatment for high blood pressure; however, there is a debate over the amount of benefit that meditation offers. Although most studies show a reduction in blood pressure with meditation, medication is still more effective at lowering high blood pressure.

Meditation may also be an effective treatment for coronary artery disease. A study of 21 patients practicing TM for eight months showed increases in their amount of exercise tolerance, amount of workload, and a delay in the onset of ST-segment depression. Meditation is also an important part of Dean Ornish's program, which has been proven to reverse coronary artery disease.

Research also suggests that meditation is effective in the treatment of chemical dependency. Gelderloos and others reviewed 24 studies and reported that all of them showed that TM is helpful in programs to stop smoking and also in programs for drug and alcohol abuse.

Studies also imply that meditation is helpful in reducing symptoms of anxiety and in treating anxiety-related disorders. Furthermore, a study in 1998 of 37 psoriasis patients showed that those practicing mindfulness meditation had more rapid clearing of their skin condition, with standard UV light treatment, than the control subjects. Another study found that meditation decreased the symptoms of fibromyalgia; over half of the patients reported significant improvement. Meditation was one of several stress management techniques used in a small study of HIV-positive men. The study showed improvements in the T-cell counts of the men, as well as in several psychological measures of well-being.

Resources

BOOKS

Astin, John A., et al. "Meditation" in Clinician's Complete Reference to Complementary and Alternative Medicine, edited by Donald Novey. St. Louis, MO: Mosby, 2000.

Baime, Michael J. "Meditation and Mindfulness" in Essentials of Complementary and Alternative Medicine, edited Wayne B. Jonas and Jeffrey S. Levin. New York: Lippencott, Williams and Wilkins, 1999.

ORGANIZATIONS

Insight Meditation Society. 1230 Pleasant, St. Barre, MA 01005. (978) 355-4378. FAX: (978) 355-6398. 〈http://www.dharma.org〉.

Mind-Body Medical Institute. Beth Israel Deaconess Medical Center. One Deaconess Road, Boston, MA 02215. (617) 632-9525. 〈http://www.mindbody.harvard.edu〉.

OTHER

Videos are available from the organizations listed above.

Meditation

Definition

Purpose

Precautions

Description

Normal results

Resources

Definition

Meditation or contemplation involves focusing the mind upon a sound, phrase, prayer, object, visualized image, the breath, ritualized movements, or consciousness in order to increase awareness of the present moment, promote relaxation, reduce stress , and enhance personal or spiritual growth.

Purpose

Meditation can benefit people who are ill or overwhelmed by stress. It also promotes well-being in healthy people. In general, people who meditate regularly experience less anxiety and depression. They also report more enjoyment and appreciation of life, as well as better social relationships. Meditation produces a state of deep relaxation and a sense of balance, or equanimity. According to Michael J. Baime in Essentials of Complementary and Alternative Medicine, meditation allows one to fully experience intense emotions without losing composure. The consequence of emotional balance is greater insight regarding one’s thoughts, feelings, and actions. Insight, in turn, promotes confidence and awareness. Meditation also facilitates a greater sense of calmness, empathy, and acceptance of self and others.

Meditation is sometimes suggested as a complement to medical treatments of disease; in particular, it is an important complementary therapy for both the treatment and prevention of many stress-related conditions. Regular meditation may reduce the number of symptoms experienced by patients with a wide range of illnesses and disorders. Based upon clinical evidence, as well as theory, meditation is seen as an appropriate therapy for panic disorder , generalized anxiety disorder , substance dependence and abuse , ulcers, colitis, chronic pain , psoriasis, and dysthymic disorder—a disorder that involves a steady, depressed mood for at least two years. Moreover, meditation is a valuable adjunct therapy for moderate hypertension (high blood pressure), prevention of cardiac arrest (heart attack), prevention of atherosclerosis (hardening of the arteries), arthritis (including fibromyalgia), cancer, insomnia , migraine, and stroke . It is a complementary therapy for moderating allergies and asthma because it reduces stress, which is prevalent in these conditions. Additionally, meditation may improve function or reduce symptoms of patients with neurologic disorders such as Parkinson’s disease, multiple sclerosis, and epilepsy.

In 1995, the authors of a report to the National Institutes of Health on complementary or alternative medicine reviewed 30 years of research and reports of individuals and health care providers. They concluded that meditation and related methods for the enhancement of relaxation are cost-effective ways to improve health and quality of life (QOL).

