Mind the Gap : The History and Philosophy of Health Psychology and Mindfulness Atenção aos

The recent surge in popularity of the concept ‘mindfulness’ in academic, professional, and popular psychology has been remarkable. The ease with which mindfulness has gained trac on in the health sciences and cultural imagina on makes it apparent mindfulness is well-suited to our current social climate, appealing to both experts and laypeople. As a subdiscipline established rela vely late in the twen eth century, health psychology has a unique rela onship to mindfulness. This ar cle elucidates the shared roots between health psychology and mindfulness as a psychological construct and fi eld of research, providing a frame of reference for the ways in which health psychology and mindfulness share similar theore cal and methodological challenges that aff ect their integra on into health, social systems, and services.

Mindfulness is omnipresent in the West today2 .A highly malleable concept, mindfulness is currently understood as a process of focusing one's a en on on experiences in the present moment, an ability individuals can enhance through various forms of training, including medita on.Such prac ces have been widely adopted by the health sciences, including health psychology.Mindfulness off ers the promise of preven ng or improving a variety of mental and physical health condi ons.Because of its poten al health benefi ts, mindfulness may seem to fi t incontrover bly in the terrain of health psychology, a fi eld whose defi ni on is wide enough to encompass any aspect of psychology that addresses health issues of any kind.However, health psychology and mindfulness research have developed largely in parallel over the same period of me, and proponents of both have had to work hard to establish legi macy within psychology and medicine more broadly.As such, while the umbrella of health psychology can be understood to cover mindfulness as a behavioural treatment, the majority of research on and the applica on of mindfulness has been peripheral to health psychology proper, conducted instead within other psy-disciplines.Nevertheless, since they have developed over the same me frame and have been informed by many of the same contextual infl uences throughout, their histories are o en intersec ng and there is insight to be gained from inves ga ng the similari es and diff erences in their progressions.
The ease with which mindfulness has gained trac on in the health sciences and cultural imagina on is the current pinnacle of a sustained societal emphasis on wellness.This surge in popularity makes it apparent that as a psychological concept, mindfulness is par cularly well-suited to our current social climate, and it is appealing and accessible to both experts and laypeople.Thus, as one of the 'lifestyle' behavioural treatments that developed over the same me frame as disciplinary health psychology and one of the most pervasively adopted since the beginning of the new century, mindfulness serves as an exemplar of the success of behavioural and cogni ve interven ons in healthcare.
The health science applica ons provided by the health psychology and mindfulness discourse communi es have similar inten ons.As such, comparing and contras ng their respec ve rela onships to the philosophical founda ons of psychological and medical science can also prove frui ul.Historical metaphors and concepts about the human body and health can aff ect how health is understood in psychology and by proponents of mindfulness more widely.The Western philosophical legacy that frames humans as natural assemblages of components -tradi onally traced through Cartesian dualism with the idea of bodyas-machine (Rabinbach, 1992) -became infl uen al in the twen eth century through the seemingly exponen al advancement of technology and technologically-oriented modes of study (Harrington, 2008;Friedman & Adler, 2011).Addi onally, because mindfulness as a psychological construct and method derives primarily from a variety of Buddhist tradi ons, it necessitates further considera on of the philosophical, epistemological, and sociopoli cal dynamics at play when science studies or co-opts other approaches to knowledge produc on.For example, both psychological and Buddhist principles are o en presumed to imply philosophical universalism -which is to say, that their beliefs, theories, and prac ces are generalizable to all humans at all mes and places (Smith, Spillane, & Annus, 2006;Lopez, 2012;Dodson-Lavelle, 2015).
