I have said many times that I am a fan of mindfulness and that in some ways undertaking Mindfulness Based Cognitive Therapy (MBCT) was a game changer for me. I might not have a regular formal practice (see below) but I use the skills I learned there every day. So I get angry and upset when I see descriptions of “mindfulness” that I simply don’t recognise or see skills wrongly applied so that service users have “have failed” or are “no good at” mindfulness (for a more thorough explanation of why I think that’s ridiculous and unfair see this post: https://purplepersuasion.wordpress.com/2012/11/30/mindfulness-for-bipolar-disorder-simpler-than-you-think/)
Pretty much every month or so there’s an article in the mainstream media on mindfulness and today it’s the turn of BBC health to report on the benefits of mindfulness in schools. It draws heavily on this paper which appeared in The Psychologist. I’ve seen worse pieces on mindfulness but still they contain misconceptions that make me despair. I’ve written the piece linked about describing what I think mindfulness is, but I’ve been thinking for a while that I needed to write a piece on what mindfulness is actually not. It’s kind of a long read, so feel free to skip to the section that most interests you. Healthcare professionals: particularly pay attention to 4 and 7.
So here goes. Mindfulness is not…
1) A religious practice. I’ve got a lot from the writings from Thich Na Hanh and yes, he is a Buddhist monk. But the techniques people like Jon Kabat-Zinn and Tara Brach have taken from Buddhism have been adapted for daily life in developed countries and are completely secular. If it gets you interested in Buddhism, go for it. There is also a strong Christian tradition of meditation and some similarities with Quaker Meetings for Worship. Myself, I’m a happy atheist Quaker, and although group mediation has some things in common with sitting in silence in Meeting for Worship, there are a whole lot of differences. So don’t let your faith or lack of faith put you off.
2) Sitting on the floor. OK, sometimes it can be that. Some people enjoy and benefit from what’s usually known as sitting practice or formal practice (what people actually do in formal practice I’ll come onto in my next point). But sitting on the floor is certainly not obligatory! You can do formal practice sitting down, lying down, lying on your back with your legs on a chair: anything that accommodates your physical needs or disability. But here’s the key part: you don’t have to undertake any formal practice at all if you don’t want to. What mindfulness is really about is a kind of waking up and paying attention to what we’re doing and what is around us. That’s pretty much it. So it means you can engage in any activity mindfully. Yesterday I walked home from the town centre, and when I got in I couldn’t really remember the journey because I had been totally lost in my own thoughts. If I’d chosen to be mindful I would have got home via the same rout in the same time period but I would’ve literally smelt the roses, the deep pink roses than overhang the fence round the corner. I might have notice green parakeets winging their way between the trees. I might have noticed the temperature of the air on my skin, the feeling of my flip-flops on my feet as they hit the pavement. Anything. Everything.
In Peace is Every Step Thich Nhat Han suggests a way of mindful eating. Recalling with great relish he would eat a cookie as a child he describes a “tangerine meditation” in which the experience of eating a tangerine becomes mindfulness practice. Focusing on the smell of it, the feel of the skin, consideration where it has come from and then the taste and the texture and juice then becomes the practice. Mary Rose O’Reilley describes watching a monk at a Buddhist retreat savouring an Indian sweet in 16 bites (she counted!) to be told, “Mindfulness is a sneaky way to live a rich life” (The Barn at the End of the World).
3) Deep/abdominal breathing. Abdominal breathing is more a yoga technique than one that belongs to mindfulness. The essence of mindfulness is to notice. To pay attention to what is happening inside of you and outside of you, to really experience what is happening instead of getting lost in your thoughts. Breathing is at the heart of mindfulness meditation, but that’s all there is. You just breathe. You don’t try to make your breath slower, deeper, longer – or anything else, because you don’t try to do anything to your breath. You simply watch what it’s doing wherever it is you can feel it most clearly. This could be nose, throat, chest or, yes, abdomen but the idea is to notice where you feel it, not make yourself feel it anywhere in particular.
4) A crisis management tool. If I have to read/hear about one more person being asked by a Crisis Team, “Have you tried mindfulness?” I’ll… well I don’t know what I’ll do. Go on a mindful rampage. No one without a very clear understanding of what they are talking about should suggest others “do” mindfulness. This especially goes for staff, whose position of power can make service users feel anxious or guilty because they keep hearing about it but they don’t really know what it means. Secondly, you cannot just “try” mindfulness. The relegates it to the level of, “Have you tried making a cup of tea?” Mindfulness is an experiential skill. Anyone who wants to can try it, but it usually takes a some classes or some useful books and CDs to get the idea.
