And that’s even amongst supporters and campaigners – see this as an example: ME Awareness Week.

But is it really true?

Actually I think behind such beliefs is a significant misconception: that chronic fatigue or ME is a single, distinct pathological entity, that is the same in everyone diagnosed. If it were, it might be reasonable to look for “the cause” (meaning a single cause).

In reality chronic fatigue is a symptom, or set of symptoms. Why should we assume that the same thing is going on in everyone with chronic fatigue? Like most other chronic illnesses, there can be multiple causal factors – even in a single individual. (Which is not to say that CFS doesn’t exist.)

In speaking of causes it’s important to distinguish between antecedents and mediators. In chronic fatigue, a mediating cause could be mitochondrial damage (mitochondria are the energy-producing structures in all our cells). On another level, a viral infection can be a cause in the sense of being (a variant of CFS is post-viral fatigue syndrome).

If you start from the assumption that the cause of CFS must be present in all its sufferers, well it isn’t surprising it hasn’t been found yet.

So we do know some of the causal factors and imbalances underlying chronic fatigue. Here are some more examples:

• Nutrient deficiency (e.g. Iron, vitamin B12);
• Hypothyroidism;
• Adrenal weakness.

You might argue that if an ME sufferer has these, then it’s simply a misdiagnosis. ME that can be “cured” by supplementing iron or thyroid hormone is not really ME. But what if all these causes are present at the same time? And there are other causal factors besides, such as  a compromised or permeable gut lining? Taking iron supplements isn’t going to cut it.

In practice, even these individual factors are controversial because they aren’t black and white. Just how slow does a thyroid have to run before it’s considered (significant) ‘hypothyroid’?

In my practice I see a lot of people with fatigue as their major symptom (though they may not have been diagnosed officially). And I do see them making significant improvements – though I never use the C word (“cured”) myself.

I think the approach that works best is to identify (objectively as far as possible) as many of the interacting causal factors as possible, ranging from biochemical and nutritional, to physiological and hormonal, to psychological and social, and then to address them with possibly multiple therapeutic interventions. This is the way of Functional Medicine. (I think Functional Medicine has got a big future ahead of it.)

All of this is not to deny there’s still an awful lot we don’t understand about chronic fatigue, or that a lot more research is needed. But certainly I think the situation is not hopeless for CFS sufferers.

What I’m doing in the training periods is a kind of mindfulness (meditation) practice. I don’t have a specific object of focus, rather my intent is to be intensely and vividly aware, or self-aware, in the present moment. It’s sometimes known as “open presence” meditation or “pure awareness” meditation.

The graph shows that my brain activates consistently during the periods of practice, and then deactivates during the television-watching rests. It must be admitted that I’m being more “effort-ful” than I would in a normal meditation. You can see how, by the end of the third, I’m beginning to tire, and the trace becomes more wobbly.

This brings out an important point about this kind of biofeedback. It would be far too simplistic to say that up is good, and down is bad, or even that activation is good and de-activation is bad. Practically speaking, the key to successful living is flexibility of state, which translates as flexibility of brain (and body) state. If I’m at the office listening to a presentation of complex ideas for which I need sharp focus, well that’s one brain state – and then when I come home and relax that’s another. And when I go to bed and fall asleep that’s another brain state again. I need to be able to easily and flexibly access them all. If my brain loses flexibility, then it might mean I can’t get to sleep at night.

Coming back to HEG neurofeedback, I find it useful to be able to train in bursts. This is in part because I don’t think the brain is particularly designed for long uninterrupted periods of intense focus, but also because it’s useful to see the flexibility. And just because the brain temperature comes back down again, doesn’t mean we lose the benefit.

There is perhaps a parallel with interval training. Recent research suggests that short periods (just a few minutes) of very intense physical activity can lead to long-lasting changes – to insulin sensitivity for example. During the exercise the heart rate goes up, but then comes back down again – it would be worrying if it didn’t. In fact the fitter you are, the quicker it will return to normal – flexibility again.

Just as in physical training we’re not aiming for a permanently high heart rate, so with HEG neurofeedback training we’re not aiming for a permanently hot brain. It’s just that regular exercise improves responsiveness, or adaptability, or flexibility.