One consequence of this presump on is a focus by health psychology and mindfulness research and applica on on individual control of experience and behaviour in an ahistorical manner, rather than on how individuals relate to their environmental, social, and cultural contexts.However, individual choice and ac ons are far from the only determinants of health and well-being.Any discipline or social system that aspires to provide health-oriented services to popula ons would be remiss not to address contextual factors, such as inequity in the alloca on of social resources and services, which stand in the way of health for so many (DelVecchio Good, James, Good,& Becker, 2005;Kahn, Ilcisin, & Saxton, 2017).Thus, this emphasis on 'universalized individualism' has been a point of conten on central to the establishment of cri cal health psychology (Gergen, 1973).It has also led to recent eff orts within mindfulness work to clarify the defi ni on and theore cal premises of Western mindfulness theories, in order to increase the rigour and accuracy of research, and to interrogate the sociopoli cal ramifi ca ons of their applica on (Tang & Posner, 2013;Lutz, Jha, Dunne, & Saron, 2015).The spread of mindfulness prac ces undoubtedly has real and profound consequences for health services as structured around these no ons of care and on the wellbeing of individuals enlisted in such prac ces.The parallel histories of mindfulness and health psychology, and the kind of naïve universalism prominent in these discourses, make evident the necessity of a ending to the historically specifi c contexts in which health concerns are realized and the forms of address these contexts engender.Neither health psychology nor mindfulness as currently realized off er suffi cient routes to health.
This ar cle surveys the historical and philosophical contexts in the development of health psychology and mindfulness in North America over the past forty years, the geographical locale in which mindfulness has most thoroughly established itself and fl ourished.In doing so, we explore how health psychology and mindfulness have interrelated, and how each (and the rela onship between them) have aff ected cultural understanding of health and the direc on of health service provision in social systems, and markets.

Historical and Philosophical Contexts of Disciplinary Health Psychology
Health psychology coalesced as a fi eld dis nct from the other psy-disciplines during the la er half of the twen eth century due to growing interest in how environment, behaviour, and biology contribute to and impact both mental and physical health and illness (Engel, 1977;Wallston, 1997).Conceptualized as a cross-cu ng area of research and applica on that would be of interest to a wide range of psychologists and other health professionals, opportunity in the fi eld gathered momentum with the establishment of a division of the American Psychological Associa on in 1978 (Division 38) (Wallston, 1997).The defi ni on penned by inaugural division president Joseph Matarazzo (1980) refl ected an aggregated inten on that through the par cular educa onal, scien fi c, and professional contribu ons of psychology, health can be promoted and maintained, illness prevented and treated, e ologic and diagnos c correlates iden fi ed, and health policy and systems analysed and improved.
A recurrent theme throughout the history of health psychology is that of how medical philosophy has interacted with the rapid changes experienced by popula ons in the so-called 'Western' socie es, including the growth of American individualism and the wide-ranging impacts of technological advancement.Reference texts on the formaliza on of health psychology relate it to theore cal and methodological trends in medicine, clinical psychology, epidemiology and public health, and the elucida on of biopsychosocial models for health and disease (Baum, Perry Jr., & Tarbell, 2004;Friedman & Adler, 2011;Pickren & Degni, 2011).More specifi cally, a century of rapidly changing causes of, and social responses to, illness, disability, and death contributed to the integra on of psychology with the burgeoning mul disciplinary fi elds of behavioural medicine and behavioural health (which focus on the prac ce of collabora ve health care and individual health needs and responsibili es, respec vely) (Matarazzo, 1980).The eradica on of previously pervasive contagious diseases, the extension of life expectancy, shi ing interna onal rela ons and the threat of nuclear a ack, equalizing gender familial roles, and dissemina on of scien fi c knowledge and authority contributed to the crea on of new concepts about health that aff ect how people understand themselves and their ac ons, including: lifestyle, stress, diet, fi tness, addic on, and mental health (Baum et al., 2004).As previously predominant realms of disease were addressed by contemporary medical industries, both federal and private research groups in the United States mandated mul ple public heath reports to explore the ways in which individual behaviour was a major contribu ng factor to persis ng illness, including the leading causes of death within developed popula ons (Pickren & Degni, 2011).This research led to late twen eth century public health ini a ves targe ng behaviours that infl uence chronic diseases, diabetes, and cancer.These kinds of endeavors focused on the interplay of public policy, communica ons, psychological-behavioural principles, and affi rmed the value of medical theory that defi nes health at the intersec on of biological, psychological, and social dynamics.Correspondingly, the reduc on of expenditure within social and health service structures increased the need for cost-eff ec ve preventa ve behavioural interven ons that can be clinically informed, but self-regulated by pa ents (Murray 2015;Davies, 2014).In the process, health psychology and behavioural medicine have been forwarded as correc ves to the limita ons of prominent biomedical theory that over-valorizes the roles of gene cs and molecular biology on health outcomes (Kaplan, 2011).
