The Mindfulness Explosion
The Perils of Mainstream Acceptance
In 1979, a 35-year-old avid student of Buddhist meditation and MIT-trained molecular biologist was on a two-week meditation retreat when he had a vision of what his life’s work—his “karmic assignment”—would be. While he sat alone one afternoon, it all came to him at once: he’d bring the ancient Eastern disciplines he’d followed for 13 years—mindfulness meditation and yoga—to people with chronic health conditions right here in modern America. What’s more, he’d bring these practices into the very belly of the Western scientific beast—a big teaching hospital where he happened to be working as a post-doc in cell biology and gross anatomy. Somehow, he’d convince scientifically trained medical professionals and patients—ordinary people, who’d never heard of the Dharma and wouldn’t be caught dead in a zendo or an ashram—that learning to follow the breath and do a few gentle yoga postures might help relieve intractable pain and suffering. In the process, he’d manage to reconcile what was then considered fringy, New Age folderol with empirical biological research, sparking a radical new approach to healing in mainstream medical practice.
Not exactly a modest scheme, and in retrospect, it seems astonishing that this nervy young guy—Jon Kabat-Zinn, the originator of Mindfulness-Based Stress Reduction (MBSR)—would manage to pull it off. And yet, as the now oft-told origin story goes, he convinced the Department of Medicine and the hospital administration at the University of Massachusetts (UMass) Medical Center that this idea was worth trying. With a core body of “interns”—anybody on staff who wanted to learn about meditation—he set up shop and began putting patients through an intensive 10-week (now 8-week) program of weekly classes, yoga postures, 45-minute guided home-meditation practice six times a week, and an all-day retreat during the sixth week. The idea was to teach a set of active self-regulation skills that patients could practice by themselves to help them cope with medical conditions—chronic pain foremost—for which standard medical remedies, such as drugs, rehab, and surgery, had proven less than completely satisfactory. The program was, Kabat-Zinn recalled later, “just a little pilot on zero dollars.”
There was just one small impediment to this plan: how was he going to persuade mainstream Americans that this approach wasn’t just New Age hokum? From the beginning, to have any chance of touching people in a deep way and motivating them to be open to meditating fairly intensively, he approached the challenge by adopting a mainstream and commonsensical American vocabulary that described meditation as a way of paying attenton and cultivating awareness in everyday life, and by using practices that were equally accessible and straightforward. Mindfulness is often spoken of as "the heart of Buddhist meditation." Kabat-Zinn's approach would be to offer training in mindfulness in ways that were implicitly anchored in Buddhist teachings, but in a universal and mainstream American idiom and framework. It would be an attempt to make that way of knowing and befriending one's own mind and body and experience accessible and acceptable to people who were suffering but had no interest in adopting a foreign tradition, philosophy, or religion, nor in meditating, for that matter. And since it was unfolding within a hospital and academic medical center, the entire program woul take its place under the ethical umbrella of the Hippocratic Oath, namely, "First, do no harm." As he has said, “I bent over backward to structure it and find ways to speak about it that avoided as much as possible the risk of its being seen as Buddhist, New Age, Eastern Mysticism, or just plain flaky.”
Kabat-Zinn emphasized that this was to be a high-demand program, meaning that patients would be expected to take full responsibility for developing their own inner resources. In other words, they should fully engage themselves, not just go through the motions. They needed to work hard every day but without—paradoxically—striving for any particular goal, like relief from pain. They might, however, hope for healing, but only in the sense that it meant “coming to terms with things as they are.” The idea was that hard-won mental and emotional acceptance could generate an inner shift in experience that often resembled a kind of cure—or as he put it, “As you befriend the pain, it can begin to go away.” At the same time, sounding more like a football coach than a spiritual teacher, he said, “I’m a strong advocate of getting tough with yourself. ‘Kicking butt,’ so to speak, or ‘Getting your ass on the cushion.’ You don’t have to like it. You just have to do it. And at the end of the eight-week clinic, you can tell us whether it was of any use or not.”
The patients, most of whom were demoralized and skeptical when they entered the program, actually did what they were instructed to do. They earnestly practiced watching their breath, following along to Kabat-Zinn’s taped instructions for the body scan, doing yoga at home, and learning to meditate, which—as he’s pointed out innumerable times—simply means “to pay attention on purpose in the present moment nonjudgmentally.” Improbably, most of these patients wound up feeling better, and in 1982, Kabat-Zinn’s first research article on mindfulness in the treatment of pain—the first such study ever in a bona fide academic journal—was published, with the ungainly title “An Outpatient Program in Behavioral Medicine for Chronic Pain Patients Based on the Practice of Mindfulness Meditation: Theoretical Considerations and Preliminary Results.” He wrote that a majority of 51 chronic pain patients reported “great” or “moderate” pain reduction, and even if their pain didn’t disappear, they experienced less depression, tension, anxiety, fatigue, and confusion.
