In 1979, Jon Kabat-Zinn, a 35-year-old doctor at the University of Massachusetts Medical School, introduced an eight-week mindfulness-based stress reduction (MBSR) programme for chronically ill patients. The programme’s success can be judged by the fact that almost four decades later, Prof Kabat-Zinn is executive director of the Center for Mindfulness at the university, and its website states that participants in mindfulness programmes report a 38 per cent reduction in medical symptoms, a 43 per cent reduction in psychological and emotional distress, plus a 26 per cent reduction in perceived stress.
And the evidence base of peer-reviewed, controlled studies showing that mindfulness-based stress reduction programmes improve diverse conditions from anxiety and depression to chronic pain and heart disease is substantial and growing.
But what is mindfulness? According to Kabat-Zinn's book Full Catastrophe Living (1990): "Simply put, mindfulness is moment-to-moment awareness. It is cultivated by purposefully paying attention to things we ordinarily never give a moment's thought to."
This is expanded upon by Limerick-based Dr Terry Lynch, a physician, psychotherapist, mental health educator and best-selling mental health author who appreciates the value of mindfulness.
Dr Lynch told The Irish Times: "Consider the chore of washing up. Vietnamese monk Thich Nhat Hanh, a global authority on mindfulness, distinguishes between washing dishes mindfully – being fully aware of every aspect of the process, all of our senses fully open and engaged as we progress through the washing up – and washing dishes mindlessly – our minds flitting from here to there, now to the future, now to something that happened earlier today."
This means, says Lynch, “that little or none of our awareness and attention is focused on what we’re doing at that time”.
MBSR belongs to the recently established field of behavioural medicine, which believes that mental and emotional factors can influence health and our ability to recover from illness and injury. It successfully blends contemporary neuroscience and medicine with an awareness of the origins of mindfulness, rooted in Buddhist meditative traditions and practices established some 2,500 years ago.
But some influential thinkers now consider that the current exponential growth of MBSR is separating mindfulness from its spiritual and ethical Buddhist roots.
For example, Prof Terry Hyland of Dublin's Mindfulness Centre (mindfulness.ie) is a teacher of mindfulness, and he warns against the evolution of "McMindfulness" by a process of "McDonaldisation". This, he says, derives from "the increasing technical rationalisation and standardisation of more and more aspects of social, economic, political life and culture".
Prof Hyland said that while Kabat-Zinn has acknowledged “opportunistic elements” that approach mindfulness as a business rather than as a way of being, their negative influence is nonetheless underestimated. “Mindfulness,” explains Prof Hyland, “has become commodified; being used to sell everything from colouring books to apps for mindful gardening, resulting in the misuse of mindfulness.”
He further cites the examples of MBSR programmes in US military training and the corporate world as abuses of the intervention: “Basic mindfulness values,” he says, “such as right livelihood, loving-kindness, compassion and non-materialism are clearly at odds with aspects of the core interests of the military and big corporations such as Google and Amazon.”
Hyland is concerned that just as measurement and standardisation inform the creation of a corporate hamburger, relying on participant self-reporting to measure the success of mindfulness interventions, “removes mindfulness from its ethical and attitudinal foundations. In short, a ‘way of being’ is not susceptible to psychological testing, and such testing confers little benefit on learners, teachers or mindfulness practitioners.”
When it comes to cultivating mindfulness in the workplace, Hyland cites the establishment in 2015 of the Mindfulness Initiative in the UK by British parliamentarians promoting mindfulness in schools, working environments and the health service. Their report, Building the Case for Mindfulness in the Workplace (2016) states that "there are many anecdotal accounts of employees walking away from toxic working environments, or pursuing other goals and career aspirations as a result of having received mindfulness training".
But Hyland is unconvinced: “Whether mindfulness programmes which allow the cultivation of values questioning working practices and the role of work in the wider political/social/cultural milieu – allowing workers to say ‘no’ as well as ‘yes’ to conditions of service in speaking truth to power – could be successfully implemented today is a question which can only be answered by the work of current and future practitioners and researchers in the field.”
One possible option, according to Hyland, would be “to insist that employee training is conducted outside of the workplace according to mindfulness-based intervention procedures designed to ensure the incorporation of ethical values and the fostering of critical mindfulness”.
Meanwhile, in Dr Terry Lynch’s workplace, where he treats patients suffering from emotional and mental health problems, he acknowledges that the cultivation of mindfulness is seen as an effective antidote to a wide range of life’s problems: “The medical profession,” he says, “has adopted mindfulness as a worthwhile intervention for stress and many other emotional and mental health issues including anxiety and depression.
Effects and resolution
“But I’d like to see trauma – its effects and its resolution – receive the same level of societal attention as mindfulness currently attracts. Unresolved trauma occurs more often than we think. Indeed, it’s not uncommon for unresolved trauma to interfere with our ability to live mindfully in the present, to be fully in touch with ourselves, others and the situations and interactions in which we engage as we move through daily life.
“I believe that a twin focus on trauma and mindfulness would likely yield far greater results than focusing so singularly on mindfulness, as has been the increasing trend in developed countries, including Ireland, in recent years.”
It’s clear that the cultivation of mindfulness and the application of MBSR programmes confer mental and physical health benefits. Today, almost 40 years after Kabat-Zinn blended ancient Buddhist meditative and ethical principles with a mainstream medical approach to stress reduction, questions and concerns such as those raised by Hyland and Lynch will shape the evolution of mindfulness and how it can best be applied to help understand and enrich our lives.