Outlook | Perspective
August 25, 2017 at 6:00 AM
We may live in a culture of distraction, but mindfulness has captured our attention.
Books on the practice are numerous, including guides to "A Mindful Pregnancy," "Mindful Parenting," "Mindful Politics," "The Mindful Diet" and "Mindfulness for Teachers." Corporations, sports teams, even the military and police departments provide mindfulness training to their employees. A bevy of podcasts offer tips for living a mindful life, guided mindful meditation and interviews with mindfulness evangelists. Another sure sign of cultural saturation: You can order "a more mindful burger," at Epic Burger in Chicago or an "Enjoy the ride" trucker hat from Mindful Supply Co.
I was dismayed when mindfulness began to encroach on my field: psychology, and specifically the treatment of suicidal behavior. A psychiatrist colleague's proposal for a book on bipolar disorder prompted a pre-publication reviewer to request "less lithium, more mindfulness" — even though less lithium can lead to more death by suicide in patients with bipolar disorder.
Of course, we're all intrigued by interventions that show promise over the standard treatment, especially for the most difficult cases. But I wanted to know whether mindfulness had merit. So I soon found myself immersed in the literature and practice — sitting shoes-off in a circle, focused on the coolness of my breath as it hit the back of my throat.
What we might call authentic mindfulness, I found, is a noble and potentially useful idea. But true mindfulness is being usurped by an imposter, and the imposter is loud and strutting enough that it has replaced the original in many people's understanding of what mindfulness is. This ersatz version provides a vehicle for solipsism and an excuse for self-indulgence. It trumpets its own glories, promising health and spiritual purity with trendiness thrown in for the bargain. And yet it misunderstands human nature, while containing none of the nobility, humility or utility of the true original. Even the best-designed, most robust research on mindfulness has been overhyped.
Although there are various definitions of mindfulness, a workable one, drawn from some of the most respected practitioners, is the nonjudgmental awareness of the richness, subtlety and variety of the present moment — all of the present moment, not just the self. Mindfulness is not the same as meditation, although meditative activities and exercises are often deployed in its cultivation. Neither is it the emptying of the mind; far from it, as the emphasis is on full awareness. And it is not about savoring the moment, which would demand dwelling on the positive. True mindfulness recognizes every instant of existence, even those of great misery, as teeming and sundry. It encourages adherents to be dispassionate and nonjudgmental about all thoughts, including those like, "I am hopelessly defective." Mindfulness wants us to pause, reflect and gain distance and perspective.
Authentic mindfulness is also humble in the sense that it places the self in its proper, minuscule place within each moment's infinitude. The mindful person is attuned to the miasma of sensation that has nothing at all to do with one's own subjectivity, but rather concerns the features of the present moment surrounding one's own mind, in its minute detail and its vastness, too. And, in addition to attunement to this external moiling of sensation, one is also and simultaneously dispassionately attentive to the contents of one's own mind.
Accepting one's thoughts as merely thoughts is very different from treasuring one's thoughts; one may as well treasure one's sweat or saliva. This is about recognizing that each thought is inconsequential and thus not worth getting depressed or anxious about. Viewing the mind's moment-to-moment products as of a similar standing as floating motes of dust — myriad, ephemeral, individually insignificant — is admirable and requires genuine humility.
But mindfulness has become pernicious, diluted and distorted by the prevailing narcissism of our time. The problem has somewhat less to do with how it's practiced and more to do with how it's promoted. People aren't necessarily learning bad breathing techniques. But in many cases they are counting on those breathing techniques to deliver almost magical benefits. And, all the while, they are tediously, nonjudgmentally and in the most extreme cases monstrously focused entirely on themselves. That is troublesome for mental health practice and for our larger culture.
Authentic mindfulness has always been susceptible to this distortion because of its encouragement of an inward gaze. At a mindfulness retreat I attended in 2013, the workshop leader exhorted us to remember the selflessness of genuine mindfulness and not to "fetishize" it as a cultist solution for self-enhancement or for the affluent's petty aggrievements. And yet we spent 90 percent of that retreat focused on our own sensations — the minute muscular changes as we engaged in "mindful walking," the strain points in our muscles and joints during "mindful stretching."
It is easy to see how this emphasis could be misinterpreted. In moderation, self-examination can lead to a reasonable and unobsessed awareness of one's emotional tendencies, thought patterns, impact on others and blind spots. But to encourage an inward gaze among incredibly self-interested creatures is to court excess.
The trendy version of mindfulness tends to be described in terms of what it can do for us as individuals. For example, a recent article on the website of Mindful magazine described "How mindfulness gives you an edge at work ." Likewise, the book "10-Minute Mindfulness" promises: "When you are truly experiencing the moment, rather than analyzing it or getting lost in negative thoughts, you enjoy a wide array of physical, emotional and psychological benefits that are truly life changing."
Or consider this promotional language for a workshop this summer co-sponsored by UCLA's Mindful Awareness Research Center: "Practitioners report deeper connection to themselves, more self-compassion, and greater insights into their lives." The emphasis is on the individual — connection to themselves, self-compassion, insights into their lives.
Indeed, self-compassion and self-care are intertwined with the popular concept of mindfulness. The notion seems to be that it is not selfish to tend to and even to prioritize one's own needs for care and understanding. After all, this line of thought goes, how can one be available for others unless one is fully present, and how can one be fully present unless one's own needs are met? The reasoning here contains a kind of trickle-down logic.