The study was small, without a control group, based on paper-and-pencil self-reports, and rated by the author, rather than a panel of independent judges—a beginning, certainly, but no slam dunk as research papers go, and it didn’t seem destined to smash paradigms. Nor did it inspire many attempts at replication. By 1990, a grand total of 12 papers on the use of mindfulness in medical treatment had been published, with Kabat-Zinn himself producing 5. So while the fledgling program could claim a kind of success, it might have seemed a stretch to imagine it having much staying power as an intervention in mainstream medicine, or much of anywhere else for that matter.
A Movement Is Born
Thirty-five years later and my, how that “little pilot” has grown! Today, more than 20,000 patients have participated in the UMass program, which has produced 1,000 certified MBSR instructors and MBSR programs in about 720 medical settings in more than 30 countries. MBSR—or, more generically, mindfulness training—and other forms of meditation are now used for an almost unimaginable range of medical conditions, including cancer, heart disease, diabetes, brain injuries, fibromyalgia, HIV/Aids, Parkinson’s, organ transplants, psoriasis, irritable bowel syndrome, and tinnitus. Mindfulness has become central to the mental health profession and is commonly used in the treatment of attention-deficit hyperactivity disorder, depression, anxiety, obsessive-compulsive disorder, personality disorders, substance abuse, and autism. In addition, it’s at the heart of psychotherapeutic approaches like mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), mindfulness-based relapse prevention (MBRP), mindfulness-based trauma therapy (MBTT), and mindfulness-based eating awareness training (MB-EAT).
Mindfulness has also spilled (or poured) out of the healthcare/psychotherapy world and into the rest of society. It’s migrated to schools, with training programs and curricula for K-12 teachers and students sprouting up like mushrooms. It’s in universities and often, but not always, attached to medical schools or psychology departments as mindfulness research and teaching centers, including at the University of Illinois, the University of California at Los Angeles, Duke University, the University of Miami, the University of Pennsylvania, the University of Wisconsin, and Brown University.
It’s in prisons, where different meditation styles and traditions are brought to prisoners by way of organizations like the Prison Mindfulness Institute in Rhode Island, which directs prison programs itself, acts as an kind of clearinghouse for groups or individuals providing “mindfulness, meditation, yoga (or other contemplative traditions)” to prisoners, engages in or initiates research, and publishes books under the winsome name Prison Dharma Press.
It’s in the US military, which is training soldiers in what they call mindfulness-based mind fitness training (M-fit), drawn from MBSR, as a form of “mental armor,” a kind of inoculation against post-traumatic stress disorder. In fact, a nonprofit called the Mind Fitness Training Institute provides courses and tutorials not only to military personnel, but to law-enforcement officers, intelligence analysts and agents, firefighters, and emergency responders. Today, even soldiers learning how to fire M-16s are being given mindfulness training to synchronize their breathing with squeezing the trigger.
Finally, meditation has made its way into high-level sports, beginning with Phil Jackson teaching Michael Jordan and his Chicago Bulls teammates to meditate and win NBA championships in the 1990s, and continuing, more recently, to the NFL’s Seattle Seahawks, who won the Super Bowl in 2013 after spending spring training focusing on mantras like “Quiet your mind,” “Focus your attention inwardly,” and “Visualize success.”
Of course, when any major social trend looms into view, US corporations are going to muscle their way to the front of it. Corporate culture has taken to mindfulness training avidly: not only are mindfulness programs and courses showing up in business schools (Harvard, New York University–Stern, Georgetown University–McDonough, for example), but quite an impressive sampling of corporations are bringing it into the workplace. Outside of the usual suspects in Silicon Valley—Apple, Facebook, eBay, Google, Twitter, and Yahoo—traditional corporate stalwarts such as Hughes Aircraft, General Mills, Abbot Laboratories, General Motors, Ford Motor Company, AOL Time Warner, Reebok, Xerox, IBM, Safeway, Proctor and Gamble, Texas Instruments, and Goldman Sachs (!) are jumping on the bandwagon. Naturally, teaching mindfulness to business leaders—“mind fitness corporate training” it’s sometimes called—is itself a growth industry.
