‘I don’t know what it is exactly- no one does- but even my GP tells me I’d benefit from it.’ (The Spectator 17/7/2017)
If you mention you are seeking help for depression its odds-on somebody will mention mindfulness. It has reached a point where it feels like the thing those of us with anxiety and depression should be doing- the self-evidently right thing to do to get ourselves ‘mentally fit’ (whatever that means), booking in to do a few exercises in the mind gym.
Last week I tweeted:
The responses were interesting. Several who felt the same way. A couple suggesting I might approach it in a different way (I’m not going to say that they thought I was doing it wrong, because that would be unkind) and one entrepreneur trying to sell me his latest product.
I’ve been interested in meditation for many years. I don’t want this to sound facetious- but I fear it will- I have often thought that I would like to learn more about Buddhism- if it didn’t require so much effort. One of the most fascinating days of my life was spent in a Zen monastery in Japan. There have been times when I’ve meditated every day, and others when I’ve not. Since retirement I have started again- a little more regularly. I’ve found it helps me to feel more centred and calm. Wanting to learn more about Mindfulness, and having benefited somewhat from learning in the past some ways to cope with ruminations using techniques based on it, I started doing a recommended on-line course. My itinerant lifestyle precludes attending a weekly group, although I think this might have been much better.
At first it was helpful, but then my mood began to dip- related to uncertainties in the world- and the guided mindfulness exercises seemed to make things worse. The ‘thought clouds’ burst and rained their contents down on me. Being asked to think about the painful things in my life with compassion for myself reduced me to tears, while having to think compassionately about others evoked anger. Haven’t I spent most of my life worrying about everyone else? Isn’t that the problem? I found myself saying. I can’t take this. It was no good. I had to stop.
I have heard of professionals telling clients that Mindfulness will put drug companies out of business. This kind of ridiculous promotion goes on in more muted forms across the media- some of it from researchers who should know better. What we can say is:
- The evidence for Mindfulness is weaker than the world would have you believe – for example see the recent systematic review for the US government’s Agency for Health Care Quality and Research or Has the Science of Mindfulness Lost its Mind in the Psychiatric Bulletin and for a more acerbic commentary James Coyne’s articles on line.
- People respond differently to Mindfulness. We know there are potential adverse effects. Recalling traumatic events, increasing your level of anxiety or depression, depersonalization and even psychosis.
- Mindfulness is suggested to people who are in the throes of depression (never mind full blown crisis)- but the evidence for its effectiveness during a current episode isn’t great– and there is none at all for Mindfulness Based Stress Reduction (MBSR- trademarked by Jon Kabat-Zinn). Mindfulness Based Cognitive Therapy has been shown to prevent recurrence when you’ve had 3 or more episodes and to be as effective as drugs for preventing relapse of depression (reported as ‘Mindfulness is as effective as drugs for treating depression.’) that’s what NICE recommends it for.
There are good reasons why it might not work when you are very depressed. You are preoccupied with anxiety, worries and ruminations. You start to focus on the very things that make you feel worse- your negative thoughts (even though you are only supposed to ‘be aware’- try telling me that when I’m not in control of my thoughts- I find it hard to even pay attention). And anyway you have to motivate yourself to get going.
The other moral objection to mindfulness comes from those who see the promotion of ‘McMindfulness’ as contrary to the values with which meditation is associated in Buddhism. It has become:
- A personal path to ‘self-fulfillment’ removed from the intention of promoting compassion for others as well as yourself.
And/or
- A corporate tool with for helping employees work more efficiently- with greater ‘resilience’ in toxic environments- thus putting the burden of responsibility back onto the individual to learn how to cope. I took pills for many years to do that- but it was my choice to- It wasn’t suggested to me by the boss.
Neither seem to be in harmony with the ethics and morals of Buddhist belief.
Indeed the moral imperative to ‘improve yourself’ by practicing mindfulness has something of the Protestant work ethic about it- I’m only too familiar with that.
We must dust some of the celebrity stardust off Mindfulness and see it for what it is. Another useful tool that will help some but not others. Those of us attracted to meditation will find it helpful- but not when we are acutely depressed. I’m meditating again now- and finding it helpful. I know I have work to do on why ‘self-compassion’ is so hard but I can recognise that, and I find reading Paul Gilbert’ books on compassion and mindfulness helpful. Others using self-help materials without support might find it much more distressing. Its one of the reasons we need to be alert as to how such tools as mindfulness are being disseminated in the community- and by whom.
We ought not to promote a therapeutic milieu where people feel they ‘must’ learn to meditate or are told ‘it doesn’t work for you because you aren’t doing it right’ or ‘do this- its better than pills’.
Please.
Patching the Soul 
Fully agree, Linda, when I tried mindfulness, when gping through a bad patch, my mood dipped, to the extent of feeling like I couldn’t go on. However, on FB when I was going through another bad patch, I had someone recommend mindfulness, and didn’t have the nerve to tell them my experiences with it. Nothing quite like having someone say, hey I know you’re feeling in pain, why not concentrate for another hour on just how much pain you’re in.