Of course, self-care in the sense of adequate sleep and nutrition is eminently sensible. But it seems that the most ardent fans of self-compassion focus on things like relaxing vacations, restorative massages and rejuvenating skin-care regimens. This preoccupation gives the impression that "self-compassion" is code, and a rationalization, for doing things people already find pleasant. There's nothing wrong with pleasant activities, but those already have a name: "pleasant activities." Calling them self-care adds little meaning and unhelpfully obscures that such activities are not essential to survival or health or caring for others — and that they can be foregone in the service of sacrifice and honor.
What do we really know about what mindfulness can do for us? "10-Minute Mindfulness" mentions advantages including reduced levels of stress, anxiety and overthinking, plus improved memory, concentration and sleep. And there is some mild scientific support for those benefits. Headlines regularly announce further breakthrough discoveries. In the past few weeks alone, we've heard that "Mindfulness-based intervention significantly improves parenting ," "Mind-body therapies immediately reduce unmanageable pain in hospital patients" and "Mindfulness may lower blood sugar levels."
It's true that numerous studies seem to support the benefits of mindfulness for a variety of life problems. Yet headlines tend to oversell what the studies show. And the effects of mindfulness seem to fade under the scrutiny of rigorous and tightly controlled experiments.
Take a look at that parenting study, a fairly typical example of mindfulness research. The study, published by the Journal of Addiction Medicine, didn't look at parenting in general. Its target population was mothers enrolled in treatment for opioid addiction who started with a low level of parenting skills. That's certainly a worthwhile focus, though narrower than one might have assumed based on the headline. The intervention was a bit of a mishmash. It involved mindfulness themes, such as attention and nonjudgmental acceptance, along with meditation and activities such as "the creation of a glitter jar to settle the mind." The mothers also received feedback on how they interacted with their babies, and they learned about the impact of trauma on parenting. So what was the active ingredient that contributed to the observed improvements in parenting behavior? It's impossible to say. And because there was no control group, we don't know if the progress of their addiction treatment or showing up with their children at a treatment center for two hours a week for 12 weeks was what made the difference.
The pain study was more rigorous. Patients reporting unmanageable pain were randomly assigned to one of three 15-minute interventions: mindfulness training focused on acceptance of pain; hypnosis focused on changing the sensation of pain through imagery; or a pain-coping education session. The study authors framed their research in the context of the opioid crisis, but their findings don't suggest that mindfulness will play much of a role in its resolution. Only about a quarter of patients in the mindfulness group reported a decrease in pain substantial enough to be considered of even moderate clinical importance. And the mindfulness group didn't exhibit any meaningful decrease in perceived need for opioid medication. Here, as in the vast majority of well-controlled mindfulness research, an intervention related to mindfulness failed to outperform — in fact, slightly underperformed — an active comparison treatment (hypnosis) and exceeded only a very inert comparison group (education). Nevertheless, studies like this are held up by mindfulness enthusiasts as proof positive of its special power.
Given my own specialty area, I have been particularly intrigued by the work of British psychologist Mark Williams and his colleagues, who have suggested that mindfulness interventions may be useful for preventing and treating depression. Unfortunately, their impressive 2014 study, which included a large and representative sample of adults, was not particularly supportive of a mindfulness-related approach. Mindfulness-based cognitive therapy — with meditation and without — failed to outperform treatment as usual (with previously prescribed antidepressant medication) in preventing recurrence of major depressive disorder. More specifically, about half of those in the study experienced a recurrence of depression, regardless of whether they were randomly assigned to the antidepressant plus mindfulness with meditation group, the antidepressant plus mindfulness without meditation group or the antidepressants alone group. (Because taking someone with major depressive disorder off medication can cause their depression to come roaring back, as famously happened with David Foster Wallace, studying mindfulness therapy without medication in this population is not an ethically responsible option.)
I don't mean to suggest that we should thoroughly dismiss the potential of mindfulness. Some reputable studies have shown that mindfulness training can reduce mind wandering and improve cognitive functioning, as measured through GRE scores. They have found that mindfulness mitigates sunk-cost bias — when we resist abandoning an effort and cutting our losses. But when many of the supposed effects of mindfulness fade in the hands of highly credentialed teams publishing well-designed studies in the best journals, we should be skeptical of the benefits promulgated by people and in outlets that are not as scientifically rigorous.
It's worth noting, too, that some research suggests that mindfulness may backfire. For instance, one study compared a group of participants who briefly engaged in mindfulness meditation with a group who did not. All the participants were asked to memorize a 15-word list; all the words involved the concept of trash (e.g., "rubbish," "waste," "garbage," etc.). A key point is that the list did not contain the word "trash." Close to 40 percent of the mindfulness group members falsely recalled seeing the word "trash," compared with about 20 percent of the control participants (who had been advised to think about whatever they liked). Ironically, being mindful meant losing awareness of details.
Mindfulness, as popularly promoted and practiced, can itself be a distraction. It purports to draw on ancient traditions as an antidote to modern living. Yet it exacerbates the modern tendency toward navel-gazing, while asking us to resist useful aspects of our nature.
Snap judgments and "mindless" but superb performance are two such elements of our evolutionary endowment. Our nervous system — perhaps nature's crowning achievement — evolved to discern figure from ground, to discriminate, to judge, often on an almost reflexive basis. And when we are fully absorbed in an activity, in a state of flow, it can be adaptive to lose self-awareness. A sure way to throw elite golfers off their game is to ask them to think aloud as they putt.
Interestingly, in contrast to much of the hyperbolic praise that is heaped on mindfulness, there is convincing evidence that the repetition of some activities, such as aerobic walking, even if done quite mindlessly, promotes health. Mere walking — three times a week for 40 or so minutes at a time — has even been shown to increase the volume of people's brains enough to reverse usual age-related loss by almost two years.
So rather than reading books on mindfulness or attending retreats or ordering a mindful burger, you may want to consider taking a walk.