But in America, the real test of whether an idea, system, service, or practice has any popular traction is the marketplace. And here, mindfulness is a boffo bestseller, both as a product and as a source of almost endless product spinoffs. Besides the centers, institutes, training organizations, retreats, workshops, courses, seminars, conferences, resorts, and travel packages, all selling various experiences of mindfulness, there’s a vast bazaar out there of mindfulness stuff. A quick look at Amazon under “meditation, books,” reveals 82,405 titles for sale, but “meditation, all departments” lists 483,672 items, including—besides books, CDs, and DVDs—all the accouterments the well-accessorized meditator could ever want: cushions, mats, chimes, timers, gongs, incense burners, prayer beads, meditation benches, prayer shawls, yoga pants, baby rompers with the Om symbol, oriental-style indirect lighting fixtures, mugs (embossed with Om), aromatherapy kits, prayer banners, statuettes, tabletop fountains, and—pièce de résistance—a Carlos Santana fedora with a pin shaped like a combination guitar and Om symbol ($37.99). Needless to say, lots of meditation apps are available for your devices, including one called Buddhify, which allows you to set your iPhone or Android on any of 16 different meditation opportunities, including eating, feeling stressed, walking around, going to sleep, being unable to sleep, taking a work break, and “just meditating I and II.”
How many people actually meditate in America, or at least claim to? Hard to say—a 2007 census report of adults seeking complementary or alternative medicines indicated that 20 million used meditation for health purposes, but these 7-year-old figures appear to be the only ones available for the present and don’t seem remotely big enough to account for the mindfulness/meditation deluge washing over the country.
Finally, remember that little preliminary, imperfect research study that Kabat-Zinn turned out in 1982? For much of the next decade, he almost single-handedly kept the tiny MBSR research flame alive with a gaggle of articles in mainstream journals—on pain reduction, psoriasis, anxiety disorders, and heart disease. Mindfulness research didn’t really take off until after 2000—but then, did it ever! By the end of November 2014, the total number of research articles in the database of the American Mindfulness Research Association was an impressive 3,403—around 1,000 for the last two years alone. And those figures don’t take into account research articles on transcendental meditation (TM), a mantra-based technique first taught by the Maharishi Mahesh Yogi during the 1950s before catching on in the West (thanks partly to the Beatles). TM began accumulating a research base as early as 1970 with an article in Science, and now 350 or 430 or 600 (accounts vary) studies can be found in peer-reviewed journals supporting TM’s psychological, medical, social, and cognitive benefits, in both clinical and nonclinical populations.
Even these databases are undoubtedly a serious undercount, if all published “research” studies (ranging in quality from abysmal to middling to excellent) on various forms of meditation (mindfulness, TM, tai chi, yoga, and qigong) are included. In a meta-analysis of meditation programs, psychological stress, and well-being in the March 2014 issue of the Journal of the American Medical Association, Internal Medicine, Madhav Goyal, a Johns Hopkins assistant professor of medicine, and his colleagues identified a staggering 18,753 citations, before winnowing the number down to a paltry 47 randomized controlled trials with 3,515 participants. As to what all these studies are trying to demonstrate, a better question is what aren’t they trying to demonstrate: they explore mindfulness as a remedy for every issue that has even a passing connection to physical or mental health or general human well-being.
Mindfulness Goes Mainstream
How did this all happen? In the popular mind, about the only people really interested in meditation during the 1970s were New Age hippies, Asian studies scholars, and a small population of home-grown seekers (young middle-class adults, often left-wing Vietnam War dissenters at odds with consumer capitalism and looking for a spiritual lift they weren’t getting from drugs or the rejected Main Street religion of their parents). Mention meditation to Mr. and Mrs. Regular American, and you might just get a blank look, or worse, “Why would any normal person want to get caught up with one of those Eastern cults?” What peculiar constellation of forces and factors were coming into alignment so that one day soon, millions of perfectly normal people wouldn’t just be sitting cross-legged with their eyes closed, watching themselves breathe, but would believe this was the best health intervention since vitamins?
First, to start at the outer ring of the circle, the medical profession badly needed help with its “problem patients.” In a 2010 interview, Kabat-Zinn explained that before opening his clinic, he asked doctors, “What percentage of your patients do you feel like you help?” and was stunned by their answers. At most, they thought they helped only about 10 to 15 percent, while the other 85 to 90 percent either got better on their own or never got better at all, becoming the bane of medical practice: chronic patients with chronic conditions chronically unresponsive to anything the doctors tried. So when Kabat-Zinn offered what was basically a way to take these patients off physicians’ hands, the docs responded enthusiastically, saying things like, “Well, I can think of a hundred people off the top of my head we could send tomorrow.” In short, even though he didn’t really hide the Buddhist and Yogic origins of his plan from other medical professionals, these doctors were desperate enough not to look a gift horse in the mouth, whatever its suspicious origins.
