Issue: March/April 1995
Title: Meditation Goes Mainstream
Meditation Goes Mainstream
Jon Kabat-Zinns yoga-based Stress Reduction Clinic is an idea that time has finally caught up to.
Worcester, Massachusetts. Population 170,000. The second largest city in New England. Settled more than 300 years ago, it is located about 40 miles west of Boston in what is known as central Massachusettscentral being the operative word, as in middle, typical, average.
Worcester (pronounced locally as Wusta) is as average a town as you will find, if not more so. Its roots are working class. The main industry since 1789 was textiles; the first corduroy cloth in the United States was produced in Worcester.
Nowadays insurance, biotechnology, and banking are its economic bread and butter. It is also home to a number of colleges, including Holy Cross, the oldest Catholic college in New England. All of which is to say that this is not a hotbed of social change, political activism, or spiritual growththis is not Berkeley or Cambridge, its heartland America, not where youd expect to encounter a radical concept in healing.
But in fact that is exactly whats happening at the University of Massachusetts Medical Center at Worcester, where a highly regarded, widely publicized, and often replicated program involving yoga and meditation in its Stress Reduction Clinic has proven remarkably successful in helping participants learn to cope with pain and stress. It may be common, almost nave knowledge to longtime yogis and meditators that these ancient disciplines could be of such benefit, but in the context of Western medicine, where Eastern practices are still viewed with wariness if not downright skepticism, we are talking about a near revolution.
I am headed for Worcester, the seat of this insurrection, to visit the clinic and interview its founder and director, Dr. Jon Kabat-Zinn. It will be a reunion of sorts. I had met Kabat-Zinn in the mid-70sa rich time of life-altering cultural sea changes, a time of questioning long-held conventions and beliefswhen we were both at the crossroads of East and West, as it were. I had worked for the mainstream press but was delving into publications that explored alternative lifestyles, a term used at the time. Jonny, as he was known then to his friends, was a renegade scientist with a zany notion of introducing the principles of yoga and meditation into the medical environment. Now he is known as an associate professor of medicine in the Division of Preventive and Behavioral Medicine at UMass Worcesters Medical Center. He is the author of two books, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (Delta, 1990) and Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life (Hyperion, 1994), the latter currently in its eighth printing and on many national best-seller lists. Television watchers may be more familiar with his work as featured on the PBS special Healing and the Mind, hosted by Bill Moyers.
Kabat-Zinn approaches Eastern disciplines not as a pill you take to get better but as a view of life you take to get wiser and that, by the way, helps you pay attention to your pain, your stress, your discomfort in a way that ultimately lessens them all.
Jon is a human bridge between Eastern spiritual and Western scientific approaches to physical health, says Daniel Goleman, who reports on psychology for the New York Times, and who has been a colleague and friend of Kabat-Zinn for 20 years. His success comes from the fact that he knows the field from the inside; he himself has been a genuine student of meditation and yoga for several decades, and he had been able to translate these teachings and methods into an easy street vernacular that anyone can feel completely comfortable engaging in. He brings a very hard-nosed sensibility to what can be a very soft subject.
When Yoga Journal suggested I write about the clinic and profile Kabat-Zinn, I jumped at the chance to renew our acquaintance. Over the years I had heard of his growing reputation and success, documented in several scientific papers as well as on Oprah and many other talk shows. Mainly I wanted to personally congratulate him for not compromising, for holding true to the essence of yogic and meditative practice and waiting patiently for the rest of the mainstream to catch up to his ideas. Too often, similar efforts have come at the expense of the basics. In a zeal to turn on everyone in the world to what previously had been considered esoteric wisdom, the fundamentals have often been distilled, packaged, and watered down for the masses to an unrecognizableeven distorteddegree. I wondered if success had spoiled or would spoil Jonny Kabat-Zinn. And I wondered if using words like mindfulness for Buddhist meditation practice or relaxation exercises for Hindu yoga postures was glossing over the depth of the practice. I worried that his mass market inroads would lead to mindfulness franchisesone billion yogis served! I wanted to find out what others could learn from the road that took him and his clinic from medical establishment outsiders to integral components of the health professionals community.
From Route 9, the original east-west artery of the state which cuts through the heart of Worcester, the University of Massachusetts Medical Center looks as institutional as it sounds. It appears on the horizon as a monolithic slab of grey. The center employs 6,000 people. It comprises a 394-bed hospital, which also treats more than 270,000 outpatients a year, and an educational center that includes a medical school, graduate schools of biomedical sciences and nursing, an allied health program, and continuing education courses. It receives $56 million a year for research through federal and private grants and contracts. In short, its a big bureaucratic facility. In the basement of this monolith, sandwiched between occupational therapy and the outpatient elevators, are the offices of the Stress Reduction Clinic, an outpatient service of the Division of Preventive and Behavioral Medicine in the Department of Medicine. The offices are tiny. There are no windows and ventilation is poor. The intense, frenetic energy of a hospital is pervasive: white coats, intercoms, the strange but familiar smell of a medicine cabinet. Nonetheless, the subterranean setting belies the fact that life-inspiring transformations take place here.
The waiting area has all the personal warmth and intimacy of a Kmart shoppers nightmare: linoleum floors, fluorescent lighting, well-worn back copies of Family Circle magazine, Sesame Street on a TV in the corner. Youd have to be pretty desperate to think that this might be the first stop on the long road to the implausible goal of a life with less pain or stress.
