Mindfulness, yoga and other forms of Eastern meditation are becoming increasingly popular in the West, not only as part of the religious traditions where they originate but also in secular medical and therapeutic contexts. Some practitioners report that these practices can cause incredible transformations and cure a wide range of psychological conditions, including anxiety and depression. A considerable number of studies have tested these claims and found them to contain an element of truth, leading to their adoption by many psychotherapists and health services. Miguel Farias and Catherine Wikholm take their readers on an accessible and sympathetic yet critical review of both the research literature and the history of these practices. The book engagingly tells the story of their scientific investigation into various meditative practices.

The reflexivity shown throughout the book is commendable. The authors make explicit the role that their personal experiences with the techniques, as well as the relationships they formed with others who use them, had in their evolving thoughts on the topic. By being clear about both their current and past beliefs, and how interactions with research material changed them, they add coherence and authenticity to the project. The combination of a critical eye and a sympathetic heart makes their conclusions more persuasive by allowing others to see and weigh all of the influences on their conclusions. In research that touches on existential and metaphysical beliefs this reflexivity is especially crucial yet often lacking.

The book is intentionally accessible and a genuinely enjoyable read. It does not assume much knowledge of either psychology, meditative traditions or scientific methodologies, and this makes it suitable for a wide audience. A consequence of this decision to make the text accessible is that at times there is a lack of detail in the analysis, but the endnotes always guide the reader towards further research.

Overview

The early chapters introduce the rationale for the research project and provide an overview of the psychology behind potential change and transformation. Meditation, and in particular yoga, is being used within prisons to facilitate the transformation and rehabilitation of inmates but the evidence to support its effectiveness has a number of methodological limitations and inadequacies. A review of the considerable body of research into Transcendental Meditation concludes that it has moderate beneficial effects but that better and more elegant studies are required to address the grander claims made by its adherents.

An examination of the evidence for personality change suggests that yoga and other meditative practices may have the potential to cause significant transformations as both extreme physical stimulation and psychotropic drugs can induce personality change. It is also suggested that meditative techniques may help some clients to transform how they experience their daily flow of thoughts and feelings in a way similar to many psychotherapeutic modalities. The authors suggest that as a good therapeutic alliance is more important than particular therapeutic techniques, it is plausible that meditative approaches which create a positive and supportive environment that encourages change may also be effective. The less intrusive and unthreatening nature of yoga and meditation, compared to more verbal approaches to rehabilitation, means they may be especially appropriate and effective with individuals who are defensive or closed to more traditional approaches.

One of the central insights of the book is that change is not always a positive thing. Within Buddhism, meditation is traditionally only one part of a much wider program for transformation that also includes changes in goals and beliefs, and which highly values community rather than individualism. Without that supportive environment, any change that is achieved may be either less significant or even dangerous. It is observed that these negative consequences of meditation for some users have been documented by leading psychologists such as Lazarus (1976) but that the majority of research continues to ignore these risks.

The dangerous myth that Buddhism is an exclusively peaceful religion is confronted and the example of Zen Buddhists in Japan during the Second World War provides a particularly powerful illustration of how meditation can be used towards violent goals. The authors argue convincingly that a positive spiritual-ethical framework is required to ensure that the changes meditation can help occur are not damaging and that this framework is absent from many secular implementations of mindfulness.

Finally, the story returns to the use of yoga in UK prisons and the authors’ own research, which found that yoga has a positive effect on wellbeing, mental health and self-control in prison populations when compared to a waiting list group (Bilderbeck et al., 2013). The low cost of such classes means that wider implementation may be a cost-effective way to rehabilitate prisoners and improve their lives.

In their concluding chapter, Farias and Wikholm identify and propose corrections to seven myths about meditation. They then elaborate on the elegant analogy that gives the book its title. Meditation, they argue, is very similar to a pill. It is not an easy or certain cure for ailments, but “like medication, meditation can produce changes in us both physiologically and psychologically, and that it can affect all of us differently. Like swallowing a pill, it can bring about unwanted or unexpected side-effects in some individuals” (p. 221). Many individuals will find meditation of one form or another beneficial, but there are others for whom it will be of little benefit or may even be harmful.

Conclusions

This balanced and grounded evaluation of both the benefits and risks of meditation is an important and much-needed contribution to a debate that is of considerable importance to public health. Future work into the use of mindfulness and other forms of meditation in the treatment of mental health problems will benefit greatly from taking the ‘Buddha pill’ analogy to heart. Not only should more rigorous methodologies be used but potential side effects and contraindications should also be actively investigated. The baby should not be thrown out with the bathwater, but it must be recognised that even water can both sustain life and extinguish it.