The Jadad scoring system is a widely used method of rating randomised controlled trials for basic methodological rigour. The Jadad system is inadequately structured to meaningfully discern the methodological standards of meditation trials. This is because the unique issues associated with controlling for non-specific effects and sources of bias are not adequately represented in this system.

Dr Ramesh Manocha

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Christian mysticism

Importantly, the experience of “thoughtless awareness” and its connection to higher states of consciousness is not exclusive to the East (although it is more systematically described in that culture than any other). There are isolated descriptions throughout the religious history of the West. For example in the anonymous Christian mystical text The Cloud of Unknowing, the writer encourages the development of a profound, introspective understanding of God that is accessible in the non-thinking state, “strike down every kind of thought under the cloud of forgetting” (Walsh, 1981).
St John of the Cross described the state as “silent music” and “the sound of solitude” (Herrera, 2004) while the poet Wordsworth (1849) suggested it in his ode Intimations of Immortality from Recollections of Early Childhood which is a meditation on the possibilities and limitations of consciousness: “Our noisy years seem moments in the being of the eternal Silence”.

Dr Ramesh Manocha

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Trans-mind states are extensively described in ancient India, and are regarded as a characteristic aspect of the spiritually developed condition.

Mahabharata

In one of India’s most ancient texts, the Mahabhrata,(13.294.16) meditation is described as follows:

He does not hear…smell…taste…see…or experience touch…his mind ceases to imagine…He desires nothing, and like a log he does not think… quoted in Feuerstein, 2006. (p97).

Upanishads

The Upanishads are some thousands of years younger than the Mahabharata. Mascaro, an eminent translator of Indian spiritual texts, summarizes the Upanishadic ideas on meditation and consciousness as follows:

In the infinite struggle of man to know this world and the universe around him, and also to know the mind that allows him to think, he comes before the simple fact that life is above thought: when he sees a fruit he can think about the fruit but in the end he must eat it if he wants to know its taste: the pleasure and nourishment he may get from eating the fruit is not an act of thought (Mascaro, 1965, pp1–47).

Mascaro’s authoritative translations of the Upanishads further illustrate these points. In the Kena Upanishad it is stated:

He (God) comes to the thought of those who know him beyond thought, not to those who imagine he can be attained by thought: he is unknown to the learned and known to the simple (p51).

Further, in the Kaushitaki Upanishad it is stated “It is not thought which we should know: we should know the thinker” (p105).

And in the Katha Upanishad:

When the five senses and the mind are still, and reason itself rests in silence, then begins the path supreme. This calm steadiness of the senses is called yoga. Then one should become watchful, because yoga comes and goes (p55).

Patanjali

One of the most well known yogic treatise is Patanjali’s Yoga Aphorisms. Patanjali was a physician who attempted to synthesise the many disparate texts on yogic discipline (such as the Hathayogapradipika, cited above) into single coherent practical guide for those aspiring to experience higher consciousness and self realisation, it is stated:

By being aware of the silent void moments pervading the emptiness between thoughts, one can glimpse and expand the skill of thought subjugation which leads to transformation (Messenger, C).

Dr Ramesh Manocha

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It seems obvious that the non-specific effect of any intervention is closely related to its credibility and plausibility as a therapeutic intervention i.e. its “face validity”. Now, some of the effects associated with meditation must be non-specific, i.e. comprising a mixture of placebo, therapeutic contact, spontaneous improvement, and so on, whereas some, hopefully, are specific to meditation alone. One might even propose that different meditation techniques have varying proportions of specific and non-specific effects. Within the context of an RCT, the control strategy should ideally:

• elicit all the non-specific effects that meditation might have, but have none of meditation’s specific effects;
• not have any specific effects of its own.

By fulfilling these criteria the control strategy makes the RCT methodology sensitive to any specific effects of meditation that might be detectable.