A central ques on in much of the history of disciplinary psychology -and that is par cularly relevant to the interrela on of health psychology and mindfulness -is whether the goal of the fi eld is to establish universal laws that can apply equally to all humans at all mes.The assump on of such universalism and ahistoricism in psychology has been predicated on posi vis c philosophies in science which have been debated by an -posi vists for three centuries (seethe philosophical posi ons of Comte, Durkheim, Schlick, Vico, and Dilthey) (Chernilo, 2007).The mid twen eth century saw what has been dubbed the post-posi vist turn in the philosophy of science (e.g., Karl Popper, Thomas Kuhn), and in psychology cri cs informed by this thinking ques oned the long-standing dominance of opera onalism and brought forth accusa ons of scien sm and methodolatry (Bakan, 1967;Putnam, 1992).Central to such arguments is the asser on that posi vist universalism invites ahistorical ques ons and explana ons in psychology, which in turn limit the capacity to address social rela ons and structures and overemphasizes the role of the individual (Davies, 2014;Murray, 2012).
On the one hand, health psychology was envisioned as the psychological component of a holis c healthcare system that could also take account of social factors (Armstrong, 1987).On the other hand, the work of consolida ng the boundaries of a new fi eld of research, which aspired to integra on with the medical fi eld, required a degree of adherence to medicine's well-established biomedical orienta on.The achievement of such integra on with medicine depended on the fi eld's simultaneous legi miza on within psychology, which demanded a certain adherence to methods grounded in the values of natural scien fi c disciplines (Murray, 2014).Thus, the inten on to create a theore cally eclec c fi eld that would be able to provide the pluralis c explanatory frameworks then absent in contemporary medical prac ce was tempered by the need to engage in quan ta ve measurements, sta s cal analyses of variables, and to interpret those in a manner consistent with the dominant prac ces of both medical science and psychology (for a cri que see Tafreshi, Slaney, &Neufeld, 2016); in other words, to construct knowledge based on averaged inferences that would apply to whole popula ons in a universalized manner.Professionalized in this way, qualita ve methods and contextually-focused theories have been marginalized in health psychology, much as they have always been in psychology.Cri cs contend that this preoccupa on with professionaliza on amounts to li le more than a reinforcement of the status quo (Stam, 2015).Framing the preven on of illness and maintenance of health in terms of ahistorical universal principles that can be measured and analysed across popula ons prevents ar cula on of how experiences of sickness and health are historically and contextually bound.
As men oned, an eff ect of this universalist approaches to research and applica on has been emphasis on individual behavioural causes and solu ons to health issues.In social systems that are complicated by inequity and disparity at the intersec ons of wealth, race, gender, religion, sexuality, as well as physical and psychological ability, health care that focuses on how individuals manage their responses to circumstance, rather than addressing these circumstan al issues directly, can be considered vic m-blaming (Stam, 2015).Func oning in this way, the fi eld can account for the biological and psychological aspects of the biopsychosocial model, but the social remains beyond its purview.Consequently, in both health psychology and mindfulness individual choice, disassociated from surrounding social and cultural factors, is posi oned as the determinant of health.

Historical and Philosophical Contexts of Mindfulness
This narra ve of the emergence and development of health psychology also provides a context for the populariza on of mindfulness as an individually-oriented behavioural construct and therapeu c interven on over the past four decades or so.Mindfulness is now generally understood by psychologists and medical doctors as a relaxa on technique useful for the allevia on of anxiety and for emo onal and aff ec ve regula on (Bishop et al., 2004).Its recent impact on academic, professional, and popular psychology has been remarkable.Publica ons about its neurocogni ve and therapeu c eff ects have proliferated (see Goyal et al., 2014;Cavanaugh, Strauss, Forder, & Jones, 2014); training programs have been ini ated in medical, clinical, educa onal, judicial, and business se ngs (Talbot-Zorn, & Edge e, 2016); mindfulness 'self-help' has inundated the popular press and blogs (Davis & Hayes, 2012;Cavanagh et al., 2014); and it has been commodifi ed and capitalized on by a broad market of services and products, everything from cell phone applica ons to yoga gear (Davies, 2014).