In a recent blog post I reviewed Richard Davidson’s theory of emotional style (presented in his book, ‘The Emotional Life of Your Brain’ co-authored with Sharon Begley). I believe Davidson’s ideas offer a framework for choosing neurotherapies, and for tailoring therapy for the individual – in effect, for realising the goal of personalised health care. In this blog post I attempt to link some of the dimensions of emotional style to neurotherapy interventions.

To recap, Davidson posited a set of six dimensions making up emotional style, each grounded in distinct brain systems. Each individual can be placed on the continuum of each dimension, between its extreme poles, for example between high and low resilience. Although there is no single ideal emotional style, there are some that are not helpful and don’t feel good.

In what follows I’ll discuss four of the dimensions of emotional style – the ones I consider to be most significant – and some neurotherapy options. I’m not going to cover every possibility that makes sense, as there are too many.

Resilience

Resilience means how quickly you can recover your mental equinimity (or return to your emotional baseline) when adverse events happen. Resilience is embodied in the left-right balance of the brain’s frontal lobes. Activation of the left side correlates with emotional positivity or high resilience.

Resilience Interventions

1. Mindfulness. Research has shown that over time mindfulness practice “corrects” right side dominance. Actually mindfulness can help to change almost all the dimensions of emotional style, so I won’t consider it in detail here.
2. Transcranial DC Stimulation. In tDCS we apply two electrical poles to the head – one positive and one negative. Depending on the practitioner’s choices we can either enhance activity in a particular region or inhibit it. The obvious choice to raise resilience is to enhance left side activity and inhibit the right. In fact in tDCS research, this protocol has been used to successfully (and safely) treat depression.

Outlook

In Davidson’s scheme outlook means one’s underlying emotional positivity. Neurologically it is embodied in the Prefrontal Cortex (PFC) activation, and particularly it’s ability to sustain activation of motivation, reward and pleasure centres.

Outlook Interventions

1. Loving-kindness meditation. Known in Buddhism as the Metta Bhavana, this practice is often taught on mindfulness courses. It is a practice of systematically cultivating positive emotions.
2. Hemoencephalography (HEG) Neurofeedback. The PFC is behind the forehead, which is the standard placement of the HEG sensor. HEG neurofeedback trains up the “muscle” of the PFC. The PFC is heavily involved with “executive function” – including concentration, planning and decision making, motivation, keeping to task, and of course emotional regulation. For this reason HEG neurofeedback can have wide ranging benefits.

Self-awareness

In order to successfully regulate out emotions we must first be aware of them – particularly their bodily manifestations. In my experience as a therapist it’s difficult to think our way out of a difficult emotional state, without at the same time the underlying physiology.

Self-awareness Interventions

1. Muscle Tension Biofeedback. My experience is that a lot of stressed people aren’t really aware of muscle tension.
2. Heart Rate Coherence Biofeedback and Breathing Biofeedback. Even assuming some awareness of the physiological expression of emotion, it’s another thing to change it. It only happens with the right attitude – allowing the natural intelligence of the body to express itself, rather than force of will. This is an important aspect of Emotional Intelligence.

Attention

Attention is the ability to maintain the mind’s focus stably in one place. What aspect of life does not rely on this fundamental capacity? William James rated its importance this highly: “The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgement, character, and will”.

An important aspect of attention is flexibility in style of attention. At times we need a sharp, narrow, one-pointed focus, while at other times a broader, open focus. In keeping with the mind-body principle, different styles of attention have different physiologies.

What has attention to do with emotion? Emotional disorders such as depression and anxiety often involve an over-focus on negative thoughts and feelings, and an inability to shift attention away from these.

Attention Interventions

Any therapy that strengthens the PFC and executive function will help attention, so all the above tools can play a useful role in strengthening attention.

Assessment

Of course decisions need to be based on an individual assessment of which dimensions are the weak points. I’ll have to leave discussion of assessment of emotional style to another post.

I was working with HEG neurofeedback. This involves having a sensor mounted over the forehead, in this case an infra-red temperature sensor. I discussed this form of biofeedback in a recent blog post. To summarise, the sensor detects changes in heat radiation from the forehead, which are presumed to come from changes in activity in the prefrontal cortex (which is behind the forehead). When I focus intently, with a bright and vivid awareness, the signal increases. When I drift into day-dreaming or dullness, the signal falls.