Second, Kabat-Zinn’s idea—to repackage Eastern meditation as a secular health intervention that wouldn’t frighten the locals—had already been road tested. Just four years earlier, in 1975, cardiologist Herbert Benson of Harvard had introduced millions of Americans to a kind of proto-meditation with his bestselling book (its sales aided and abetted by the indefatigable Oprah), The Relaxation Response, in which he described the stress-reducing effects of simply focusing the mind on one thing for a little while. Benson had almost accidentally made his discoveries during the early 1970s, when, much against his better judgment as a self-conscious man of science, he’d been talked by TM practitioners into doing some quick research on what they claimed was their ability to reduce their own blood pressure at will simply by meditating on a mantra. He was astounded by the study results: 20 minutes of meditation caused a decrease in heart rate, blood pressure, breathing, pulse, stress hormone production, and so on, in effect, reversing the fight-or-flight response. But he was terrified that the merest taint of Eastern spirituality—particularly if it was associated with a long-haired, bearded, robed, flower-draped Hindu with the foreign name of Maharishi Mahesh Yogi—might spell doom for his professional reputation.
So in his book, he made only the barest of references to TM, substituted the word relaxation for the dreaded M-word (meditation), and argued for the purely physical health benefits of focusing single-mindedly on a “mental device,” which could be almost anything at all—a mantra or a prayer, sure, but also a neutral word, nonsense syllable, or object—or the “device” could consist of concentrating on a process or “muscular activity,” like yoga or qigong, but also walking, jogging, rowing, swimming, or knitting. It all sounded so normal, so ordinary—which is exactly what made the book sell . . . and sell, and sell; it’s sold more than 4 million copies and is in at least its 64th printing.
By 1979, even though the scientific and medical communities still weren’t entirely on board with this meditation thing, the times they were a-changing. That year, the Dalai Lama made his first visit to the United States, amid a media blitz, visiting cities, houses of worship (including a visit to Cardinal Cooke at St. Patrick’s Cathedral in New York), and universities; giving addresses; and generally wowing people with his unexpectedly charming personality. An obvious exotic, with his shaven head and maroon robes, the master of an alien but strangely glamorous religious tradition, he also professed a totally disarming interest in Western science—since he was a boy, he said—and confessed that he’d probably have become an engineer if he hadn’t gotten into the lama biz. He was particularly interested in any scientific linkages between consciousness and matter. Bingo! Scientists with an interest in Buddhism and/or meditation in general were thrilled: here was a revered spiritual leader who was also a scientist! And here was the chance to find the philosopher’s stone—to bridge the so-far unbridgeable gap not only between science and spirituality, but between mind and matter.
One such smitten scientist was Herbert Benson (apparently no longer worried about associating with “spiritual” types), who boldly asked His Holiness for permission to visit India and study the physiology of Tibetan monks. They could, he’d heard, raise their own body temperature in the freezing Himalayan air just through the intensity of their meditation. The Dalai Lama first said no: the monks were meditating for religious reasons, not so they could have their bodies poked, prodded, and stuck with various measuring devices (including rectal thermometers) for some hare-brained Western scheme. Then, mid-sentence almost, he changed his mind and agreed, explaining to his monks later, “For skeptics, you must show something spectacular because, without that, they won’t believe.” So early in the 1980s, Benson and some colleagues made several trips to India, looking for something “spectacular.” On one trip in 1985, described by Anne Harrington in her book The Cure Within: A History of Mind-Body Medicine, the monks duly complied with a demonstration of “g Tum-mo,” or “inner heat” meditation, raising their own body temperature while, in this case, draped with wet sheets (which sent up eddies of steam in the frigid air for added drama).
Four years later, in 1989, the Dalai Lama received the Nobel Peace Prize (for his efforts on behalf of Tibetan liberation from the Chinese, but also to protest the Chinese massacre of Tiananmen Square protesters), which generated a new paroxysm of infatuation for all things Tibetan. In particular, the Dalai Lama was lionized even more as somehow embodying the exotic mystery and ancient wisdom of Tibetan Buddhism and the rational, empirical spirit of modern Western science.