Precautions

Meditation appears to be safe for most people. There are, however, case reports and studies noting some adverse effects. For example, 33% to 50% of people who participated in long, silent meditation retreats (two weeks to three months) reported increased tension, anxiety, confusion, and depression. On the other hand, they also reported that meditation was associated with very positive effects. It has been noted, however, that these studies failed to differentiate between serious psychiatric disturbances and normal mood swings. Nevertheless, the evidence suggests that meditation may not be appropriate for people with psychotic disorders, major depression, or severe personality disorders . Some researchers point out that the relaxed, trance-like state that characterizes deep meditation is similar to a hypnotic trance. Hence, meditation, as well as hypnosis, may be contra-indicated for people who have difficulty giving up control, such as people who are obsessive and compulsive.

Description

Background

Meditation has been practiced for millennia. Historically, meditation or contemplation was intended to develop spiritual understanding, awareness, or gratitude. It also was meant to help the person commune with God, or ultimate reality. The many different religious traditions in the world have given rise to a rich variety of meditative practices. These include the contemplative prayers and chants of Christian religious orders, the Buddhist practice of sitting meditation, and the whirling movements of the Sufi dervishes. Although meditation is an important spiritual practice in many traditions, it can be practiced by anyone to relieve stress and pain regardless of religious or cultural background.

In recent decades, a holistic approach to medicine has become increasingly popular. This approach developed in response to the ideas that health care providers treat whole persons, and that wellness and illness are better understood in terms of the body, mind, and soul. Some refer to this type of medicine as integrative, (that is, the Western biologic model of disease) and notions of appropriate treatment are modified by knowledge garnered from other cultures—especially those of China and India. When foreign ideas are tested in the U.S. both clinically and scientifically, if found to be valid they are integrated into Western medicine.

With the increasing acceptance of holistic medicine, there has been more interest in the use of alternative or complementary therapies, such as meditation, hypnosis, and progressive relaxation. As a result, training in meditation and meditation sessions are offered in medical clinics and hospitals. Meditation has been used as primary therapy for treating certain diseases and as complementary therapy in a comprehensive treatment plan. Moreover, it has been employed as a means of improving the QOL of people with debilitating, chronic, or terminal diseases.

When people are dying, they often cope with enduring pain, anxiety and fear, and end-of-life spiritual concerns. Meditation can be a way for the patient with terminal illness to self-manage pain and anxiety. This can partially reduce the amount of drugs required for effective pain control. People who are dying sometimes reject narcotics in an effort to preserve their consciousness and their communication with people who are important to them. Meditation is a means of preserving consciousness and life as the dying patient knows it. Also, meditation can be tailored to the religious or spiritual needs of the patient, and may be a means to spiritual solace.

In general, there are two main types of meditation: concentration, and mindful meditation. Concentration meditation involves focusing one’s attention on the breath, an imagined or real image, ritualized movements (as in Tai chi, yoga, or qigong), or on a sound, word, or phrase that is repeated silently or aloud (mantra). In the Christian tradition, chanting and saying the rosary are forms of meditation. (A rosary is a string of beads used to keep track of the prayers recited.) One purpose of concentration meditation is to fully experience the present moment with serenity. The benefit of being fully present is that worries and anxieties fade, and a feeling of peace ensues. It is the feeling of peace that has physiological benefits, and has been referred to as the relaxation response. When thoughts or emotions arise, the person gently directs his or her mind back to the original focus of concentration.

In comparison, mindfulness meditation involves becoming aware of the entire field of attention. There is an awareness of all thoughts, feelings, perceptions or sensations as they arise from moment to moment. Mindfulness meditation is enhanced by the person’s ability to quiet the mind and to accept all that is perceived with composure. Many approaches to meditation are a blend of concentration and mindfulness.

Meditation may involve a quiet, relatively motionless seated posture or it may involve ritualized movement. Sitting meditation is generally done in an upright position, either in a chair or cross-legged on a cushion or mat on the floor. The spine is straight, yet relaxed. The eyes may be closed or open and gazing softly into the distance or at an object. Depending on the tradition, the person may be concentrating on the sensation of the movement of the breath; counting breaths; silently repeating a mantra; chanting a prayer; visualizing a peaceful and meaningful place; focusing awareness on the center of the body; or increasing awareness of all sensory experiences.

Movement meditation may be spontaneous and free form or it may involve highly structured, choreographed, repetitive patterns, as in the practice of Tai chi or qigong. (Tai chi and qigong are ancient Chinese forms of meditation with movement; both are believed to promote health by preserving or restoring the life force, or qi.) Movement meditation is particularly helpful for those people who find it difficult to remain still.