On this occasion I was working alone in my office on a Saturday afternoon. A group of kids appeared outside. They were playing on skateboards in the car park. Since I was sitting by a ground-floor window, one of them noticed me, with a prominent sensor strapped to my forehead. He invited his mates to ‘come and have a look at this’. Although I’m sure there was no malice on their part – they just wanted to know what I was up to – I decided my best response would be to ignore them. So I kept looking at the screen, didn’t even move (which was useful in that I know that the data I recorded was not caused by movement artefact).

What was so fascinating was what happened to the signal in light of my emotional responses. At first I was embarassed, and quite quickly got annoyed, especially when the kid started to tap on the window.

The figure below shows what happened to the infra-red temperature signal.

You can see there are three quite marked falls, the first beginning at about 2 minutes. The first two are relatively close together, and are really part of the original incident. By the time of the third drop, the kids had moved on, but what happened was that my mind went back to the event. I imagined going out there and giving them a piece of my mind. As I indulged in my anger I got another fall.

I didn’t lose control completely, as is evidenced by this simultaneous recording of my breathing rate:

What’s the interpretation? The negative emotions (principally anger) that the event precipitated, caused my prefrontal cortex to deactivate. The prefrontal cortex acts as the brain’s executive control centre, heavily involved in attention, purposeful behaviour, decision making, and (crucially in this case) emotional regulation. Of course this was quite involuntary, but on reflection it fits with my subjective experience, which was a narrowing, and a sort of fogging out of my awareness, or presence of mind. I’m sure it’s what happens in others too – people commonly report losing control and later regretting what they did or said during the emotional “hijacking” caused by anger (or anxiety for that matter). (Dan Goleman describes the process quite well in his best-selling book ‘Emotional Intelligence’.)

The drops are quite precipitous. The signal dropped much faster than I was able to raise it (either before or after).

Although it was only a one-off event, and therefore does not constitute scientific research, I would say that my experience of HEG biofeedback is consistent with this event – that even passing thoughts that are charged with negative emotion can affect the prefrontal cortex in this way. It was an instance of genuine and clear-cut emotion that would be very hard to reproduce on demand in a controlled scientific experiment. For me it was a hands-on demonstration of how the neurobiology of emotion plays out in real life, in a very tangible way. More convincing and memorable than reading about it!

Professor Richard Davidson’s recent book, ‘The Emotional Life of Your Brain’ (co-authored with Sharon Begley), offers us a glimpse of a future in which mental health issues such as anxiety and depression are defined not in terms of their symptoms but rather which specific brain systems are out of balance or need to be strengthened. Such an understanding would naturally inform our choice of therapies.

Professor Davidson is a leading figure in the field of “affective neuroscience”, or the study of the brain mechanisms behind emotions. The book explores his theory of “emotional style”, a way of describing our emotional propensities based on a set of six dimensions, each representing a relatively independent trait and embodied in distinct brain circuits that can be measured objectively using the tools of neuroscience. Examples are resilience, or how quickly you recover from adverse events, and self-awareness in the sense of how well you perceive bodily sensations that reflect emotions.

Each person’s emotional style is defined by where they fall on each of the six dimensions. In other words they are not like distinct personality types, rather each of us is a particular permutation of all six, just as a computer can represent colours digitally as a mix of three dimensions: red, green and blue.

The book describes all six dimensions, and the research which identified their neural underpinnings.

There is no one ideal emotional style, but on the other hand there are points on the spectrum you’d rather not be, because they leave you more vulnerable to mental and emotional health problems.

Knowing a person’s emotional style will suggest methods for helping them overcome such problems, especially if we know how particular therapies tend to affect the brain systems underlying emotional style. This applies to both psychological therapies such as CBT and mindfulness based therapy, and neurotherapy, for example neurofeedback or transcranial direct current stimulation.

An understanding of mental illnesses based on emotional style has two main advantages over the current system of psychiatric diagnosis. Firstly, diagnoses such as depression, anxiety and ADHD are not seen as distinct diseases in the way that hepatitis is, but rather in terms of a continuous spectrum ranging from health to ill-health. They may share considerable overlap in terms of both symptoms and underlying neurology. Secondly not all people with depression (for example) are the same. There are probably several sub-types, with distinct neurophysiological underpinnings.

It’s interesting to note that Prof. Davidson doesn’t refer to neurotransmitters such as serotonin in his account of the neural systems underlying emotion – presumably he doesn’t think they’re all that relevant.