And finally, it is totally inappropriate for crisis. Distraction is often recommended in crisis and is much more appropriate – people need a break from intense thoughts of harming themselves. Mindfulness is the opposite from that – it’s a focus on what is going on mentally and physically. Sitting silently with thoughts of suicide or self-harm can create a kind of echo chamber for those thoughts to become more developed. And someone who is highly agitated or distress is just not going to able to wash up mindfully. Not going to happen. The teaching that I received was clear: if your thoughts are too painful or distressing, get up and walk away. Don’t sit. Distract.
Jon Kabat-Zinn suggests thinking our mind as the surface of a lake ocean, and our thoughts as waves. Sometimes they’re just little ripples and sometimes they’re big, but they can be churned up by winds when the water is churned up and pulled in different directions. “People who don’t understand meditation think that it is some kind of special inner manipulation which will magically shut off these waves so the mind’s surface will be flat, peaceful and tranquil. But… you can’t artificially suppress the waves of your mind, and it is not too smart to try.” (Wherever You Go, There You Are).
5) A relaxation exercise. Many mindfulness teachers use guided meditations to help you along. For example, many MBCT courses start of with the “body scan”, an exercise where you work your way all around your body, from your little toes up to your head. This can seem a lot like the kind of guided relaxation exercises many people will be familiar with from yoga classes or meditation CDs, but again the emphasis is very different. In a guided relaxation, there is a goal: relax as much as possible in each area of the body you examine. Mindfulness has no goal so when you tune in to your toes you’re not asking them to do anything. You’re not asking them to relax or to let go of tension. You’re just observing them, just as you would observe your breath, with a sense of detached curiosity. Do they feel cold or hot? Is there any sensation of tingling or burning? Does your little toe still hurt where you stubbed it on the desk on Tuesday? And… that’s all.
6) A means to a state of happiness. As I hope I’ve made clear so far, there is no goal in mindfulness. It’s true that sensations of joy or wellbeing might crop up as a result of mindfulness (especially when you smell the roses) but it is a kind of a by-product of paying attention, not a state to aim for. Much of the time sitting practice can be far from blissful. It can be uncomfortable, boring, frustrating, or even lead to a sense of being trapped in your own body. It can lead to doubts about what you are trying to do and why you’re even bothering. These things emphatically do not mean you have “failed” or that you are “doing it wrong”. Mindfulness is paying attention, and you are paying attention so you are being mindful! Then you have choices – what is safe for you? Do you want to carry on? Do you want to stop completely, or to get up and do a different practice like mindfully walking round the room? It’s fine to decide that what you’ve been doing isn’t for you.
7) Something that’s suitable for everyone
I was disturbed to read this phrase in the Psychologist article: “There is no downside risk, and the evidence shows these things work.” First of all there is no intervention without some risk and it’s ridiculous to suggest such a thing. Applying mindfulness – well, mindlessly, does put people at risk. People who have asthma or other breathing problems may find the focus on the breath stressful or distressing. People who have experienced trauma, especially bodily trauma such as sexual assault, may well have developed coping strategies that involve not feeling that inhabit their bodies. Forcing them to feel what it is like to be in their bodies can be extremely triggering and damaging, especially if they feel trapped inside.
Also: what does this quote mean when it says: “the evidence shows these things work”? There is a growing evidence base, but this seems strongest in terms of people who have been depressed but are in remission, in terms of being a relapse prevention tool. That’s about as far away from a crisis as you can get under the mental health umbrella. (Also, can I just say: “‘mindfulness resistance techniques might help people avoid the temptation of chocolate”? Just no.)
So there you have it. These are the things I wish healthcare professionals would consider. There’s still a place for mindfulness in the NHS but if we are serious about mindfulness we need to be putting professionals through at least the 8 weeks of experience practice on MCBT. Leaving people with mental health problems feeling that they have “failed” or are “no good at” mindfulness can damage already shaky self-esteem or sense of self-efficacy. Meddling with people’s minds with technique you don’t fully understand is risky.
Peace is Every Step Thich Nhat Han
Radical Acceptance Tara Brach
The Barn at the End of the World Mary Rose O’Reilley
Wherever You Go, There You Are Jon Kabat-Zinn