Early legi miza on of mindfulness as a secular concept was achieved by academics that came of age during the mid-century upheaval of colonial dominion and the reconfi gura on of interna onal rela ons according to neocolonial policies (McMahon, 2008;Murray, 2015).As part of this broader renego a on of established authority, public and intellectual discourse communi es began introducing alterna ves to the biological framework of medical theory, including American proponents of medita on from Buddhist lineages who integrated their prac ces into medical and psychological research programs under the banner of mindfulness (see Goleman, 1971;Benson & Klipper, 1975;Engel, 1977;Shapiro, 1980;Langer, 1989;Kabat-Zinn, 1990).These founda ons contributed to the produc on of a core of work on the subject during the 1980s and 1990s, se ng the groundwork for the rela ve prolifera on and populariza on of mindfulness during the 2000s.
Given their similarly short and varied history, and the medical (and socio-poli cal) relevance of mindfulness as a method for self-regula on, it is not surprising that there have been interac ons between health psychology and mindfulness research since their beginnings.In fact, its broad scope of interest, and lack of narrow defi ni on, has allowed health psychology to engage with the many diff erent ways that mindfulness has been represented and interpreted in the Western psy-disciplines (as compared to other subfi elds of psychology which theore cally may only fi nd one or two approaches to mindfulness relevant to their agendas).
One of the earliest, and perhaps the most well-known, mindfulness research ins tutes in the United States is a behavioural medicine program: The Mindfulness-Based Stress Reduc on (MBSR) clinic at the University of Massachuse s Medical Center.Founded by Jon Kabat-Zinn in 1979, MBSR is not only one of the most successful mindfulness programs in terms of its contribu ons to the legi miza on of the prac ce in secular contexts, but also one of the most explicitly health-oriented.The MBSR program is intended to address the experience (and cause) of stress and suff ering through the development of innate capaci es for self-healing via mindfulness (Kabat-Zinn, 1990;2011;Dodson-Lavelle, 2015).The MBSR methods have been applied variously to suit specifi c needs that have arisen in rela on to par cular medical condi ons as addressed within healthcare systems.The clinic's approach has been integrated as complementary medicine within oncology (see Will et al., 2015), modifi ed specifi cally for addic ons relapse preven on and disordered ea ng awareness (see Kabat-Zinn, 2011), and its eff ec veness in addressing a mul tude of other health-related issues, like insomnia and chronic pain, has been tested (see Hayes, Villa e, Levin, & Hildebrandt, 2011).
Clinical mindfulness modali es for mental health cons tute the most substan ve aspect of mindfulness research.While these are not central to health psychology per se, they are nevertheless relevant given their impact on clinical theory, methods, and culture.The value of crea ng therapeu c interven ons and clinical measures garnered a en on during the fi rst two decades of mindfulness theorizing.Such eff orts proliferated in the 2000s and include Mindfulness Based Cogni ve Therapy (Segal, Williams, & Teasdale, 2002), Cogni ve Based Compassion Training (Ozawa de Silva, & Lobsang, 2013), the Toronto Mindfulness Scale (Lau et al., 2006), the Mindful A en on Awareness Scale (Brown & Ryan, 2003), and the Cogni ve and Aff ec ve Mindfulness Scale (Feldman,Hayes, Kumar, Greeson, & Laurenceau, 2007), among many others.As the establishment of Kabat-Zinn's MBSR within a medical research center a ests, mindfulness func ons well as a cogni ve-behavioural component of medically organized healing.It has also opened the door for greater mobiliza on of knowledge between psychological and medical clinical contexts.Beyond this, because mindfulness-oriented interven ons are aimed at understanding and increasing health and well-being in general, rather than only healing and preven ng of illness, research has also inves gated its usefulness to healthcare professionals (as well as those from a wide range of other industries) as a tool for stress allevia on and performance op mality (Davies, 2014;McCann, Marion, Davis, Crandall, & Hildebrandt, 2015).