One of the best things about the book is that it includes a questionnaire which can help readers identify their own emotional style. I can imagine this could become a really useful assessment tool for psychotherapists and neurotherapists – albeit only a starting point. Professor Davidson’s research is based on objective measures of the brain systems underlying the six dimensions, and ideally the psychotherapy of the future will use similar measures as well.

In the final chapter of the book Professor Davidson discusses ways of changing your position on each of the six dimensions. Mindfulness and meditation figure prominently – they are not specific to any one dimension. It strikes me that biofeedback, neurofeedback and neurotherapy techniques are very pertinent here – though Dr Davidson doesn’t mention them. I’d like to devote a future blog post to how specific biofeedback and neurotherapy methods relate to the six dimensions of emotional style.

You can see the results in the following two graphs.

The first one shows the no-feedback session. The IR temperature rises for a few minutes, then generally drops away. In contrast, the IR temperature rose consistently throughout the whole feedback-assisted session.

Let me clarify what I was actually doing in the feedback assisted session. I set up the software for threshold based audio feedback, meaning that a bell rang every time that the IR temperature started falling (strictly speaking it had to be falling for 3 seconds continuously before the bell rang.) I could also see the graph if I chose to open my eyes, which I occasionally did but mostly my eyes were closed.

The software also monitored my breathing rate, which was pretty consistent at around 6 breaths per minute throughout. I also set audio feedback to tell me if my breath sped up, as I know it tends to when I spin out into a more energetic train of thought. As it happens my breathing wasn’t significantly different between the two practices.

I focused on my breath, but in a sense the breath was only a background focus – my real concern was to experience a clear and vivid awareness as continuously as possible. My aim was to maintain a sense of alertness, awakeness, as though something important were about to happen. I had clear motivation, a desire, even a drive to build and maintain a sense of mental energy, and yet at the same time it was a calm steady state rather than a frenetic or teeth-gritting intent.

In the no-feedback session my intent was the same, but I experienced much more distraction, in the form of drifting into a kind of dull day-dream or train of thought, which is very much my personal tendency. However I can say I made a genuine effort to meditate.

But what does the result actually prove?

Well it is certainly a long way from rigorous scientific experiment. In fact it’s only one trial. However I would expect it could be repeated – I know I can in general maintain an upward trend when I’m practising with IR temperature feedback. (What’s new is the no-feedback recording, and that’s because I’ve only just upgraded the software to allow me to generate the whole session graphs.)

Does it mean that the feedback session was in some sense a “good” meditation while the no-feedback session was “bad”? Not really. Increasing the metabolic activation of the prefrontal cortex (which I assume is what I’m doing) is not my aim in meditation, and I don’t suppose it is anyone else’s either. As any student of mindfulness will know, we are trying to let go of the judging mind, so calling a meditation good or bad is really beside the point.

Can I say that undistracted concentration correlates with increasing IR temperature from the forehead? Not in any general sense. In the meditation I applied my mind in quite an intense, even forceful way. Not all meditations are like that. Commonly the aim in meditation is to calm the mind. I can easily imagine that it is possible to calm the mind and lower the brain’s energy, at the same time as concentrating the mind.

What I can say is that I believe that this form of biofeedback helped me considerably in meeting my purpose in this particular practice, which was to hold my focus steady and energise my mind. When I looked at the graphs after the sessions I was happy to see they agreed with my subjective sense, that the feedback made a difference.

Whilst some people might be tempted to say it doesn’t really matter if the mind wanders off a lot so long as you keep bringing it back, personally I’d far rather be concentrated than distracted.

Neurofeedback Workshop – Open University – London March 2012

I’m delighted to see it happening because I think that the Open University’s QEEG and Brain Research Laboratory’s commitment to neurofeedback represents a significant boost to the credibility of neurofeedback in the UK.

Neurofeedback research dates back to the 1960′s, since when lots of (admittedly small-scale) research studies have backed its efficacy. That’s why Professor Frank Duffy, a neurologist at Harvard Medical School,  made this statement in a major scientific journal in 2000: “In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used”.

More than ten years on neurofeedback is still not widely used, especially in the UK where we seem to lag behind the leading countries like the USA and the Netherlands.

In my experience most doctors haven’t heard of neurofeedback, let alone their patients. Their typical response seems to be, if there were anything in it, they would already know about it.

I fear neurofeedback and neurotherapy are perceived as “alternative” therapies, which is a real shame because, while their history isn’t exactly unblemished they are essentially scientific disciplines.