Dr Ramesh Manocha

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Despite the scientific establishment’s equivocal conclusions about the efficacy of meditation, positive perceptions are evident among the Western lay population because of the increasing popularity of the philosophy, metaphysics and folklore associated with the ancient and traditional Indian ideas of meditation. So it is important to develop an understanding of meditation, in the words of Taylor (2005) in the context of its:

“…particular spiritual tradition, situated in a specific historical time period, or codified in a specific text according to the philosophy of some particular individual.”

While the biomedical Cartesian worldview that developed in the West from the mid-19th century weakened the connection between health and spirituality, this did not occur in India. There strong associations between health and spirituality were made and utilised to promote better physical wellbeing and quality of life. Typical of this health philosophy was the practice of yoga, which combined spiritual teachings with more mundane health factors such as lifestyle, diet, physical exercise and positive psychology in order to achieve its ultimate aim, the development of consciousness (this will be explained at greater length below). Similarly, the ancient and still widely used Ayurveda health epistemology was used to cure illness and enhance wellbeing by combining spiritual practices such as meditation, mantras and prayer with lifestyle measures such as exercise, diet and massage. Proponents of this epistemology also advocated the use of an extensive herbal pharmacopoeia, while its diagnostic system was based on psychological predisposition and personality type (Chopra Et al., 2002). In fact the followers of Ayurveda proposed a perspective of the human corpus in which the mind was not contained within the confines of the brain, as in Western perceptions. Instead, it was seen to be closely intertwined with the physical body, thus forming a body-mind whole in which physical health status was seen to be a direct reflection of consciousness and vice versa.

Dr Ramesh Manocha

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The aphorisms of Patanjali on the Yoga Sutras are contained in four chapters and are nearly two hundred in number. The author of the aphorisms is said to be the same Patanjali who wrote the famous commentary on Panini’s aphorisms, under the name of the Mahabhasya or ‘The Great Commentary’. Another work on Medicine is also attributed to him. He was not only a great grammarian and a great philosopher, but a great physician. He prescribed for the body, mind and spirit. The age of Patanjali is now generally fixed at three centuries before Christ.

Patanjali is credited with formalising the spiritual science of India. His writings describe a multi faceted discipline involving physical exercise (Hatha yoga), breath control to arrest thought (Raja yoga), meditation (Dyana yoga) which is achieved after the mind is silenced, pure love of the divine (Bhakti yoga), ethical behaviour (Karma yoga) as well as intellectual study, various cleansing practices, etc., etc.

His system was designed to prepare the aspirant by purifying, balancing and strengthening the energy plexuses and channels that exist as a subtle mechanism in the body. It is this subtle body, said Patanjali, that is the mechanism by which self realisation occurs.

Patanjali’s yoga system is the basis of all yoga systems that are popularly known today. Interestingly, Patanjali did not intend the disciplines to be used separately to the exclusion of others. Rather, he emphasised the need for integrated use of the various techniques according to the needs of the individual, in order to achieve harmony in the body, mind and soul. Nor did he recommend the use of the paradoxical, and now fashionable, so- called ‘sexual yogas’, nor the gaining of ‘siddhis’ (occult powers such as levitation, astral travel, ESP etc). Indeed, Patanjali warned against them as both damaging to the subtle mechanism as well as hazardous to the seeker’s ascent as a whole.

Excerpt from A Seeker’s Journey by Greg Turek. If you would like a copy of the book, Greg would be happy to send you a PDF version. He can be contacted here.

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Despite an absence of reliable evidence, complementary and alternative treatments are rapidly increasing in popularity in the treatment of Attention-deficit hyperactivity disorder (ADHD). They include dietary modification, the use of nutritional supplementation (such as essential fatty acids, zinc, magnesium, amino acids, megavitamins) and herbs (such as ginseng and ginkgo). Also important are environmental therapies (which involve eliminating pollutants such as lead, and manganese from the environment), biofeedback, relaxation training, and meditation. Arnold’s review (2001) of alternative approaches to the management of ADHD noted that meditation was one of a number of promising strategies and warranted further systematic assessment. However, so far there have been only two unpublished dissertations suggesting that in children with ADHD, meditation may mitigate tendencies to impulsiveness both at home and in the classroom.