Outside of clinical interven ons, research into mindfulness has been dominated by inves ga ons into the physiological veracity of claims about mindfulness's allevia on of forms of suff ering like stress, anxiety, and depression, and its promise of nurturing forms of wellbeing like relaxa on and increased capacity for a en on (e.g.DeBerry, Davis, & Reinhard, 1989;Tlockzinski & Tantriella, 1998;A anas & Golocheikine, 2001;Tang et al., 2007;Lutz, Slagter, Dunne, & Davidson, 2008;McCann et al., 2015;Droit-Volet, Fanget, & Dambrun, 2015).As with their applied counterparts, these inves ga ons also carry mindfulness into the domain of health psychology.Psychophysiologists and neuroscien sts like Richard Davidson have done much to center discourse about individual health on the rela onship between psychological states and processes with changes in the brain, nervous, and immune systems (Davidson et al., 2003).Contemporaneous with Kabat-Zinn, Davidson began his research on awareness and states of consciousness in the 1970s, founding the Center for Healthy Minds at the University of Wisconsin-Madison in 1984, and at the turn of the twenty-fi rst century, his clinic was the fi rst to conduct neuroimaging studies of meditators.Since Davidson's ini al forays into the fi eld a robust literature on the psych-and neuro-physiology of mindfulness has been produced, which has in turn been assessed in a variety of reviews and meta-analyses.These assessments of the accomplishments and limita ons of the fi eld thus far serve to increase the validity of mindfulness's clinical outcomes and further its status as a cu ngedge realm of scien fi c inquiry (Tang & Posner, 2013;Lutz et al., 2015).
In addi on to these applica ons and research programs like Kabat-Zinn's and Davidson's, which par ally derive from and engage with Buddhist teachings and prac ces, secular constructs of mindfulness and mindlessness were also developed during the 1970s.Social psychologist Ellen Langer, who diff eren ates her concepts from those derived from Eastern tradi ons, understands mindlessness and mindfulness as basic states of mind or being, including but not limited to: minimal and novel informa on processing, infl exible and fl exible cogni on, reduced a en on and alert and lively awareness, reliance on previously drawn dis nc ons and categories, and the processes of drawing novel dis nc ons and the crea on of new categories (Langer, 1989;1997;Langer & Moldoveanu, 2000).She has iden fi ed health as one of the three areas of research, along with educa on and business, most engaged with her work (Langer & Moldoveanu, 2000).In the fi rst of several of books on mindfulness (Langer, 1989), Langer elucidated the research on aging from which she derived her mindfulness theory during the 1970s, and how it related to health theory.This explana on emphasizes that cogni ve focus on novelty, openness to new informa on, and the crea on of new categories all serve to exchange unhealthy mindsets for healthy ones, and increase general mindfulness, which in turn creates more personal "control" (Langer, 1989, p. 195).Langer's fi ndings have been part of the broader development of research on neural plas city and the posi ve psychology movement.
This historical survey illustrates the unique manner in which mindfulness research relates to health psychology in contrast to its rela onship with the other psy-disciplines.
Mindfulness has served as a par cularly pervasive area of health interest that exemplifi es how psychophysiological research and clinical methods can be applied within and informs the administra on of medical and other healthcare se ngs.In fact, given their interrela on, it is perhaps surprising that health psychology has not done more to locate mindfulness within the boundaries of its disciplinary authority, especially when it could serve well as an ambassador for health psychology in the public sphere.

