Mindfulness: An Upstream Approach

Photo by Bill Oxford

After over 20 years of seeing clients as a psychologist (or psychologist in training) in a variety of settings, I’ve been slowly transitioning away from individual psychotherapy practice. Instead, I’m increasingly serving people in a non-clinical role through the Midwest Alliance for Mindfulness. This is due to the growing sense that, in the grand scheme of things, I can be more useful working outside the traditional clinical arena. Psychotherapy, though life saving and necessary for some and helpful for many, is an inefficient “downstream” approach to addressing the primary causes of human suffering.

Many of the symptoms for which my clients are seeking psychotherapy are the unfortunate and predictable side effects of a lifetime of immersion in larger cultural and systemic problems. In our clinical work, mental health practitioners are encountering people who are in crisis, for whom our medical model system holds us accountable for a quick and inexpensive solution, without actually addressing the underlying roots of the problem. Working with individual clients on reducing their suffering sometimes seems like building sandcastles against the ocean’s tide – and I’m discovering I’m not alone in this feeling.

  • Marshall Rosenberg, creator of Nonviolent Communication (NVC), found his role as a psychologist inadequate in addressing the roots of violence and in disseminating peace. He left clinical practice so he could reach more people, more rapidly, and at lower cost. He shifted to addressing social structures and the community through group NVC training and activism, rather than focusing on individuals. He founded the Center for Nonviolent Communication in 1984, a global organization that helps people peacefully and effectively resolve conflicts in personal, organizational, and political settings.
  • In his interview with Krista Tippett of On Being, attorney Bryan Stevenson, author of Just Mercy: A Story of Justice and Redemption, spoke of his dawning realization that practicing law wasn’t sufficient to stem the tide of suffering he encountered in the legal system. He began to recognize that a cultural reckoning was needed in America – “we were gonna have to get outside the court and create a different consciousness.”  According to Stevenson, “the reckoning that has to happen in this country has to be rooted in a moral awareness, a moral awakening, a consciousness that evolves in a way that we begin to do the things that we must do, if we’re going to not only save the country, but save ourselves.” In 1989 he founded the The Equal Justice Initiative, which is committed to ending mass incarceration and excessive punishment in the United States, to challenging racial and economic injustice, and to protecting basic human rights for the most vulnerable people in American society.
  • Reuben Jonathan Miller, author of the book Halfway Home: Race, Punishment And The Afterlife Of Mass Incarceration, started his career counseling children in foster care, then working as a volunteer chaplain. He shifted into research and policy because, “I noticed while doing the work as a chaplain that people from my neighborhood, and, in fact, people who look just like me, would move in and out of this jail or prison no matter what I did, no matter how many services I referred them to, no matter how much spiritual counseling that I offered… I wanted to know what drives all this stuff. And I wanted to stop thinking so much about the behavior that’s expressing itself in the moment and think about some of the root causes and some of the consequences.”
  • Ex-police officer Raeford Davis left the force due to the moral conflicts he frequently experienced doing his job. He stated, “You arrest people for selling drugs, they become criminalized, and it destroys any opportunity for them to be productive members of society.” While making drug busts in a notorious area of town nick-named “4-way”, he came to the realization “that amount of effort and violence in a neighborhood that’s had a drug problem since before I was born seemed horribly dangerous and counterproductive.” He now works with Law Enforcement Action Partnership, a nonprofit promoting alternatives to arrest and incarceration, addressing the root causes of crime, and working toward healing police-community relations.

A wonderful article entitled Social Adversity, Mental Distress, and the Theatre of the Oppressed by Eva Paska, PhD addresses some of these concerns. She wrote, “the field of psychotherapy is often in a bit of a difficult position today. Namely, it is bound to work with problems created in a certain social context, but it often has to solve them without being able to tackle the systemic characteristics of that exact context. Yet, how is that possible—to transfer certain psychological resources from the healing setting to a wider social setting where the power processes are at odds with this? What if the situation outside of the healing setting is stronger than the individual agency allows?”

We’ve pathologized and labelled as “mental illness” that which is really a completely rational response to the times in which we live.Hiro Boga

Dainius Pūras, a psychiatrist/medical doctor, professor, human rights advocate, and United Nations Special Rapporteur has called for a paradigm shift in the way we approach mental health, de-emphasizing a medical model and focusing more on human rights and the social determinants of health. A recent study revealed that The EU Social Justice Index is one of the strongest predictors of national life satisfaction. But for over a decade, the United States has continued to place among the bottom ten countries on social justice, especially in terms of Poverty Prevention, Social Inclusion/Non-discrimination and Intergenerational Justice, ranking dead last in poverty reduction and inclusion of the interests of youth and the elderly in public policy.

