Mindfulness Rebranded: Misappropriation in Modern Medicine
- longcovidadvocacy
- 1 day ago
- 12 min read
How Jon Kabat-Zinn’s Vision of Mindfulness Became Medical Dogma
Cognitive Therapies: Part One
Welcome to this critical exploration of therapeutic uses of mindfulness and meditation in medicine. Together, we shall look at the skyrocketing of mindfulness in healthcare, examine its assimilation into cognitive behavioural therapy during its third wave, and unpack the influential role of Jon Kabat-Zinn.
In typical Nagarjunan style, we shall adopt a sceptical lens to investigate the consequences and risks of decontextualising and commodifying mindfulness. We need to ask, is there a dark side to the force?
In Part Two, there will be a reckoning of how cognitive therapies have been applied in chronic illness, with a focus on Long Covid, ME and chronic pain. We shall explore wider mindfulness and meditation applications that we are exposed to through mind-body medicine, brain re-training and the wellness industry. Special focus will be given to arch-messiah Paul Garner, his latest BMJ opinion piece, and the SIRPA conference.
Hopefully, this article will help the community be informed, to know our history, and to turn up the sceptical dial - aims that are important to us at Long Covid Advocacy.
Zen by Prescription: Cultural Amnesia in Modern Medicine
Western medicine typically excludes prayer, laying on of hands, and calming decontextualised contemplative Christian practices. Conversely, meditation and mindfulness, rooted in Buddhist and Eastern traditions, present a different case and have been rapidly accepted in secularised forms - often without question.
If one is chronically ill, one cannot seem to move without being told to apply mindfulness or psychological methods to cope with or cure symptoms. In fact these techniques are now standard medical practice. There’s a good reason our old buddy Prof Michael Sharpe tried to flog CBT as hotcakes - it’s the latest zeitgeist. But why have we been so keen to embrace mindfulness-based medical practices from different cultures?
Reflecting on our cultural roots in Christianity, it is understandable why religious techniques and medicine have become separate. If we examine medical history, this wasn’t always the case. We had embedded in our society from religious ideas that moral purity was related to health and sin to disease. Just as the humoral system of medicine connected our negative emotions to different imbalances of phlegm, black bile, yellow bile and blood.
It’s easy to forget that there was a powerful shift when medicine embraced the biomedical model. It has a bit of a bad rap these days as a cold, heartless, mechanical way of viewing the body. However, it revolutionised medicine by disconnecting sin and negative emotions from disease comprehensively. In many ways, it freed us.
Since the 1970s, a move towards the biopsychosocial model has tried to reintroduce mental factors into the mainstream. Although, to be fair, emotional and moral interpretations of health have always lurked under the surface.
The psychologisation and adoption of decontextualised religious practices began to spread like wildfire in the 1990s. The work of Jon Kabat-Zinn brought mindfulness into medicine with his MBSR (mindfulness-based stress reduction) model, predominantly through his experience of Zen. The explosion of CBT/MBCT (mindfulness-based cognitive therapy) and a torrent of other acronym treatments, like an out-of-control sourdough culture, is now applied to pretty much any chronic illness.
We might be more sceptical if someone tried to de-spirit Ignatian visualisation or apply St Augustine’s unceasing attention to medicine. Yet, the feeling these analogies stimulate starts the understanding of the issues present in modern therapeutic practice with the introduction of mindfulness in CBT and techniques from the East.
A Healthy Dose of Scepticism
We have seen an unequivocal adoption of CBT and its third-wave offspring, such as ACT (acceptance and commitment therapy), MBCT (mindfulness-based cognitive therapy), and DBT (dialectical behavioural therapy) in medicine but has it become dogma?
Scepticism is an important factor in Western and Eastern philosophy, be it the Pyrrhonian scepticism of the Greek philosopher Pyrrho of Elis, of Descartes or the Buddhist Madhyamika thought of Nagarjuna or Confucius.
Because these medical misappropriations are connected to being empathetic and compassionate, if scepticism is applied and the methods are questioned, this is often perceived as a threat that the practitioner is not compassionate or not very nice. Moving on from this is much harder than it should be.
The irony is that it is more astute spiritually and practically to be sceptical and discriminating than to blindly accept poorly adapted techniques. One also does not have to exclude themselves from having a spiritual worldview or engaging in practices to help us cope with illness if we do not agree with their medicalisation.