Philosophical Underpinnings of Mindfulness
Like psychology by psychologists, secularized mindfulness techniques are forwarded by most of their proponents as universal and ahistorical methods, of value to all humans.As a concept, mindfulness has remained undertheorized and oversimplifi ed; however, it can also be argued that this general under-determina on has contributed to its success, including ongoing liberal applica on in disparate se ngs, with at-mes incommensurable inten ons (Lutz et al., 2015;Dodson-Lavelle, 2015;Harrington & Dunne, 2015).The most widely disseminated and accepted defi ni on within the literature is an opera onaliza on that is simultaneously accessible and monolithic, by Kabat-Zinn.He explains mindfulness as follows: "paying a en on in a par cular way: on purpose, in the present moment, and non-judgmentally" (Kabat-Zinn, 1994, p. 4).This defi ni on brings with it some assump ons (e.g., that mindfulness can describe both a soteriological way of life and a set of cogni ve processes, see Lutz et al., 2015), but it is vague enough to be widely inclusive, encompassing methods that in prac ce have divergent aspects.Mindfulness is thus an 'umbrella' term that can be accommodated to fi t many needs (Kabat-Zinn, 1994).Such ambivalence is appropriate within clinical contexts but is less func onal within empirical research aimed at understanding the "underlying mechanisms" of such prac ces (Kabat-Zinn, 1994).
A empts to defi ne mindfulness are also o en characterized as challenging or undesirable due to the complexi es involved in secularizing a religious prac ce in a way that emphasizes its universality and commensurability with the scien fi c value of objec vity (Dodson-Lavelle, 2015).How such a task is approached has varied between advocates.Psychologists and neuroscien sts such as Davidson, Francisco Varela, and Cliff ord Saron have championed partnerships with Buddhist con ngencies who promote the compa bility between medita ve methods and science (Davidson & Harrington, 2002).In contrast, Kabat-Zinn discusses the extent to which he strove, in the fi rst couple of decades of his work on mindfulness, to prevent it from appearing beyond the scien fi c pale-he describes bending over backwards to ensure his research on medita on did not seem "New Agey," mys cal or worse, fl akey, while striving to present it as eviden ary, ordinary, and mainstream (Kabat-Zinn, 2011).Whether obscuring mindfulness's religious origins or emphasizing them for legi macy, advocates like Kabat-Zinn and Davidson claim to access the heart of a Buddhist prac ce that refl ects a universal human reality; a "lawfulness" that is not a characteris c of the religion specifi cally, but that is rather universally inherent and commonsensical (Kabat-Zinn, 2011).This interpreta on asserts that the extrac on of this crucial methodological component of Buddhist teachings is suffi cient, and in fact necessary, to be the greatest benefi t to the most people globally.
Disassociated from the Buddhist cosmological epistemology of human suff ering and its relief, mindfulness has instead been fi ed into Western ontological metaphors about the body-as-machine and its corresponding explana on of health-as-machine-maintenance (Rabinbach, 1992).Within psychology this concept has been at play in theore cal and methodological trajectories from the beginning of the discipline's ins tu on, and it can be traced through func onalism, behaviourism, and cogni vism.This philosophical legacy found a par cularly strong foothold in mid-twen eth century psychological theories about the brain-as-computer, by way of ecology, systems theory, cyberne cs and computer engineering (Bateson, 1979;Harrington, 2008;Friedman & Adler, 2011).The indeterminacy of what mindfulness means within psychology allows its purpose to be interpreted in diverse ways according to any number of theore cal priori es.For example, in posi ve psychology, mindfulness is said to produce a subject whose relaxa on contributes to their strength in the face of adversity (e.g.Shapiro, Schwartz, & Santerre 2002); in cogni ve behavioural therapy, a subject whose relaxa ons helps them aff ect how they think, feel, and behave (e.g.Koszycki, Benger, Shlik, & Bradwejn, 2007); and in neuroscience, a subject whose relaxa on can be detected physically, measured, and established as a 'real' occurrence in their body (e.g.Vestergaard-Poulsen et al., 2009;Raff one, & Srinivasan, 2010).
In terms similar to health psychology's adherence to predominant approaches in medical scholarship and industry in an eff ort to establish its value, mindfulness has also gained legi macy through commensurability.The fact that the meaning of mindfulness is ambiguous has allowed it to remain complementary to many psy-disciplines; its philosophical consistency with the theore cal trends in science and Western thought more broadly has provided the opportunity for 'verifi ca on' through scholarly methods and professional applica on and has thus garnered epistemological authority.In this context, whatever parts of the medita on modali es from which mindfulness has been par ally extracted that are incongruent with the predominant philosophical presump ons already at play in the culture will con nue to be precluded, obscured, or prevailed upon.At the same me, those aspects that happen to correspond to current cultural ideals will con nue to be emphasized.
