Mindfulness as Mental Health Treatment?

A response to an opinion piece in The New York Times

Visnja Milidragovic
Fit Yourself Club
Published in
5 min readNov 30, 2016

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My eye wandered to a New York Times op-ed in my Facebook newsfeed yesterday, that my psychologist had friend shared. In it, Ruth Whippman, the author, argues against mindfulness, saying, as goes the article’s title, “Actually, Let’s Not Be in the Moment.” This spurred an interesting conversation between my friend and me, which I will try to share here.

Bráulio Amado

Whippman’s whole argument is anchored around the premise that “our lives are often much more fulfilling lived outside the present than in it.” This, however, is exactly what mindfulness practice hopes to decondition us from. There’s no contentment found in the blind optimism she nods to, I think.

She says, “Our happiness does not come so much from our experiences themselves, but from the stories we tell ourselves that make them matter.” Mindfulness, however, tries to teach us to believe the opposite of this — that really the only story that matters is the lived experience — even if it is washing dishes (an example of what causes her discontent). What makes us not enjoy washing dishes is our delusion that imagining doing something else will make us happier — when in fact, we are still washing dishes; that is the reality we should hope to accept and appreciate through mindfulness.

When we think about applications in more adverse situations, where the present moment isn’t concerned with washing dishes or having a board meeting, but with trauma or physical pain, however, I do think mindfulness can fall short.

Whippman references a reputable meta-analysis examining mindfulness-based intervention which found that this type of treatment was not effective. This is a point my friend raised, as well, in addition to citing other reputable empitical studies that have shown the same in regards to mindfulness as ‘first-line treatment’ for intervention. However, I do not think it is for the reason that mindfulness in itself is flawed, as the author suggests.

I won’t venture to pretend I have a confident grasp of medical and clinical research to this effect. But, I do wonder: Perhaps the medical community misunderstands mindfulness, which does not enable it to study — nor ‘prescribe’ — it properly. To attack mindfulness in its pure form is flawed; to attack mindfulness as it has currently been applied in clinical practice isn’t.

The problem with prescribing mindfulness

As my friend and I discussed the article at hand, our conversation steered toward the current claims for and against mindfulness as treatment for mental health. He made a point in saying that while there isn’t a lot of research backing up its efficacy (particularly compared to other treatments), there has been a lot of hype around its applications, as well — perhaps, in part, because it’s been commercialized in the West.

I’ll quote him here, (though will leave his identity anonymous):

“The lack of evidence for mindfulness-based treatments hasn’t, however, deterred healthcare providers from recommending mindfulness-based interventions for a range of physical and psychological problems including attentional difficulties, substance use disorders, eating habits, weight loss, sleep problems, and chronic back pain. Some have gone as far as stating the mindfulness improves survival among cancer patients and that mindfulness is as effective as psychiatric medication for recurrent depression.

Despite the lack of evidence to support these claims, mindfulness interventions are currently being rolled-our across large-scale corporations, in the United States Armed Forces, and might soon be routinely administered in many of the schools in the UK. On a larger scale, this translates to more resources being directed towards mindfulness research and interventions, thereby diverting resources away from individuals at the greatest need and from developing, researching, and implementing more effective treatments.”

While I am a believer that cogent claims are required when making decisions, especially when they impact lives, I venture to say that perhaps the issue here isn’t that mindfulness doesn’t work; I think the issue here is that mindfulness is misunderstood. It isn’t being ‘administered’ properly, nor studied properly, which makes it not surprisingly ineffective.

As with other types of therapies and treatments, it is all about approach and how mindfulness is applied and received; just as a medical practitioner must choose the correct treatment, they have to also administer it properly — wherein the challenge lies for mindfulness as intervention. For mindfulness to be truly ‘effective’, it has to be more than just done — it has to be experienced, lived. It is a philosophy and a spiritual practice, and I can’t say that all mental health patients — nor anyone for that matter — can fully embrace it nor see its long-term benefits by just being told to do it.

In more traditional terms, pulling from vipassana meditation, my feeling is that mindfulness as ‘treatment’ is likely too concerned with samādhi (concentration of mind) but does not necessarily include the notion of paññā (the wisdom of insight or purification of mind), which leads to the full benefits of mindfulness. Perhaps the medical community is studying and prescribing only one half of the treatment.

Mindfulness is a very personal experience and so isn’t as easily observed or evaluated through an empirical lens. More onus probably rests on the patient to ‘do it properly’ than with other treatments (i.e. recording how many hours someone meditates can’t be likened to managing someones dosage correctly.) There is a process that occurs within — and which is essential — and those with mental health may or may not be able to undertake the required degree of self-observation to follow ‘treatment’ properly.

Further, mindfulness, in its ‘full, proper’ form takes time — a lifetime even. This of course, for many, is not enough time to see benefits or observe and record them. Also, in my view, the practice can be much more effective and accessible when someone seeks out the practice themselves (think: self-help), so framing it as a treatment is challenging and may be setting up the practice as treatment to fail.

But, as my friend mentioned, we can’t reject the scientific method because it failed to validate our beliefs. So, how can we improve the way that mindfulness is studied and applied in clinical practice? Should we?

Thoughts?

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Visnja Milidragovic
Visnja Milidragovic

Written by Visnja Milidragovic

Digital consultant plagued by recurring dreams of analog times. Current muse: childhood memories.

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