The Rise and Rise of Mindfulness
What is taught in monasteries and what is practiced in Buddhist monasteries is essentially no different from what is taught in MBSR and MBCT. Jon Kabat-Zinn.
Let’s further examine Kabat-Zinn, the progenitor of mindfulness in medicine. What JKZ did was secularise or de-soteriologise the Buddhist practice of mindfulness. In other words, he took a lot out. Whilst claiming it was the same as Buddhist practice. Hmmmm. What is less commonly known is that JKZ was a mindfulness magpie. It wasn’t only Soto Zen he mined, but also Hatha Yoga, Vipassana and Vedanta.
This might not seem a problem, as from a Western perspective, it can be easy to assume various Asian religious systems are homogenous and one can do a nifty pick and mix. Just picking what you like from diverse systems is far from respectful and can lead to trouble.
Edward Said warned against Orientalism: the West commodifying and defining the East on its one terms. The risks of cultural flattening, especially through the lens of colonialism, is something we need awareness of. It’s not a timeless past we are able to seamlessly bring into modern medical practice.
Mindfulness without Mandala: A Cultural Dislocation
It’s easy to assume that those practising in these traditions would be thrilled at this move to integrate techniques from their repertoire. The reality - not always so. I remember being at a Kathina festival in the presence of Ajahn Sumedho, and it was clear that meditation removed from its roots wasn’t a good plan.
Why would this be? Well, it turns out medical misappropriation has its downsides. Removing mindfulness from its context, to be honest, waves some hefty red flags.
The first is that in Buddhism, techniques are rarely practised in isolation. They are connected to networks and antidotes to ensure that hindrances and problems don’t ensue. Think one-winged birds and how this is an evolutionary non-starter.
Mindfulness is usually applied to develop concentration, which in turn is practised to form insight. It is often paired with calm-abiding (samatha), or loving-kindness (metta), to deal with the shocks to the ego that come with insight and to counter the dryness or detachment that can arise if practised alone. In Buddhism, mindfulness isn’t a meditation in itself.
The Chill Pill: A Medical Shortcut
This is where another issue arises - the conflation of mindfulness and meditation with calm. In healthcare, we assume they are applied to quickly create calm and therefore decrease stress. Yet in its original context, mindfulness, when it creates insight, can be pretty wild – especially with the radical deconstruction of the self - as is an EEG of a practitioner in an energisation (piti) flare.
Meditation and applying mindfulness are also not necessarily tranquil, predictable or easy. In the early stages of calm-abiding meditation, when trying to pacify the mind, it is compared to a rampaging, out-of-control, enraged elephant. Beginning this journey to equanimity can be rough and requires strenuous effort. Becoming calm doesn’t just magically happen when one meditates.
Adding this burden and intense process to someone who is chronically ill in order for them to cope with or relieve their symptoms is pretty unreasonable and unjust.
Mindful of what?
Kabat-Zinn will have us believe that his mindfulness program is equivalent to how it is practised and taught in Buddhist monasteries. The question is which country, which tradition, which valley, which teacher?
Mindfulness is not a simplistic, one-way zone. It has many interpretations.
Within Theravada, Buddhism’s oldest existing school, the four factors of mindfulness - form, feeling, mind and phenomena - are only tools to develop access concentration and ultimately meditative absorption (jnana) and liberation. One does not stay endlessly mindful of our bodies or feelings.
In the direct perception schools like Dzogchen or Chan it is mindfulness of the nature of mind or presence that matters. Just as a Vedantist is ever mindful of the ultimate nature, satchidananda.
The tantrics are mindful of body, speech and mind being the deity, not our lowly human perceptions.
Mindfulness, per Tsongkhapa (founder of the Gelug school in Tibetan Buddhism - the one the Dalai Lama is head of), means focusing consistently on the meditation object, which is not necessarily the constant flow of our thoughts and emotions.
The essence is that regardless of what school or tradition one follows, it’s not a mish-mash of techniques, and the goal is liberation.
Buddhists are concerned about secular mindfulness because its aim is to make us more content in samsara. Instead of waking us up to the pressing issue that samsara is a bitch and an endless wheel of suffering.
From Liberation to Therapy: The Rebranding of Suffering
Yet, now we move to assumptions about suffering, and this is connected to translation. Dukkha in Pali has been translated in the West as suffering. But as subtleties of feeling weren’t always hot in early Buddhist scholarship, a more nuanced interpretation is unease or dissatisfaction. This changes the understanding of what mindfulness and meditation are supposed to treat.