As it stands, mindfulness is comprehended only to the extent that it fi ts into psychological and medical premises and is used in ways that reaffi rm the well-established humanis c3 concepts of a universalized ontological individualism (Grogan, 2012;Davies, 2014).Those forms of mindfulness that do not successfully fi t into this framework evade apprehension when divorced from their epistemological bearings.

Conclusion
The parallel successes of health psychology and mindfulness are also what incite cri que.Many of these cri ques fall along similar lines.Health psychology's coherence as a fi eld has been achieved primarily through its usefulness in applied clinical cogni ve and behavioural interven ons and research, rather than theore cal rigour or advancement (Stam, 2015).Cri cal psychologists contend that while this approach has helped it integrate into medical systems, it has also stymied the transforma ve aspira ons from which it originally arose (Murray, 2012).From this perspec ve, the infl uence of ahistorical universalism has prevented refl exive considera on of how health is defi ned and experienced historically, contextually, and interela onally-as such, the health services it can provide cannot address issues of inequity, and its healing poten al is inherently limited.Nevertheless, what with the strength of its applica ons, health psychology has largely remained unconcerned about such cri cism.Current recommenda ons within health psychology suggest further integra on with the medical fi eld, rather than divergence, and emphasize the strength and resources associated with loca ng itself as an integral component of such services (Kaplan, 2009).They also acknowledge an a endant vulnerability to the same philosophical, prac cal, and sociopoli cal issues as the rest of medicine (Lawrence & Barker, 2016).The disciplinary perks of inclusion in the medical sphere have, however, trumped such considera ons.
In contrast, as an 'importa on' of an order beyond Western disciplines, and as a burgeoning construct requiring valida on through novel research instrumenta on, the spread of queries into the soundness of mindfulness has elicited a diff erent response from its researchers.Concerns have been expressed from a variety of angles: from a religious perspec ve, the secular 'dilu on' of Buddhist forms of medita on as mindfulness has been framed by some to be misappropria on (Wilks, 2014;Gooch, 2014); moralis c stances have that theore cal instability or philosophical 'fence si ng' has led to inappropriate commodifi ca on within social systems and markets, as well as ethically dubious applica on in contexts like military training (Barker, 2014;Davies, 2014;Davis, 2015); and scholarly or scien fi c concern has o en focused on issues of theore cal and methodological superfi ciality (Tang, Hölzel, & Posner, 2015;Davidson & Kaszniak, 2015).Some mindfulness discourse communi es have ac vely sought to address these cri cisms through engaged conversa ons about the intended future of their subfi eld, as well as explicit eff orts towards philosophical clarifi ca on and analy c development (Dimidjian & Segal, 2015;Harrington & Dunne, 2015;Tang & Posner, 2013;Lutz et al., 2015).
An underlying tension in cri ques of both health psychology and mindfulness research is the diffi culty of cri cizing work that aspires to -and by many metrics does -benefi t psychological and physical health.Under the ideological banner of posi vist universalism mindfulness prac ces have been promoted by health disciplines as panaceas for all manner of challenges in the modern world.Adopted within a variety of diverse contexts, mindfulness promises not only to resolve what ails you, be it physical or psychological, but also to improve your well-being more generally.Promoted as a democra c, self-directed prac ce that can benefi t everyone, mindfulness has captured the imagina on of health professionals, scien sts, and the public at large.As a consequence of this wide-ranging support, any cri que of mindfulness all-too-easily appears to be a cri que of this very aspira on for health and wellness.In this ar cle, however, we have documented how a en on to the historical and epistemological underpinnings of health psychology and mindfulness reveals a fundamental failure of these fi elds to address the sociohistorical condi ons of health issues.As currently conceptualized, health psychology and mindfulness are unable to account for the many determinants of health beyond individual choice and ac on (Chang & Fraser, 2017;DelVecchio et al., 2005;Kahn et al., 2017).Bridging the gap between health psychology and mindfulness necessitates not only integra on of the la er into the former, but broader acknowledgement of and eff orts to redress, the current inability of such ini a ves to account for, and address social and health inequi es at systemic levels.