Where justice is denied, where poverty is enforced, where ignorance prevails, and where any one class is made to feel that society is an organized conspiracy to oppress, rob and degrade them, neither persons nor property will be safe. – Frederick Douglass

A recent study compared the economic and psychological effects of an unconditional cash transfer, a five-week psychotherapy program, and the combination of both interventions in people living in poverty in rural Kenya. One year after the interventions, the cash transfer recipients had both greater assets and psychological wellbeing than those who received psychotherapy as well as the control group. In fact, psychotherapy had no measurable effects on either psychological or economic outcomes and the effects of the combined treatment were similar to those of the cash transfer alone. Similarly, randomly selected residents of Stockton, CA living in neighborhoods at or below Stockton’s median household income were given $500 per month for two years with no strings attached. Not only did the payments measurably improve participants’ job prospects, financial stability and overall well-being, they also decreased measurable feelings of anxiety and depression compared with the control-group. Contrary to criticisms of this type of program, this study and research and trials from the previous three decades did not indicate that work ethic was negatively impacted and the benefits rippled out into the community as resources were less taxed and time for nurturing relationships and community engagement was increased. I suspect the lesson here is that, at the very least, basic needs must be met before psychotherapy can make an impact on wellbeing.

True compassion is more than flinging a coin to a beggar; it is not haphazard and superficial. It comes to see that an edifice which produces beggars needs restructuring. A true revolution of values will soon look uneasily on the glaring contrast of poverty and wealth…and say “This is not just.” – Martin Luther King, Jr., “A Time to Break Silence,” Riverside Church, New York City, April 4, 1967

The call to “defund” the police stems from the growing recognition that it hasn’t been an effective strategy to rely on law enforcement officers and the penal system to solve problems resulting from generations of poverty, systemic racism, and trauma that have led to an epidemic of mental disorders, addictions, homelessness, and violence. There is a push to reallocate portions of police funding to more upstream services such as job training, affordable housing, education, and violence prevention programs.

Changing the world for the better will require so much more than putting out individual fires, passing laws, making policy changes, weeding out a few “bad apples”, or asking a few dedicated individuals to work ever harder. Eliminating the root causes of suffering will require a paradigm shift – and I believe mindfulness training can help us cultivate the fundamental skills needed for such a profound second order change:

Paradigm Shift How Mindfulness Can Help
Valuing self-awareness and agency regarding inner experience and actions (concentration, emotional regulation, psychological flexibility, ethical and critical thinking, curiosity, creativity) Modulates stress response while strengthening attentional and impulse control, present moment awareness, nonjudgmental exploration of thoughts, feelings, sensations, and urges, self-compassion, and cognitive flexibility
Viewing our own self-interests as equal in importance to others, without discrimination Awakens us to our common humanity and interconnection, cultivates compassion for others
Prioritizing wellbeing over achievement and acquisition Develops gratitude and contentment with “enough”
Recognizing the importance of environmental stewardship Reconnects us with our fundamental interdependence
Valuing kindness, service, and caregiving over amassing wealth, status and power Cultivates compassion, lovingkindness, and appreciative joy, increases pro-social behavior
Promoting a culture of trust and integrity Makes space for critical thinking, allowing us to question harmful habits and conditioning, connects us with our deepest values, cultivates courage and equanimity

Contemplative learning and mindfulness practices are no substitute for professional mental health, medical, or legal services (and vice versa). However, we have been relying on individuals to turn a tide powered by the force of dominant cultures, institutions and systems. This is a rigged game that benefits a powerful few at the expense of the wellbeing of many. We can disrupt this game by utilizing downstream approaches more selectively and appropriately and investing more time and resources in upstream approaches. Mindfulness can help us pave the way, but we must all work together if we wish to live in a truly flourishing world.


Di Martino, S., & Prilleltensky, I. (2020). Happiness as fairness: The relationship between national life satisfaction and social justice in EU countriesJournal of Community Psychology48(6), 1997-2012.

Haushofer,J, Mudida, R & Shapiro, JP (2020). The Comparative Impact of Cash Transfers and a Psychotherapy Program on Psychological and Economic Well-being. NBER Working Paper No. 28106

Weichselbaum, S, Thomas, WC, & The Marshall Project (2019). More cops. Is it the answer to fighting crime? USA Today.

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