November 23, 2017

Sam Harris, Meditation, Mental Illness and a Question from British Columbia

Picture from ABC News 

I'm going to preface this post by saying that I like and respect Sam Harris. I think he is one of the preeminent popular intellectuals that is currently active and I am in agreement with him on the majority of issues which he speaks about. I think his takes on identity politics, free speech, religion, and many other topics are largely correct.

In addition to that, one thing I really appreciate about Sam is how thoughtful he is. That thoughtfulness can be heard in his podcast in the respect he has for his guests, in how he wants his guests treated by his audience after they are on the podcast and in what he wants the experience of being on his podcast to be like ( about 28 minutes in.

In addition to that, he shows his thoughtfulness in his approach for donations to his podcasts where he asks for donations, but limits his request to those who can easily afford it. This may seem trivial, as someone who doesn't have the money to donate, probably wouldn't donate anyway, but it shows how he is expressing a feeling for his listeners that often isn't expressed. I respect him making that statement and the thought that went into making it.

Yet, I do have an issue with something Sam said in response to a question asked at The Orpheum Theater in Vancouver that was recorded in his most recent podcast. I think in answering the question he missed the thoughtfulness that he usually gets right.

Question: "Hi my name is Randy. My question is for Sam. I wanted to know what role meditation has played in your mental health, I guess. Have you been more resilient to depression or anxiety? Because it seems like your always kinda being attacked by somebody either Batman or having Charles Murray on your Podcast. Because I'm at a point where I'm kinda done with antidepressants, psychotics and mood stabilizers. I want to try something new, so what's your take on meditation as a mental health treatment?"

Answer: "Well, I think it can be incredibly useful. I think there are certain people who probably shouldn't go on intense silent meditation retreats so I wouldn't recommend the most intense meditation experiences for everybody. There are people who find going into silence for a week or a month destabilizing and that's a tiny percentage of people but you should be aware that it is possible to have a bad experiences doing a lot of meditation. 

The kind of meditation I recommend is just learning to pay much more careful attention to what it is like to be you. When you pay attention, you begin to notice all the ways in which you are suffering unnecessarily. The universe didn't have to be this way, but is just so happens there is a direct connection between seeing more of what is actually happening in your own mind and ceasing to suffer in many of ways that are unnecessary. Honestly, it is the most important thing I've ever learned, but it's not necessary to learn most other things, it's orthogonal to almost everything else we care about intellectually. It's not that I don't suffer in all the ordinary ways that I suffered with before I learned to meditate. The half-life of suffering, the half-life of something like anger or anxiety or embarrassment or fear or whatever the negative mindstate is, it's cut way way down and also behavioral consequences of those negative emotions, the door is closed to those. 

When you think of the difference between being angry 10 seconds and then actually letting it go and being angry for an hour, right, it's an enormous difference, because in that hour you can get up to doing all kinds of life deranging things on the basis of anger and feel good about doing those things, right, because you damn well should be doing those things because you're pissed. Just shorting the time of all these negative states is [an] enormous benefit. Meditation is a great tool for that."

I didn't want to judge Sam's response and write this without looking into the efficacy of meditation as a treatment for depression and there is some pretty solid evidence [1, 2] that meditation may be as effective a treatment as antidepressants for depression, but this is to be taken with some precaution. The general results from different studies tend to point to mindfulness being more successful at dealing with stress than anxiety or depression, which each have smaller effect sizes. There does seem to be an effect for meditation in the treatment of mental illness, what I presume Randy was suffering from, with meditation.

However, there are two larger problems pointed out by Steven Novella.

1.The problem with this research is that it is largely preliminary, as the specifics that makeup mindfulness is not always consistent, and there remain questions about what type of people benefit the most and with what severity of condition mindfulness is most effective at treating. This is fine as the results seem to be trending in the right direction of it being an effective treatment, but there are issues that remain to be settled.

2. The control measures used as opposite of mindfulness are not adequate. Mindfulness is tested against medication and placebo medication, but not against relaxation or sham mindfulness. This is problematic, as it makes it unclear if there is something specific about mindfulness that is helpful or if it is a product of relaxation which isn't specific to mindfulness.

That being the case and my expectation that Sam, who is likely more educated on the subject than I, should have had a more thoughtful response to that question. I am fine with him talking about his experience and how it has affected his life, but I think that his response lost track of the context of the question being that, the person asking the question is someone with serious problems talking about ceasing to take all their medication. Somewhere in that response there needed to be a caveat about talking to a doctor about his decision or getting some kind of medical advice before just stopping his medication.

Sam's response, unfortunately, reminded me of the type of response that is characteristic of proponents of alternative medicine, 'Here is my personal experience of it working and it was good for me.' In that, I expect a higher quality response for Sam Harris and maybe he simply lost track of that part of the question, but I was disappointed that it wasn't there from someone who usually gets those parts correct. Further, he didn't mention the evidence in support of meditation being used to help treat mental illness which is also disappointing, but that bothered me less than not addressing the context of a person threating to stop taking all their medication.

Given that there is some medical evidence for meditation being helpful am I over-reaching in my criticism of Sam's response? Does he, as a proponent of meditation, have an ethical responsibility when someone is asking a question like that?

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