Good luck to the Open University and others in rolling back the prejudices.

What exactly is tDCS? It’s a very simple form of brain stimulation – indeed it’s hard to imagine a much simpler technology. The hardware is little more than a 9V battery together with a means of connecting its positive and negative terminals to the head. One of the poles is applied to a relatively small area of scalp using a salt water soaked sponge to carry the voltage. The other pole is attached to a wider area, either somewhere else on the scalp or on the neck or shoulder. When the device is turned on, a constant voltage is applied, creating a tingling sensation, and a total current of something like 1 milli-amp. A typical session lasts about 20 minutes, and the research suggests repeated sessions numbering of the order of 10 to be efficacious.

There are a couple of choices to make. Firstly, where to place the electrodes, or in effect which part of the brain to stimulate, and secondly whether to apply positive (or anodal) stimulation or negative (cathodal) stimulation. The former is thought to enhance neuronal excitability, while the latter inhibits it. Both are potentially therapeutic, and bear in mind that the brain’s internal dynamics mean that stimulating one part of the brain is likely to inhibit other parts not being directly stimulated.

What does it mean to change neuronal excitability? It means making neurons either more or less likely to fire. That’s also what neurotransmitters seem to do – and of course much of mainstream therapy for disorders such as anxiety and depression is pharmacotherapy targeted at neurotransmitters. Typically for anxiety you’d want to make neurons less excitable, on the assumption that they’re actually over-active. (Incidentally at least one study suggests tDCS may alter dopamine dynamics.)

On what basis do we make these two choices of location and polarity? Because tDCS is an experimental technology there are no hard and fast rules. Speaking personally I take into account firstly the results of brain assessments, most notably a simple form of EEG assessment that I’ve described in previous blog posts. Secondly, my client’s pattern of symptoms (e.g. depression, attention problems), and thirdly knowledge of brain functioning and research findings. An example of the latter is the discovery that emotional positivity correlates with a greater activation of the left prefrontal cortex relative to the right. Depressed people tend to have the opposite, so therefore an obvious protocol for tDCS is to positively stimulate the left side. This is what some of the researchers have tried (e.g. see this paper by Fregni et. al.) apparently with some success. Of course all depressed people may not show this asymmetry, which is why it is useful to do some form of brain assessment.

Research has shown tDCS may be effective for mood problems, cognitive problems such as working memory, chronic pain, stroke and brain injury, alcoholism and sensory perception. The effects seem to be long-lasting.

One of the most interesting ideas is around is that tDCS may enhance learning (e.g. see this tDCS article and tDCS research paper). Perhaps by affecting a type of brain cell structure called the NMDA receptor, which is associated with learning. Related to this is the idea that the New Scientist article explored, that tDCS may facilitate access to flow states.

I haven’t come across any research that found safety issues with tDCS, although it is worth saying that the long term effects of repeated stimulation are unknown, and also that anything that is capable of positive effects may also have deleterious consequences if used in the wrong way.

Nonetheless I feel very excited for the future of this technology, not least because unlike many new treatments we hear about in the media, it is amazingly cheap. (I’m using tDCS equipment developed by Mind Alive, Canada.) I look forward to working with more clients using tDCS.

The ANS is made up of two branches, the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PSNS), which between them control much of the body’s automatic functioning such as heart rate, digestion, metabolic activity and blood sugar. The traditional understanding is that the two have opposite and antagonistic effects on the body’s arousal level. The SNS ramps it up while the PSNS calms it down again. They’re like the accelerator and brake in a car, or like the two arms of a set of scales insofar as they mutually inhibit each other.

The classic view of stress is that in the acute phase at least, the sympathetic is dominant. The sympathetic response is commonly known as the fight or flight response because it prepares the body for action. The parasympathetic is sometimes known as the rest and digest response, because it calms us down and re-engages the digestive system (which the SNS tends to switch off).

It’s not that this picture is wrong – just too simplistic or incomplete. For instance it can’t explain that asthma is typically made worse by stress, yet physiologically it is a state of parasympathetic dominance (the PSNS restricts the air ways in the lungs).