Soon, it became all the rage to study Tibetan monks scientifically to discover how, through long and advanced forms of meditation, they could not only transcend the usual limits of bodily self-control—raise and lower body temperature, control blood pressure, even improve immune function—but also achieve levels of spiritual transcendence hardly known in the West. Over the next two decades, a panoply of high-tech instrumentation—body temperature sensors, calorimeters (for measuring metabolism), EEGs, fMRIs, and so on—had been used in Western research centers and lugged up Himalayan mountains directly to monks’ huts for studies of what actually happens in the brains and bodies of these adepts.
Meanwhile, back down in the lowlands of pragmatic healthcare, in 1990, Kabat-Zinn produced a book titled Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, based on the Stress Reduction and Relaxation Program (SR-RP) at UMass Medical. A hefty read of more than 500 pages, it recapitulated in print what he’d been teaching for the previous 12 years, but now promoting its relevance for everybody, not just sick people. The “catastrophe” is taken from a line from the movie Zorba the Greek, when Zorba is asked if he’s ever been married and replies (in Kabat-Zinn’s paraphrase), “Am I not a man? Of course I’ve been married. Wife, house, kids, everything . . . the full catastrophe!”—shorthand for the poignant enormity of our life experience.
The real big break for mindfulness came in 1993, when Bill Moyers featured Kabat-Zinn’s SR-RP in a 40-minute segment of a five-part PBS television series, Healing and the Mind, which included a look at Chinese traditional medicine and other examples of alternative healing methods. The series won an Emmy Award and turned Kabat-Zinn’s Full Catastrophe Living into a bestseller. While Americans were clearly warming up to Easternism in whatever form—tai chi, yoga, meditations of various kinds—the show substantially boosted the stock of mindfulness. Here were regular people—teachers, truck drivers, carpenters, schoolteachers, business executives, stay-at-home mothers—trying to find the inner stillness beneath the turmoil of their life with bemused tolerance and growing trust. And here was Kabat-Zinn, an intense, good-looking man, whose tough-minded candor and deep kindness to his students made this mindfulness thing look okay. Even better than okay! Who could watch the interaction between patient and teacher—a woman obviously struggling through severe pain to do a simple yoga position and Kabat-Zinn on his knees, speaking softly to her, resting a hand gently on her back, tenderly wiping tears and sweat from her face—and not be moved?
The McMindfulness Backlash
The explosive growth of mindfulness in America has inevitably triggered a backlash—a low, rumbling protest, particularly from Buddhists claiming that mindfulness has increasingly become yet another banal, commercialized self-help consumer product, hawked mostly to rich and upper-middle class white people who still wouldn’t be caught dead in a real zendo. While few critics quarrel with using MBSR as a way to alleviate suffering in mind or body, they’re disturbed by how much meditation in America appears to have been individualized, monetized, corporatized, therapized, taken over, flattened, and generally coopted out of all resemblance to its noble origins in an ancient spiritual and moral tradition.
In a 2013 blog for The Huffington Post titled “Beyond McMindfulness,” Ron Purser and David Loy—American academics and well-known Buddhist teachers—declared that enough was enough. The effort to “commodify mindfulness into a marketable technique,” they wrote, required engaging in a kind of bait and switch, branding mindfulness programs “‘Buddhist inspired’ to give them a certain hip cachet,” but leaving out the heart and soul of the original practice. As a result, what was once a powerful philosophical and ethical discipline intended to help free people from greed, ill will, and delusion becomes just another mass-marketed self-fulfillment tool, which can reinforce the same negative qualities. People can, in effect, use mindfulness to become better at being worse. “According to the Pali Canon (the earliest recorded teachings of the Buddha),” the authors reminded readers, “even a person committing a premeditated and heinous crime can be exercising mindfulness, albeit wrong mindfulness.” A terrorist, an assassin, and a white-collar criminal can be mindful, Purser and Loy tell us, but not exactly in the same way as the Dalai Lama.
Further, mindfulness in America is so relentlessly marketed as a form of personal stress reduction that it tends to blind adherents to the larger conditions that create and perpetuate widespread emotional and physical stress in the first place. Stress originating in social and economic arrangements is, the author wrote, “framed as a personal problem, and mindfulness is offered as just the right medicine to help employees work more efficiently and calmly within toxic environments . . . re-fashioned into a safety valve, as a way to let off steam—a technique for coping with and adapting to the stresses and strains of corporate life.”
Google, for example, has developed a now famous mindfulness/emotional intelligence training program, the Search Inside Yourself Leadership Institute (SIYLI)—led by Chade Meng Tan, who has the supercute nickname Google’s Jolly Good Fellow—which it offers to employees and scores of corporate and institutional clients. According to the SILYI media kit, “We help professionals at all levels adapt, management teams evolve, and leaders optimize their impact and influence.”
