In the last few years, you might have noticed a new word make its way into the media: “mindfulness”. There’s mindfulness for stress, mindfulness for depression, mindful running, mindful shopping – and the government is even considering introducing mindfulness classes in schools. For mental health clinicians like me, the word is now part of our everyday language. We advise depressed clients to “become more mindful” and advise a human resources department that their stressed-out workforce “do some mindfulness”. But as the concept spreads, it’s being met with little questioning and insufficient scepticism.
The Mental Health Foundation’s definition of mindfulness is “meditation, breathing and yoga” where one pays “attention to the present moment”. This helps people to “become more aware of [their] thoughts and feelings so that instead of being overwhelmed by them, [they’re] better able to manage them.” Originally a Buddhist practice, it was adapted by Jon Kabat-Zinn in the 1970s, and popularised by clinical psychologists such as Mark Williams. Now, it is increasingly being adopted as part of cognitive behavioural therapy treatments. Even the National Institute for Health and Clinical Excellence (NICE), the official body for clinical evidence in the UK, has stated in its guidelines that mindfulness-based cognitive therapy should be offered to individuals for recurrent depression.
NICE, which makes recommendations based on scientific trials, mainly takes its evidence from randomised controlled trials (RCTs), seen as the gold standard of scientific enquiry. But this method has its downsides. For example, how applicable is the RCT lab to real life? Do the positive effects continue after the trial has taken place, especially for people with chronic conditions like depression or anxiety? Mindfulness fits nicely into the RCT style of research. It’s easy to set up a control group and it’s easy to ask people to rate, for example, their levels of subjective stress – so it is easier to show gains where in fact there may not be any when we come up against “real life”.
What’s more, mindfulness relies on the participants’ ability to assess themselves. One of the core assumptions of mindfulness is that the individual can recognise the difference between thinking and feeling – and can learn to be aware of these internal processes. This is easy for some, a challenge for others. One of the purposes of mindfulness is to teach this awareness, but how do we know when someone is “aware”?
To address this question, formal systems like the “Mindful Awareness Attention Scale” have been developed. The problem, however, is that by asking a person “how aware are you of X?”, the very question will make them aware of it and distort the answer. Much like Donald Rumsfeld’s “unknown unknowns”, what happens when we are not aware of what we are not aware of? “Measuring” mindfulness seems an impossible task.
One reason mindfulness is so popular right now, in an increasingly cash-starved NHS, is because it’s cheap and easy to deliver. But perhaps it’s also popular because it places the responsibility for one’s well-being on the individual rather than society. It suggests that it’s the interpretation of an event (how one feels about losing one’s job, for instance) that leads to negative emotions, rather than the event itself (being made redundant). Therefore, it’s up to the individual to manage their own stress and depression. Even the government’s White Paper “No Health without Mental Health” states: “good mental health and wellbeing ... bring wider social and economic benefits.” But what about flipping this statement around? What about recognising that a healthy society creates benefits for individual mental health? What are the political gains if the individual alone is held responsible for how they feel? We should be wary of mindfulness being used to obscure social reality or to avoid taking a more collective approach to what individuals are going through.
I don’t want to write off mindfulness entirely. I’ve seen it give great benefits to some people I’ve worked with. Nor am I claiming to be an expert on its techniques and intricacies. However, as good scientific practice comes from questioning and critique, I merely intend to raise some questions that, it seems, are not being raised.
Siobhan Jones worked as a Psychological Wellbeing Practitioner from 2009 to 2013 and is now training to be a Clinical Psychologist
