I was sitting at my dining table with Tom and two members of the Crisis Team. They were there because I was experiencing overwhelming intrusive thoughts of running away and killing myself. My mind was totally out of control; I didn’t feel like “me” anymore. I was beyond self-help strategies, and that is why we were considering another hospital admission. I had thought we were all clear on these points, but then the healthcare assistant leaned in and said, “Have you tried mindfulness?” This was not the first time a member of a Crisis Team had asked me this very question.
Well, crisis lady, as a matter of fact I have tried mindfulness. When I was working I paid a lot of money to undertake private Mindfulness Based Cognitive Therapy, and over the years I have dipped in and out of a formal “insight” meditation practice. I learned a lot from MBCT about what mindfulness is – and what it isn’t.
The first thing I learned is that mindfulness is unsuitable for people who are poorly. My MBCT teacher phoned each prospective group member individually to warn them that if they were actively unwell, now was not the time for them to undertake the course.
The next thing I came to understand is that mindfulness is a skill. It has to be taught. You can learn from books, but it’s probably a lot easier to learn from a teacher. It is both a philosophy (loosely drawn from Buddhism) and a technique. It has to be practised. One cannot “try mindfulness” as a one off event requiring no prior knowledge or experience, the way one can try a cup of chamomile tea to see it helps them sleep.
My main takeaway from MBCT was that in practising mindfulness we don’t seek to do or change anything. Whatever thoughts, feelings, bodily sensations arise are to be observed, but not consciously changed. It’s about noticing, not about trying to make things different. Most often in mindfulness meditation your breath is used as an anchor point; when you feel your mind starting to wander away from noticing what is (which it inevitably will), you pull your mind back to you breath. Again, you are not trying to change anything, so you don’t breathe in a certain way to try and make yourself more relaxed. You just watch.
My latest brush with “mindfulness” – and I put that in quotes for a reason – has been on an NHS Emotional Coping Skills group work programme I recently completed. It was pretty much an abridged version of Dialectical Behavioural Therapy (DBT), which tries in improve people’s ability to tolerate painful feelings, increase their ability to soothe themselves when in distress, and have more effective interpersonal interactions. A central tenet of DBT is that mindfulness is a key skill in learning to deal with and regulate strong emotions.
This NHS brand of mindfulness left me confused. Some of it did seem like mindfulness as I understood it – for example, we undertook a meditation where we just observed the sounds around us, trying not to attach to any of them or make any judgements about them. We also did the dreaded “raisin meditation”, which has become rather a joke in the online mental health community because it is so ubiquitous (I had already experienced it in MBCT) and so… silly. The idea is that you choose or are given a raisin (one man in my group work programme was allergic to raisins, so he was allowed to have a Rich Tea biscuit), which you then interact with. You look at the raisin, concentrating minutely on its appearance, on its uniqueness, on how its wrinkles are like no other raisin. You sniff it to see how it smells. You bring it to your ear (yes, really) to see if it emits any sound. You roll it between your fingers, feeling its texture. Eventually you are allowed to pop the raisin into your mouth, but you have to hold it there, noticing if your salivary glands are activated, noting if you have the urge to chew. Finally, you are allowed to bite into it. I admit that by this point I find the raisin tastes better than anything I have ever eaten, almost too sweet to bear. And that is the point of the exercise – to slow things down so we can really notice what’s going on. If we cram handfuls of raisins into our mouths, as I am won’t to do, we are missing out on the authentic experience. But it does feel pretty embarrassing as an exercise.
Anyway. So some of it was proper mindfulness stuff, but then there was “distraction as mindfulness” or perhaps “mindfulness as distraction”. This confused me, because it involved completely turning our attention away from what we were thinking or feeling and engaging in some other task. Word searches, for some reason, seemed very popular. We did one about breeds of dogs and another one about healthy eating. The meditation bell was rung at the end of the allotted time period, to make it seem more… mindful. But if the goal of mindfulness is to notice but not change things, how can deliberately doing something different to change your mind state be mindfulness? Surely mindfulness and distraction are two very different things?
And here’s the key thing for me. I think they are different things, and I think that for crisis situations, distraction is an excellent tool to use, as long as you are distracting yourself with something safe. I use colouring books. I know I’m probably the only person in the world still surfing the adult colouring wave). I do jigsaw puzzles, I read (when I can concentrate on it), I have a bath or shower, I try eating something, whatever, to distract myself from suicidal thoughts. I believe that sitting with them and noticing them gives them houseroom and is dangerous. This BBC article notes that mindfulness can be damaging in that it can make you aware of difficulties, without giving any tools to deal with them. Some people find meditation, especially watching the breath, makes them feel panicky, particularly people with breathing problems like asthma.
I could move onto more political objections to mindfulness, that it puts the onus on the self to observe reactions to structural inequality, austerity, racism etc without putting any energy into fighting social ills that generate mental health problems. From that perspective, it is an ideal neoliberal therapy. But that could be a whole blog post in itself.
There is no real standard against which mindfulness teachers are judged. You can have decades of formal meditation practice, or you can do a brief course and set yourself up in business. It’s pretty obvious that most NHS mental health professionals – particularly nurses and healthcare assistants – will have done very little training in mindfulness, if any. “Mindfulness” is a buzzword. Most people suggesting it have no idea what they are suggesting, let alone that it is a skill that takes potentially a lifetime of practise, never mind the fact that it can be dangerous in active episodes of mental illness.
Yet still it gets recommended by Crisis Team members over and over again. By rights I should wait until tomorrow to finish this post, because my Twitter poll doesn’t close until then, but what the hell: as of this moment, 81% of 302 people say that they have been asked the question, “Have you tried mindfulness?” when they believed that they were at imminent risk of harm.
Why are we allowing this to happen? Why are Crisis Team staff encouraged to recommend something they know nothing about? Why are so few people talking about the fact that mindfulness can be dangerous if practised at the wrong time or without the necessary grounding? How is this OK, and how have we come to this point?
And now we’re at this point, how do we change things?