A peculiar example of a corporate leader’s “optimizing” what might have been an embarrassing situation occurred early in 2014 at the Wisdom 2.0 conference in San Francisco, a huge yearly Silicon Valley glamorfest, where stars from high-tech firms, academia, science, and show biz come to be inspired by each other and listen to “mindful living” luminaries, including Kabat-Zinn, Roshi Joan Halifax, Jack Kornfield, and Eckhart Tolle. During a panel discussion (with Jolly himself on the panel) titled “3 Steps to Corporate Mindfulness the Google Way,” a group of activists infiltrated a hall packed with attendees, mounted the stage in front of the speakers, unrolled a banner reading “Eviction-Free San Francisco,” and handed out leaflets to protest the frequent evictions of low-income local residents from the city so landlords could jack up the rents for well-heeled employees of Google and other area corporations.
After the security guards had managed to disrupt the disruption, a Google senior manager on the panel solemnly asked the audience to “check in with your body [to] see what it’s like to be around conflict with people who have heartfelt ideas that may be different from what we’re thinking. . . . Take a second to see what it’s like.” The crowd dutifully closed their eyes and settled right down. Critics pointed out that rather than even consider what and why the activists were protesting, Google tossed the attendees some vintage mindfulness pablum, exposing what Christopher Titmus, a retired Buddhist monk and teacher, called “the shallowness and absurdity of corporate mindfulness.”
Recently, even the scientific foundations of mindfulness have been the subject of increased critical scrutiny. After all, the science of mindfulness is what got it in the door of the healthcare system; the science that impressed academics, therapists, educators, prison administrators, and corporate honchos; the science that made millions of Americans not embarrassed to say they were taking up meditation. Science is what makes meditation different from Eastern faith healing techniques and New Age woo. So how solid is all that science, anyway—those thousands of studies attesting to the empirical evidence of its power to help heal or relieve just about any physical or mental ailment to which human flesh is heir? There’s little doubt that mindfulness and other meditative discipline are genuinely useful to many people in many ways for many conditions. The question is what discipline, for what conditions, under what circumstances, how helpful, for whom, and when? At this point, the issue gets a little gnarly.
There’s a reason why Madhav Goyal and colleagues, the authors of the massive 2014 review and meta-analysis, found it necessary to winnow nearly 19,000 trials down to 47—or three percent of the total. Mindfulness/meditation-based interventions are inherently difficult to study and compare, like trying to pin down clouds in a gale. Variables of different approaches—TM, MBSR, tai chi, yoga, qigong—are hard to compare. Simply defining what meditation is or what it’s supposed to do tends to devolve into a word-salad of mix-n-match terms, like awareness, nonreactivity, openness, curiosity, describing, acceptance, nonjudging, and self-transcendence. The thousands of trials represented a mishmash of programs, which varied widely by type of meditation, length of meditation practice (three weeks to six years), training duration (roughly 12 to 39 hours), experience and training of the teacher, whether or not physical techniques (tai chi, yoga, qigong) were included, and population (how experienced participants were in meditation, what their complaints or ailments were). Most trials have been small before-and-after snapshots—uncontrolled and unrandomized, with no predetermined criteria, usually no long-term follow up, and high dropout rates.
From the saving remnant of the 47 good (or at least okay) randomized, controlled studies, the authors focused narrowly on research showing that meditation alleviated psychological stress (including pain) associated with medical problems. They came up with some mildly encouraging results, finding “moderately strong evidence” that mindfulness/meditation had a “small but consistent benefit” in relieving anxiety, depression, and pain (though what kind of pain—chronic, acute, or both—couldn’t be determined). The depressive symptoms were improved by roughly 10 to 20 percent, similar to the effect of antidepressants. As for the rest of the literature extolling the healing properties of mindfulness for all kinds of other specific conditions or its ability to improve the overall quality of life, the authors don’t reject these claims; they simply explain that the scientific evidence is insufficient to draw firm conclusions about them one way or the other.
These authors suggest that one reason for the low-to-middling results (compared to the hype, that is), and for the difficulties of doing this sort of research at all, may reflect a profound division between Eastern and Western attitudes toward meditation in the first place. The West, and particularly the research world, views meditation largely as a pragmatic, expedient, short-term intervention, comprising specific behavioral steps, intended to achieve clear, observable goals—such as relieving anxiety, pain, and depression. But historically, Goyal and his colleagues remind us, meditation was conceived as a lifelong practice, a hard-won skill within a rich spiritual, ethical, and social framework. It was never intended to be a quick-acting mental Ibuprofen/Xanax, but a long-term discipline that increased awareness, resulting in deep insight into the subtleties of existence itself—something that perhaps can never be measured or quantified without access to some wizardry for measuring the “subtle energy body” the Tibetan Buddhists describe. As the authors put it in a laconic understatement, “The translation of these traditions into [Western] research studies remains challenging.”