The unreflective logic in medicine is that meditation and mindfulness will remove suffering, as its original translation in Buddhism is, and therefore remove the suffering of body and mind. But the reality is different - in practice, and if we take dukkha to mean dissatisfaction. We can see that Buddhist masters had awful illnesses. Pema Duddul was wracked by arthritis. The Buddha had chronic headaches. Jigten Sumgon had leprosy. No one prescribed mindfulness to eliminate their ailments.
Buddhist techniques liberate from suffering/unease as it is thought that meditation, mindfulness and insight enable the nature of suffering and mind to be perceived. The relief of suffering comes from the Buddhist worldview, not the medicalisation of techniques.
Kabat-Zinn’s Non-Judgmental Interpretation
In ‘Full Catastrophe Living’, Kabat-Zinn’s influential work and the basis for MBSR (mindfulness-based stress reduction) and MBCT (mindfulness-based cognitive therapy) defines mindfulness as “moment-to-moment, non-judgmental awareness.”
Now, this is supposed to be the same mindfulness in Buddhist monasteries, but the JKZ misses a key factor. That, when applied in context, mindfulness is judgmental. Why?
We’ve seen that mindfulness is applied differently, but JKZ’s definition has significantly influenced what the public thinks the concept is. This idea can be more akin to relaxation, non-judgmental acceptance and ‘letting go’. In context, this is too loose a process.
The point of mindfulness in Buddhist practice is not really to uncritically accept an endless stream of thoughts and feelings – in some ways, it’s counter to what we should be recollecting. I can’t talk for the Buddha, but I’m not sure he’d think it was a great plan to strip it of its critical, liberatory force.
For example, in the four foundations of mindfulness practice, one is judging if form, feeling, mind, or phenomena are good, bad or neutral. It is an active process that has the aim of developing insight and wisdom, where the point is to understand impermanence, which requires analysis and criticality.
Selective Attention: What Mindfulness Forgot
The same goes for another meaning of mindfulness in Buddhism – recollection. Here we have an issue with translation. In Pali, mindfulness derives from sati and in Sanskrit, smriti. It’s not the typical understanding of mindfulness JKZ gives. Its meaning is more connected to remembering, recollecting or memory. This is usually done in two ways: recollecting what has happened in one’s meditation practice and recollecting teachings or dhamma, such as the 8-fold path, 7 factors of awakening or Right Mindfulness.
Stripping mindfulness of its meaning in relation to memory and its context of teachings, McMindfulnesses, to borrow the term from Purser, the process. It simplifies and misappropriates mindfulness - turning it into something it is not.
Is Meditation Always Safe?
Regarding cultural assumptions, we often view meditation and mindfulness as benign. They have been applied indiscriminately in therapeutic practice like a Gatling gun. But traditionally, meditation is not seen as always safe. Within Buddhist cultures, it is unusual for lay (non-monastic) communities to engage in meditation. Due to the issue that the application of these techniques comes with risk and to be prudent, you need an environment with experienced practitioners.
Protection and safety are key factors that discourage some Buddhists from embracing the secularisation of mindfulness. If we are to get a bit more way out, one practices in the blessing of the stream of practice, the Buddha, the Dharma and the Sangha, which protects one if one strides into darker areas of the mind. Meditation (gomde) in Tibetan culture, especially Vajrayana, is well known to be a dangerous path, often compared to trying to climb up a hollow bamboo tube, one slip and down you go.
Is it safe or advisable for someone with chronic illness or mental health issues to constantly focus on all the thoughts and feelings that they are experiencing? Is that where their attention should be?
Mindfulness Gone Wrong: What the Research Tells Us
What does the evidence say about mindfulness when it is decontextualised? Is there a dark side and do these practices come with risk?
One reason that psychological interventions are researched and given in clinical practice is that they are seen as harmless and with much less risk than, say, pharmaceutical treatments.
Yet, a study in Clinical Psychological Science by Dr Britton found that about 6% of people engaging in mindfulness experienced negative effects, with 14% having disruption over a month. These adverse effects ranged from emotional numbness and detachment from the people around them.
Further research indicated that this emotional blunting and dissociation was from an increase in prefrontal control over the limbic system and amygdala, areas associated with emotional regulation. So much for Gupta’s secret amygdala retraining hypothesis.