As an anglican priest I am fully aware of and have used meditation personally and in groups. Personally I have been directed to Mindfulness because I have Bipolar Disorder type II. I agree, whole heartedly with your comments. When my symptoms are a very present reality, I am no more able to ‘do’ mindfulness as I am able to juggle kittens whilst on a unicyle. But then I am not able to ‘do’ the traditionally daily offices that anglican priests promise faithfully to do when ordained. Yes mindfulness can be helpful, as can prayer, but when unwell both of these are a no no, otherwise I just become even more depressed and disheartened, thinking I am a crap priest, or if having an episode of hypomania, can easily believe that what I am experiencing is a delightful ‘spiritual’ experience. When my care coordinator mentions mindfulness these days I growl. It is not a panacea, but it is something that services can provide, so it tends to make those who want to do something for you, feel happier as they are doing something. As a priest I have found just sitting next to a person in distress more helpful. I am not teaching or directing, just by mere presence, gently saying, you are not alone, I am here with you, and I believe that where we are now, God is also present. Whatever the faith or belief of the person, wearing a dog collar can bring something, I don’t know how to describe it, to a share experience. That’s it, that is all I do. It seems to help others and relieves me of the burden of whanting to ‘do’ something. My GP and psychiatrist tend to giggle when I describe my experiences of being taught mindfulness. Although, of course, we all accept that it is helpful for SOME people, some of the time and in some situations, as the NICE guidelines say.
I’ve been waiting for you to write about this for a while, Linda and I’m glad you have. I frequently have problems with the way in which the discourse around which “mindfulness” is framed. And it’s fair to say I have some significant reservations about the whole concept of mindfulness as a therapeutic tool. For those of us (myself included) who encountered the idea of mindfulness through our involvement with buddhism, it’s as if we are talking two different languages. Even the idea of mindfulness as a “technique” is baffling. The current mindfulness movement came to us via Joseph Goldstein and Jon Kabat-Zinn and has it’s roots in the teachings of Mahasi Sayadaw and S.N.Goenka. It’s a twentieth century invention; it’s important to bear that in mind. Mahasi, in particular, developed a “technique” which he thought would lead to the attainment of a goal; Nibbana, the cessation of suffering and it is this technique that has been so assiduously developed in the west over the last 40 years. But here lies my biggest problem with it; it’s not a technique. It’s not something you *do* at all. Mindfulness is just one of the fundamental faculties we possess that make us human. We have creativity, we have compassion, we have intelligence, we have empathy, we have mindfulness. I can only describe it as our capacity to know what’s happening, as it’s happening, without preference. To say something like “I did mindfulness and it didn’t work.” or “Mindfulness will make you better” doesn’t make any sense at all because you can’t instrumentalise it. No-one can say, “Mindfulness isn’t for me” because we haven’t got any choice in the matter, we’ve got it whether you want it or not. And it’s an embodied faculty; it’s there in our guts. I witnessed my father’s last breath, I have felt incredible pangs of rage, I have experienced horrible pain and self disgust, people have threatened to kill me. None of these things were pleasant moments but I was present for them all and I’m glad I was because what was the alternative? Finding another moment to live in? Avoidance? My own teacher told me, “Do what makes you feel anxious, not what makes you feel depressed.” In other words, recognise the difference between acceptance and resignation. And you have to really notice what is going on in your internal environment, in the moment, before you can do that. This is what mindfulness training allows us to do. I like the word “training” – it’s a very zen word that describes exactly what is involved – we train, diligently, for the whole of our lives. I worry that mindfulness is becoming just a therapeutic tool, divorced from its ethical roots and without the tradition and community necessary to sustain it and support those who practice it – because, yes, it can be unsettling and difficult. I think it’s a hugely beneficial practice but I agree, it needs to be handled with caution. Don’t teach Vipassana meditation to vulnerable people who can’t handle it, teach them something else instead – there are plenty of alternatives. But in the end we all have to face the same prognosis which is the reason I practice and will continue to do so. And, as an aside, I wouldn’t dream of recommending it to anyone. People have to find out for themselves – another very sound Buddhist principle. Thanks for the post and the chance to debate this. I think it’s an important issue.
Seems to be like many things promoted for depression.. ..good for when you are not deeply unwell, impossible when you are very unwell. Same goes for exercise, healthy eating, ect ect etc
Thank you so much for saying this out loud! I think the most wonderful thing I’ve heard through Zen-based meditative arts is that there are many paths up the mountain. I’m not sure if it’s a Western thing, a modern thing or a world thing that’s been going on for a very long time but there seems to be a propensity to want one solution for all the problems. ‘If you lose weight your life will be better’, ‘If you meditate you’ll never have to worry again’, ‘CBT! Cures what ails ya!’ Yoga, pilates, meat-based diets, non-meat based diets, circuit training, aggressive positivity. It goes on and on. Each year there’s a new way to cure everything and make us be better people. My problem has always been, ‘What if this is as good as i get? Why isn’t that enough?’ These are my questions – everyone has their own ways to beat themselves up (I have loads of others, actually, but they don’t need to be gotten into just here) and there are all manner of ways to seek help. I’m a dance therapist (just one more way to get through) and I tell clients all the time that it’s good to try out a bunch of different techniques. Some will work some days, others on other days and maybe the most ‘popular’ ones aren’t for you at all. Thanks again for this beautifully written article.
Thank you Linda for this thoughtful and helpful article which chimed a lot with me. In fact my group mindfulness course specifically warned against doing the course (or subsequently practising) during an acute episode.
I just wanted to add that, frustratingly, I don’t find that MBCT approaches help me in preventing recurrence. The premise seems to be that if you can stop the downward spiralling thoughts at an early stage, that will prevent an episode of full blown depression. But for me, I can be bouncing along just fine, using CBT techniques without even consciously having to try to and then the episode arrives (often feeling ‘out of the blue’) and one of the features/symptoms of it is profoundly disordered thinking. So what feels like an overwhelming physical/biochemical change precedes and ushers in the psychological change of downward spiralling thoughts.
I guess what we call depression probably covers a multitude of different experiences and patterns and that (as ever) what works for some individuals (and even works for enough patients to get it recommended by NICE) doesn’t work for others.
Thank you again for your website and your blog and book- they have been so helpful to me.
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