Even if the research doesn’t—can’t—live up to its popular media hype, the hype keeps on expanding. In an interview with Tricycle magazine, Catherine Kerr, assistant professor of medicine at Brown University, who directs translational neuroscience for Brown’s Contemplative Studies Initiative, points out that the problem is twofold. First, the media cherry-pick newsworthy scientific results and ride roughshod over cautiously worded research findings, typically reducing them to a one-sentence factoid, “a circulating meme that people put up on their Facebook pages and that becomes ‘true’ through repetition alone.”
Kerr knows of which she speaks: she was herself a coauthor, with Sara Lazar, on the famous 2005 paper “Meditation Experience Is Associated with Increased Cortical Thickness,” which led to countless articles suggesting that you can engineer a complete brain makeover with just a few weeks of mindfulness. As she recalls, “The typical headline in the popular press was ‘Mindfulness Makes Your Brain Grow.’” The problem was that all this took place in the absence of other replicating studies showing genuine evidence for some kind of structural brain change following mindfulness training and without any explanation of what physiologically was causing the apparent change and how it was affecting people’s experience and behavior.
Carefully parsing the results of her own study in the cautious language of science, Kerr will say only, “There are some clues from brain science that meditation might help enhance brain function. That is an evidence-based statement. The mistake is investing 100 percent in a result and not holding a probabilistic view of scientific truth or risk and benefit.”
The second problem is that the science of mindfulness itself isn’t immune to hype and distortion. Researchers need to generate a certain amount of buzz about their early research in order to get grants to carry it on. Observes Kerr, “To get things going, get collaborators, and gain NIH interest, you need to be a little entrepreneurial. . . . Researchers have to strike a tricky balance between expressing genuine enthusiasm and cautioning about limitations.” Scientists, like everybody else with something to sell, increasingly need to advertise, to do the kind of PR that will get them noticed.
And meditating scientists aren’t necessarily less inclined toward bias and overstatement than their non-meditating colleagues—possibly the reverse. “When we first started research on meditation, there was this principle that the scientists should be meditators because they understood it,” says Willoughby Britton, an assistant professor of psychiatry and human behavior at Brown. “But we are all also incredibly biased! Meditation is not just a practice we do, like ‘I like to run.’ It’s an entire worldview and religion. I worry about this kind of bias in meditation research.”
Finally, meditation isn’t without risks of its own. Marketed as a kind of warm bath for the psyche, Britton says, meditation has a shadow side, familiar to experienced meditation teachers but almost never mentioned in the popular media—that is, the not uncommon tendency of some people when they begin practicing in earnest to freak out (lose ego boundaries, hallucinate, relive old wounds and traumas, experience intense fear, and even have psychotic breaks, as well as exhibit strange physical symptoms, like spasms, involuntary movements, hot flashes, burning sensations, and hypersensitivity). These effects are well documented in Buddhist texts as stages along the long, hard path to inner wisdom, but they haven’t been studied in the West and aren’t featured in mindfulness/meditation brochures. Britton is one of the first to begin researching these phenomena seriously, in an undertaking she at first called the Dark Night Project. But since that name wasn’t attractive to funding sources, she renamed it The Varieties of Contemplative Experience Project. Along with the mass enthusiasm for meditation, Britton says, has come “an epidemic of casualties,” which needs to be recognized and incorporated into the promotion and study of these disciplines.
In short, while meditation has been acclaimed and sold as a quick, no-risk, easily mastered technique to achieve just about any conceivable desired goal—health, happiness, freedom from physical or mental pain, relaxation, self-confidence, career success, sexual success, inner peace, world peace!—it’s, in fact, a far deeper, more complex, and less well-understood process than many people realize. For one thing, whatever the measurable effects of meditation on behavior or physiology, the cognitions and feelings it arouses inside are entirely subjective—which makes it inherently unfriendly to the necessarily objective methods of empirical science. But these conscious experiences are as real as the people having them, and, quantifiable or not, they’re as much a part of mindfulness meditation as the mind and brain that produced them. The fact that meditation is fundamentally a matter of consciousness is exactly the problem: what, exactly, consciousness is or why we have it has been called “the hard problem” by many scientists and philosophers precisely because it resists cogent scientific explanation.