Meditation in health care settings

The use of meditation in health care settings often involves one of the following: transcendental meditation (TM); methods developed by Dr. Herbert Benson to elicit the relaxation response; or adaptations of the program of mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn.

Transcendental meditation (TM) has its origins in the Vedic tradition of India and was introduced to the West by Maharishi Mahesh Yogi. TM has been taught to several million people and is one of the most widely practiced forms of meditation in the West. Much of what is known about the physiology of meditation is based on studies of TM. In transcendental meditation, the person sits with closed eyes and concentrates on a single syllable or word (mantra) for 20 minutes, twice a day. When thoughts or feelings arise, the attention is brought back to the mantra. According to Charles Alexander, a TM researcher, the experience of TM involves a calming of thoughts and ordinary wakeful-ness, which is transcended and replaced by fully aware consciousness.

Eliciting the relaxation response involves a similar form of mental focusing. Dr. Herbert Benson, one of the first Western doctors to conduct research on the effects of meditation, developed his approach after observing the profound health benefits of a state of bodily calm (the relaxation response). In order to elicit this response, he teaches patients to repeat a word, sound, prayer, phrase, or activity (including swimming, jogging, yoga, or even knitting) for 10 to 20 minutes, twice a day. Patients also are taught not to pay attention to distracting thoughts and to return their focus to the original repetition. What is repeated is up to the individual. For example, instead of Sanskrit terms, the person may choose something personally meaningful, such as a phrase from a Christian or Jewish prayer.

Mindfulness meditation stems from traditional Buddhist meditation practices. Psychologist Jon Kabat-Zinn has been instrumental in bringing this form of meditation into medical settings. In formal mindfulness practice, the person sits with eyes closed, focusing the attention on the sensations and movement of the breath for approximately 45 to 60 minutes, at least once a day. Informal mindfulness practice involves bringing awareness to every activity in daily life. Wandering thoughts or distracting feelings are simply noticed, without resistance or reaction. The essence of mindfulness meditation is not that on which the individual is focusing, but rather the quality of dispassionate awareness the person brings to each moment. According to Kabat-Zinn, the purpose of mindfulness meditation is to become aware of one’s body and mind in the present moment. Discerning observation differentiates mindfulness from other types of meditation. The MBSR program consists of a series of classes involving meditation, movement, and group participation. There are more than 240 MBSR programs offered in health care settings around the world.

KEY TERMS

Anxiety —A feeling of apprehension and fear characterized by physical symptoms (heart palpitations, sweating, and feelings of stress, for example).

Anxiety and anxiety disorders —Chronic conditions that can be characterized by an excessive and regular sense of apprehension, with physical symptoms such as sweating, palpitations, and feelings of stress. Anxiety disorders can be caused by biological and environmental events.

Anxiety-reduction techniques —Skills taught by a therapist to help an individual overcome anxiety, stress, and tension, and can include relaxation, visualization and imagery, diaphragmatic breathing, stress inoculation, and meditation.

Biofeedback —Biofeedback is a technique that uses monitoring instruments to measure and feed back information about muscle tension, heart rate, sweat responses, skin temperature, or brain activity.

Bodywork —Any technique involving hands-on massage or manipulation of the body.

Dervish —A person who belongs to one of the various mystical and ascetic Muslim orders, such as the Sufis. A whirling dervish meditates by whirling or spinning an ecstatic dance.

Hypnotherapy —The use of an induced trance state, or hypnosis, as a therapy.

Mantra —Originally, a sacred word or phrase repeated over and over to help focus the mind during meditation; in the Western world, this may refer to any repeated syllable, word, or phrase used to meditate.

Pain disorder —One of several somatoform disorders described in the revised, fourth edition of the mental health professional’s handbook, the Diagnostic and Statistical Manual of Mental Disorders. The term “somatoform” means that symptoms are physical but are not entirely understood as a consequence of a general medical condition or as a direct effect of a substance, such as a drug.

Progressive relaxation —A technique for managing stress in which the person relaxes major muscle groups in a fixed sequence, often beginning with the feet and moving towards the head.

Transcendental meditation (TM) —A meditation technique based on Hindu practices that involves the repetition of a mantra.

Yoga —A system of exercises for achieving bodily or mental control and well-being.

Meditation is not considered a medical procedure or intervention by most insurers; therefore, if there is a cost associated with training, patients pay for it themselves. Frequently, religious groups or meditation centers offer meditation instruction free of charge or for a nominal donation. Hospitals may offer MBSR classes to their patients for a reduced fee, and to the general public for a somewhat higher fee.