The polyvagal theory derives its name from the vagus nerve, a complex and multi-branched pathway which carries parasympathetic signals from the brain to the viscera, but which also carries sensory data in the other direction, from the viscera to the brain. Dr Porges saw that the vagal system could be subdivided into two, based on function, anatomy and phylogeny. PSNS signals originate from at least two brain nuclei. Dr Porges notes that the two vagal subdivisions arose at different points in our evolutionary past. Let’s call them the old and the new vagal systems. Very old species such as sharks have only the old vagal system. The SNS appears to have evolved separately again. So what we have is a hierarchy of three systems.

At the lowest level is the old vagal, which seems to have evolved as a defence against scarcity by ramping down metabolism to conserve resources. It’s still present in mammals and humans, where it manifests its effects as a freezing response, involving a loss of muscle tone and a blanking of the mind, even fainting. This can be catastrophic, even resulting in death at times. Next up we have the SNS, which is also a defence but this time it ramps up metabolism to prioritise resources for action. The SNS inhibits the old vagal system.

At the highest level we have the new vagal system, which is found only in mammals. It differs from the old vagal system in using myelinated nerves which work much faster than the old vagal’s unmyelinated nerves. The new vagal system acts as a brake on the SNS. Anatomically it stimulates the heart and lungs, and also the face. The muscles of the face allow us to express emotions, particularly positive and social emotions.

This new understanding helps us see how stress and anxiety in the form of sympathetic dominance put us at such a disadvantage: we become hyper-vigilant and our social systems are disengaged. The new vagal enables us to re-engage our social systems. In the most extreme cases of stress, such as in trauma, the old vagal system may come to dominate.

 I’ve certainly got a lot more to learn about the polyvagal theory. I’ve order Dr Porges’ book.

One of Haidt’s first insights is that much of social interaction revolves around the principle of reciprocity. If you help me I’ll feel a strong impulse to help you in return. If you wrong me, or even if I simply see you doing wrong by someone else, I’ll feel a desire to see you “punished”.

Next insight: instances of pure evil are relatively rare. Rather, most people who do wrong actually think they are doing right. Typically they are retaliating against a perceived wrong to them. In the Australian tennis open this week, one player, Tomas Berdych, was booed because he refused to shake hands with his opponent at the end of the match. Turns out he was feeling badly done by after the other guy hit a shot straight towards his face.

Next: we have quite a strong self-bias in our moral awareness. We’ve probably all heard the old chestnut about 90% of drivers thinking they’re above average. Well it turns out we’re all a bit like this in respect of our moral and ethical judgements. In research, people who play games in which they can choose to be either cooperative and fair or selfish and greedy at the expense of others, tend to predict they themselves will be fair and then prove themselves not to be. And yet we’re so quick to impute negative motives to others. Even when told explicitly about this tendency, most people attribute it to others but not themselves. (I really am one of the above average drivers, even though I know most others who think so are wrong.) No wonder conflict is so common.

Religions and traditional philosophies exhort us to be virtuous, but does science offer any support? Haidt’s answer is yes: the reward is greater happiness, well-being and engagement in life. Happy people tend to be kinder and more helpful – but which way does the causal link point? There is evidence that it is both.

In the west we tend to see virtue in terms of altruism: putting others’ interests before out own. What I like about Haidt’s book is that he sees it is so much more. For example working hard is virtuous but not necessarily altruistic. Living a simple life is virtuous but not necessarily altruistic.

Concepts like character, strengths and virtues are at the heart of Positive Psychology. That’s why I think it’s future is bright. It’s also one of the reasons why I think there’s such a need for a Positive Psychotherapy.

Mindfulness training is like most of therapy approaches in that it doesn’t really grasp this particular nettle. Yet the traditions from which mindfulness derives most certainly do. The Buddhist path is seen in terms of the threefold way of ethics, meditation and wisdom. Mindfulness is most obviously connected to the second stage, meditation. In Buddhism, meditation is classed as either concentrative or insight (vipassana). Insight is about seeing into the true nature of mind and reality. Concentration (the ability to hold the mind steady in its focus) is a necessary preparation for insight. The first stage of the path, ethics, is also in one sense a necessary preparation. That’s why it’s first (and not because we’ll ever reach the end of it). We can see it as a process of purifying the mind. This ethically loaded term is perhaps not popular in our culture but it is part of the tradition.

Many people in mindfulness classes find that their mind is anything but steady in its focus, anything but still. Often it’s conflicts and emotionally-laden memories that bubble up into mind. Maybe it’s something to do with how we live the rest of our lives. Maybe what we really need is to simplify our lives and live ethically and virtuously.