All of which doesn’t mean that scientific research into meditation isn’t improving and producing more genuinely valid studies, which will help us better understand what meditation is and how it changes our brains, experience, and behavior. It’s simply that, as both Kerr and Britton argue, a little caution would be advised. After all, we still know precious little about the neurophysiology—and not so much more about the psychology—of love, sex, anger, fear, learning, sleep, feeling, emotion, and thought. How much less do we know about that quieting of the mind, so unusual for Americans, called mindfulness?
People still aren’t entirely clear about what mindfulness is, Britton argues, or what distinguishes the different practices, or “which practices are best or worst suited to which types of people. When is it skillful to stop meditating and do something else? I think this is the most logical direction to follow because nothing is good for everything. Mindfulness is not going to be an exception to that. . . . If we think anything is going to fix everything, we should probably take a moment and meditate on that.”
To the outpouring of complaints by some Buddhist practitioners that secular mindfulness is basically a fraud dressed in bodhisattva clothing, the response of many others is essentially “Chill out, people.” Meditation, these critics of the critics say in effect, is a good discipline that’s helped suffering people all over the world. And if it isn’t always done in a perfect spirit of selfless “right mindfulness,” or doesn’t always produce better, more compassionate, wiser human beings, well, this is Planet Earth, inhabited by the same imperfect human race that lived here 2,500-plus years ago, when Siddhartha Gautama wandered around India preaching the Dharma. To the accusation that Buddhism has lost its purity to the crass ravages of modern corporate America, for example, antipurist critics respond cheerfully, “What purity?”
Jeff Wilson, author of several books on Buddhism in the West, including Mindful America: The Mutual Transformation of Buddhist Meditation and American Culture, has pointed out that there has never been just one Buddhism, but a welter of Buddhist practices, organizations, ways of life, and opinions in a never-very-centralized tradition that’s moved from India to China to Burma, Japan, and finally the West, picking up accretions along the way. Whatever anybody said about Buddhism, somebody else could say the opposite. What you had, Wilson said, was just “a great big mess called ‘Buddhism,’” which adapted itself to an astonishing variety of social and political circumstances everywhere it landed.
As to the question of whether poor, innocent, little Buddhism can withstand the withering pressures of the marketplace, there never was a time when it wasn’t deeply connected to the political and economic realities of the world. “The truth of the matter,” says Wilson, “is that Buddhism has not ever at any point from its very beginning, or at any stage of its evolution, been apart from economic matters.” The ideal of the master sitting alone in his cave or high on a mountain, isolated from the nonspiritual hoi polloi, is essentially a myth. Buddhism has long been deeply embedded in the larger political economy. Monks have often exchanged spiritual goods (chanting to produce merit for a donor or a donor’s family) for economic support by the community.
Furthermore, the benefits people hoped to achieve by supporting the sangha (but not meditating; that was the prerogative of the monks) were often less spiritual and more worldly, practical, personal, and even selfish: success in love and business, good health, relief from pain, protection from evil, safe childbirth, better karma for the next go-around. This makes what most lay Buddhists in historical times wanted from their religion no different from what most people in most eras have always wanted, including people today: protection from disaster and harm, hope for the next life (however conceived), and a sense of peace in the security of knowing that there was some greater meaning to the unpredictable, often frightening, frequently miserable ebb and flow of mortal existence.
In a deeply stressed and stressful society, the basic, general mood du jour seems to be some variable mix of depression, anxiety, fear, rage, self-loathing, loneliness, alienation, yearning, envy, and other items in a much longer catalog. So what are we to make of the purist critics of the mainstreaming of mindfulness practices? In a blog last year, Seth Zuiho Segall, science writer for Mindfulness Research Monthly and editor of the blog “The Existential Buddhist,” asked himself the question that seems addressed to the purist critics’ concerns: “Is mindfulness guilty of making people happier without making them enlightened?” His answer? “You bet. Guilty as charged.” And then he went on, “Down through the ages, most nominal Buddhists have chosen to pursue better karma and rebirth rather than aiming for enlightenment. If mindfulness only results in happier human beings, then . . . so be it. Those of us who choose to pursue awakening and transformation can still do so, happily untroubled by the sight of all those cheerful, mindful people milling about in our vicinity.”
Now if that’s the worst-case scenario for the vast majority of those who take up mindfulness training (with appropriate psychiatric attention to the freaker-outers, of course), wouldn’t most people be more than willing to make a deal? Mindfulness? Bring it on!
Photo © Corbisimages / Massimo Borchi
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