This effect on people around one also has social implications, as another study that involved over 14000 participants that focused on breathing meditation, found that it dampened the relationship between transgressions and the desire to engage in reparative pro-social behaviours. In other words, meditation reduced feelings of guilt due to emotional blunting.
A review published in 2022 of over 40 years of research stated that the most common adverse effects were depression and anxiety, followed by psychotic or delusional symptoms, dissociation or depersonalisation, fear or terror.
When the Dalai Lama was asked about Britton’s research, he stated it was due to “the lack of fuller knowledge, a fuller picture.” He makes a valid point, and we have discussed this earlier. Removing mindfulness and meditation from their context, especially their moral and ethical grounding, can have serious consequences.
Evidence and Efficacy: A Reality Check on Mindfulness
So, because of this rapid adoption of mindfulness, we can assume it’s because of a solid and sound evidence base? There are two aspects to consider - its effectiveness in reducing symptoms and its ability to help people cope with untreatable chronic or mental illness.
But even though mindfulness was promoted as the transformative panacea to a whole plethora of woes the research shows this was over-promised.
If we look at systematic reviews and meta-analyses, the crown jewels of evidence-based medicine, there is overstated efficacy. Only modest benefits were shown, and even this level of effect is questionable due to plausible claims of bias:
Goyal et al 2014 found that it only produced small to moderate effect sizes for anxiety, depression and pain and no significant impact on stress, quality of life or attention.
Another review, Goldberg et al, 2018, found that MBSR and MBCT had small effect sizes and their benefits were not superior to active controls.
The most expensive study in meditation and mindfulness research, MYRIAD, with over $8 million in funds from the Wellcome Trust, found that mindfulness failed to improve the mental health of children and may even have detrimental effects in those at risk of mental health problems. This research had hardly any media pick-up.
Publication Bias and the Cult of Mindfulness
We also have the problem of publication bias, which is often the case for more ‘holistic’ approaches in medicine. Studies are published in lower-quality journals, with positive studies being more likely to be published. This then floods research with dross that gives the veneer of scientific acceptance and science's authority to Jo Public.
The problem is that many mindfulness and CBT trials lack adequate controls that make it hard to rule out expectancy and placebo effects, as well as researcher bias.
Even JKZ admitted in 2017 that “90% of the research is subpar.” Whilst in 2015 also claiming in the UK Mindfulness All-Party Parliamentary report that it can transform “who we are as citizens, as communities and societies, as nations, and as a species.” Pretty amazeballs claims based on?!
Patients evidently see the emperor’s lack of clothing far more readily than invested professionals. Recent findings showed that only 40% completed the prescribed six CBT talking therapy sessions from the NHS.
The result is ideological overreach, and mindfulness becomes hyped out of all control to be the universal panacea from a universal truth lovingly extracted from ancient, timeless wisdom.
Final Reflections
Does this critique suggest complete avoidance of meditation and mindfulness? No. But mindfulness in medicine must be named for what it is - a modern construct shaped by cultural erasure, ideological overreach, and systemic deflection.
The point is nuance and wisdom. Techniques are in themselves neutral, they can take you up or down. It is how we use them that is important. Just as a spoon can be useful, harmless or a deadly weapon. There is a reason why there is right mindfulness in Buddhism.
We've seen that misappropriation is risky. We must carefully examine how these practices are being mechanically implemented in healthcare. It is not something fluffy that we can just extract from the East.
The medicalisation of mindfulness comes with baggage, in the form of assumptions, power dynamics and consequences. Its over-simplification and sanitisation can cause real harm, both personally and institutionally.
We therefore issue a clear call to action for mindfulness and CBT’s role in chronic illness to be seriously re-evaluated, with a de-escalation of its blanket rollout that acts as a poor proxy and a distraction for effective treatment. We don't need to mindfully eat any more raisins to cope with life-shattering illness.
Part Two is coming… Subscribe to know when it drops
Stay with us for Part Two, where we will examine together - with this foundational knowledge - how medicine and mind-body medicine have co-opted and commodified mindfulness, CBT and other eastern techniques in Long Covid, ME and chronic pain. Do the hotcakes have a soggy bottom?
Yes, Paul Garner, the BMJ and SIRPA, the sceptical magnifying glass, is coming your way. We shall look at how you have created a closed circuit of self-responsibility, where mindset becomes the prescription and the diagnosis, with blame falling on the patient if they don’t apply enough hope for their recovery.