The EEG studies of Aftanas & Golocheikine (2001, 2002) suggest that meditation might influence those parts of the brain that govern attention. Furthermore, anecdotal feedback from teachers and meditation practitioners has indicated that meditation could help to focus attention, enhance concentration and memory and improve children’s performance at school. Given the background of neurological, physiological, and psychological research as well as practical experience, it seemed reasonable to evaluate the potential of meditation as a useful alternative treatment for children with ADHD.

Dr Ramesh Manocha

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Methodological validity is therefore the major challenge to meditation research, and the chief problems within this broad category are first, the use of appropriate control strategies, second, the need for randomisation and other strategies to exclude bias and third, a definition of meditation that allows inter-trial comparability and remains consistent with the traditional ideas of meditation as a state of non-thought.

Plausible controls
Plausible control groups are critical in behaviour therapy research because of the need to exclude the significant confounding effects of non-specific factors (such as placebo, therapeutic contact and researcher expectancy). The significance of this issue is borne out by the fact that even comparative trials of behaviour therapies often end up demonstrating equivalence of effect255. Such non-specific factors are also significant in meditation research. Expectancy alone, for instance, has been shown in a number of studies to positively influence the apparent effect of meditation4.
The essential criteria for a control strategy in meditation trials should therefore be first, convincing plausibility as an active intervention in its own right and second, a process that involves relaxation and reduction of somatic arousal (since this is the nearest conventionally understood phenomenon that resembles meditation).

Randomisation and other strategies to exclude bias

There are a large number of controlled meditation trials using dissimilar cohorts in non-randomised trials. The need for randomisation to exclude selection bias is obvious, yet as previously pointed out, less than 4% of the total number of peer-reviewed publications used random allocation of participants.

Dr Ramesh Manocha

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Reports such as those described previously call for a deeper examination of meditation’s potential adverse effects. Thorough, systematic surveys post marketing surveillance-style studies need to be conducted, For this to be done properly, meditation instructors and organisations may be required to cooperate by providing comprehensive lists of those who have learnt or who currently practice meditation. In practice this may be difficult to achieve given the commercial interests of some organisations, the somewhat anti-establishmentarian views of those who practice in or participate in these organisations as well restrictions arising from privacy laws.

When decisions about a new intervention are being made, the net clinical benefit needs to be carefully assessed by balancing reported benefits and side effects. The CONSORT check-list includes reporting of such adverse events as item 19 of the CONSORT statement. Only proper and systematic reporting of side effects will allow adequate assessment of the potential net benefit of any intervention.

Dr Ramesh Manocha

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The fact that the mental silence construct, more than any other factor my research, correlated positively with a wide range of health measures raises interesting implications in several areas of study. The findings emanating from my research imply that the notion of mental silence and its associated yogic philosophy, may be important in the ongoing development of our understanding of meditation and the various definitions and taxonomies that relate to it. It also provides some new clues for scholars interested in the “essential factors” of religiosity and the question as to why some forms of religiosity are beneficial and others not. Furthermore, it provides empirical data that may help to progress the ongoing debate about the theoretical differences between “religiousness” and “spirituality”. Perhaps most important of all they provide empirical evidence of a positive relationship between a well-defined state of consciousness and health and wellbeing. That, it is asserted, constitutes a significant contribution to the nascent field of consciousness research as well as our understandings of health. It implies a nexus between religiosity, consciousness and health that is accessible to measurement. The practical ramifications are that meditation may have a valuable role to play in the promotion of mental health and the prevention of mental illness primarily as a result of the beneficial impact of the mental silence experience.

Dr Ramesh Manocha

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