Mindfulness – Patching the Soul

‘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.

It’s fortunate that my other half and I share the same acerbic sense of humour.

‘When you aren’t well you start to talk all the time, and about 80% of it is rubbish, ’ he told me, ‘and you’re doing that now.’

It was at this point that I was finally able to admit that my mood, up and down since last autumn, had taken a major nosedive since New Year. The problem is that when I’m going down, I don’t generally recognise it until quite late, and I’m not always willing to listen to advice to ‘slow down’. This time, along with the usual symptoms of depression I’m so familiar with, I experienced the worst constant physical symptoms of anxiety I have ever felt; resulting in panic when I lost my bearing in Manchester’s Arndale Centre and I couldn’t immediately find the way out. This time, nothing would relieve the anxiety apart from alcohol. What my other half was referring to was the emotional and verbal expression of my anxiety. The constant seeking of reassurance and ruminating out loud about life problems, in a way that probably drives those around me crazy too.

However given my history of recurrent depression, it’s no surprise really that I’ve had another relapse. I had hoped that since retirement I somehow wouldn’t experience the same stresses I used to. And I’d been pretty well for a couple of years at least. But I was wrong. Losing my animal companion and several major family and health stresses I won’t go into here were enough to tip the balance again. It was back.

It’s the beginning of March now. For a while I panicked when I simply switched on the desktop computer. Now I can write again. I burst into tears in the middle of my last blog but I forced myself to get it finished. I have this feeling that if I can’t write then somehow I couldn’t live. Maybe it isn’t right, but I kind of believe that. For the last couple of weeks I’ve gradually been feeling better and the constant anxiety is subsiding to its usual level. I don’t feel like something awful is going to happen imminently and I’ve stopped thinking about death (I was having passive thoughts that life wasn’t worth living again). I heard birdsong the other day as I walked up the garden path and I realised I hadn’t taken any notice of the birds in the garden or their choruses or the bulbs shooting up for…well I’m not sure; because depression creeps up insidiously.

Why is my mood lifting?

Perhaps it just would do anyway. Spring is on the way. I’m bound to feel better…except for me it doesn’t happen that way. Even after the events that precipitate it are all past, my downturn goes on and on, thought not as low or for as long as when I was off medication altogether.

I can only make sense of it as a combination of the following and as you might expect from me, it’s a biopsychsocial combination of remedies:

I found a way to talk about my worries and fears about the future with my partner. It wasn’t easy but we managed to resolve some practical things I was concerned about.

I was able to utilise some of the practical coping skills for managing my rumination I learned from cognitive therapy and I started to use the guided mindfulness CD I had always been ‘too busy’ to listen to. I tried to stop myself from fighting against my mood, and simply accept that I was feeling terrible: bleak sad and empty. Paradoxically once I do that, I’ve learned, it is always a little easier to move forwards.

I forced myself to keep going out even though I wanted to shut myself in the house and never come out again. I’ve met many people in my career who have done just that. I had to ‘feel the fear and do it anyway.’

I was able, too with support, to put aside some of the impossible self-imposed deadlines I place on myself. I have to remember that my ‘Rules for Living’ are nigh impossible to live up to. Instead I set myself somewhat simpler goals like going out for a walk, and doing some washing. Small achievements which then helped me to move forwards.

I agreed to a change of medication. I wasn’t happy about it. I’m now on multiple tablets for my various conditions, but at the point I was at, it was worth a try. I cannot bear the thought of being sedated by medication and fully understood all my patients who refused to take medication that numbed their thinking. My mind has to be clear but when I’m very low I can’t frame the words and sentences either. I try to get to somewhere in the middle. I just cannot do it without pharmaceutical aid.

I sought and accepted the support of friends, real life and on line.

My other half did his part by being there for me, as he always is, even if I am talking rubbish, and arriving home one evening with a present of Lindt chocolate bunnies. Chocolate has antidepressant properties too, I tell myself as I bite the head off one of them. He tells me he knows I am getting better because I’ve started to talk about it all in the past again now. I think I’m getting better too, but I wont really know until I can look back and recognise how much I’ve improved.

That’s the nature of the beast.