Normal results

The scientific study of the physiological effects of meditation began in the early 1960s. These studies demonstrated that meditation affects metabolism, the endocrine system, the central nervous system, and the autonomic nervous system. In particular, there is a slowing of cardiac and respiratory rates, a decrease in blood pressure, and an increase in alpha brain waves. These effects are typical of reduced anxiety.

There is a growing body of evidence supporting the medical benefits of meditation. For example, meditation is particularly effective as a treatment for chronic pain. Researchers have found that meditation reduces symptoms of pain and reliance on drugs used to control pain. For example, in one four-year follow-up study, the majority of patients in an MBSR program reported improvement in the experience of pain as a result of participation in the program.

For many years, meditation has been recommended as a treatment for high blood pressure; however, there is a debate over the effectiveness of meditation compared with medical treatment. Although most studies show a reduction in blood pressure as a result of meditation, medication is relatively more effective.

Meditation may be an effective treatment for coronary artery disease (CAD). For example, a study of 21 patients practicing TM for eight months increased their tolerance of exercise and their capacity for work. Also, meditation is an important part of Dr. Dean Ornish’s program for the prevention or reversal of CAD. His program involves a low-fat vegetarian diet, moderate exercise (for example, walking 30 minutes per day), and techniques for reducing stress, including meditation.

Researchers have found that meditation is effective in the treatment of chemical dependency. Gelder-loos and others reviewed 24 studies and concluded that TM is helpful in programs that target smoking behavior and drug and alcohol abuse.

The scientific evidence also suggests that meditation is particularly helpful in treating anxiety-related disorders and in reducing symptoms of anxiety triggered by stress. For example, researchers conducted a study in 1998 of 37 patients with psoriasis—a chronic, stress-related skin condition. They found that patients who practiced mindfulness meditation and who received standard ultraviolet light treatment experienced a more rapid clearing of their skin condition than the control subjects. Another study found that meditation moderated the symptoms of fibromyalgia (a chronic condition where people suffer diffuse muscular pain at several sites on the body); over half of the patients reported significant improvement. Meditation was one of several stress management techniques used in a small study of HIV-positive men. The study showed improvements in immune function and psychological well-being.

In sum, holistic practitioners speak about the body’s capacity for healing itself; since meditation leads to a peaceful, relaxed state with measurable physiological benefits. Healing is facilitated presumably by moderating the state of arousal generated by chronic stress. There is a variety of stress-reducing techniques available, such as hypnosis, progressive relaxation, biofeedback, guided imagery, and aerobic exercise. Health consumers are encouraged to investigate the various techniques and seek referrals to good physicians, therapists, or stress counselors who are willing to design a flexible program that meets their needs.

Resources

BOOKS

Astin, John A., and others. “Meditation.” In Clinician’s Complete Reference to Complementary and Alternative Medicine, edited by Donald Novey. St. Louis, MO: Mosby, 2000.

Baime, Michael J. “Meditation and Mindfulness.” In Essentials of Complementary and Alternative Medicine, edited by Wayne B. Jonas and Jeffrey S. Levin. Baltimore, MD: Lippincott Williams and Wilkins, 1999.

Benson, Herbert, M.D. with Miram Z. Klipper. The Relaxation Response. New York: Avon Books, 1975.

Kaplan, Harold I., and Benjamin J. Sadock. “Alternative Medicine and Psychiatry.” In Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences / Clinical Psychiatry. 8th ed. Baltimore, MD: Lippincott Williams and Wilkins, 1998.

Turpin, Graham C. H., and Michael Heap. “Arousal Reduction Methods: Relaxation, Biofeedback, Meditation, and Hypnosis.” In Comprehensive Clinical Psychology, edited by Alan S. Bellack and Michel Hersen. Volume 6 edited by Paul Salkovskis. Oxford, UK: Elsevier Science, 1998.

PERIODICALS

Li, Ming, Kevin Chen, and Zhixian Mo. “Use of Qigong Therapy in the Detoxification of Heroin Addicts.” Alternative Therapies in Health and Medicine8, no. 1 (January/February 2002): 50-59.

ORGANIZATIONS

Insight Meditation Society. 1230 Pleasant, St. Barre, MA 01005. (978) 355-4378. http://www.dharma.org

Mind/Body Medical Institute. 110 Francis Street, Boston, MA 02215. (617) 632-9530. http://www.mbmi.org

National Center for Complementary and Alternative Medicine. NCCAM Clearinghouse, P.O. Box 7923, Gai-thersburg, MD 20898. (888) 644-6226. http://www.nccam.nih.gov

Linda Chrisman Tanja Bekhuis, Ph.D.