Then you meet Ferris Urbanowski or Elana Rosenbaum, or Saki Santorelli, the clinics associate directorinstructors among the professional training staff who conduct initial interviews with prospective participants in the programand already you feel more at ease. The success of the program relies not entirely on the process, you begin to realize, but on the people who run it. These are not the type of folks who will try to impress you with window dressing; they are for real. And most important, they are all longtime practitioners of yoga and meditation; thats an absolute requirement for anyone involved professionally in the program. And it shows.
The first step for participants is a referral from a physician. The second is a one-hour interview. Every contact we make is important, says Urbanowski. From the first call, we want to make people feel comfortable with who we are and what theyre getting into. A physician referral is not enough, though. The staff make sure the patient is doing this for him or herself. Urbanowski continues: Theyve got to be self-motivated for there to be any possibility that the program will help them. We dont do therapy per se, says Rosenbaum, but for that one hour were really there with the patient to listen as fully as possible. This is not touchy-feely, new age talk. Pretreatment testing includes a medical symptom checklist and a psychological distress questionnaire. Other tests, such as for pain, panic disorders, and degree of psychological hardiness, are also used for specific studies.
Sometimes I try to talk people out of taking the program, admits Rosenbaum. She recalled rejecting a quadriplegic whose reason for taking the course was because his doctor wouldnt continue prescribing pain killer if he didnt. Thats not the right motivation.
Were honest, explains Urbanowski. We tell prospective participants: Its going to be hard, its going to be boring, its going to require homework. But you dont have to like it, you just have to do it.
I have found that people have enormous capacity, adds Santorelli. Im fond of Michelangelos line that There is nothing in the mind of man that is not already in the marble. I believe that is the way to approach human beings. It is made clear from the outset that this is not magic. Its not mystical. Its not offered as a panacea, not as remedy or elixir. It is not the answer to all lifes questions or problems. There will be no cessation of pain or stress, there will be no cure. It will be simply (simply? ha!) a lesson in how to pay attention and, through paying attention, how to live more comfortably and more effectively with pain, stress, and illness.
The actual program consists of two-and-a-half-hour classes meeting for eight consecutive weeks, plus 45 minutes of meditation practice a day (the homework) and attendance at a seven-hour silent retreat in the sixth week. Following completion of the program, there is a one-hour individual follow-up interview.
The class takes place in a newly constructed room, about 25 feet square, with chairs surrounding the room, zafus on the floor, and built-in storage space for yoga mats. It is opposite a noisy lounge, but inside its a different world. In the first class, participants receive a set of guided mindfulness meditation audiotapes. One set includes a guided body scan meditation on one side and a guided mindful hatha yoga sequence on the other. The other set includes a guided sitting meditation and different yoga postures. Patients also get a stress reduction workbook which includes additional mindfulness meditation exercises and brief readings on health, diet, and fitness.
What happens during those eight weeks is nothing less than life transforming for some. Often the way in is through a raisin. The first meditation exercise is to eatvery slowly, very mindfullya single raisin. We tie the moment-to-moment awareness of ones experiencefrom seeing, chewing, tasting, swallowingto experiencing ones breathing in the same way, explains Kabat-Zinn. Then the exercise moves to the floor, where participants lie, focusing on the rising and falling of the abdomen as they ride the waves of their own breath.
In what is tantamount to their first mindful yoga posture, the corpse, the group is guided through a body scan, continuing to pay attention to their breath. Basically we begin to orient people to the direct experience of living in the present moment, says Kabat-Zinn. We remind them they are human beingsnot human doings, so its important to make some time for being as well as for doing things. The yoga postures and techniques, taught over a period of weeks, are the most basicamong them, pelvic tilt and twists, a half bridge, the cat, and other poses to stretch and relax the lower back. The approach is very gentle, emphasizing nonstriving. Wherever you can stretch to, thats exactly where youre supposed to be, Kabat-Zinn tells practitioners. What we are going for is the cultivation of wisdom and liberation from pain and suffering. Were not saying that all ones life problems will clear up when you begin paying attention. In fact, they will get more vivid. But when you move in close to sensations, you discover moments of stillness and peace that are pain-free and that are accessible all the time when you choose to notice how much the mind itself inflames the body. Pain is a fact, but we are so quick to try to anesthetize it. We see how thoughts about pain are not the same as the pain, and that pain is not suffering.
Pain is sensations, and suffering is how you develop meaning around the experience. There are a lot of alternative ways to interpret pain that could be more valuable and create less suffering. We develop a capacity to hold the entirety of experience without pushing it away. We learn something about living with things as they are.
From there the process unfolds. By the last week, people who would have rejected outright any suggestion that they become spiritual beings are talking about awareness and inner stillness. They are talking about acceptance of things as they are from their own experience. Appearing once on Oprah with Kabat-Zinn, Bud, a Worcester resident who participated in the clinic after suffering neck injuries, reported from the perspective of Everyman: This is probably a little confusing, but I focus right on the pain so that I can accept it. I have to look right at it so that I can get to the other side.
When Winfrey asked how going through the program changed the quality of his life, Bud testified, My realization of my values and my appreciation of all the beautiful things in life are so much more intensified. Pressed by her, he held his ground. Of course I would feel better without the pain, but would I feel better? Not emotionally, not spiritually. I can achieve those with or without the pain. Spoken like a true yogi, but in the empirical show-me world of science that is called soft or anecdotal evidence. There is, however, hard proof as well. According to studies of the program published in the Clinical Journal of Pain, the American Journal of Psychiatry and the Journal of Behavioral Medicine, an astounding 90 percent interviewed for the program enroll, 85 percent of those who start also finish, and 91 percent report keeping up practicing the stress reduction techniques at a three-month follow-up. And heres the payoff: For people suffering an average of six to seven years with chronic pain problems, 30 to 55 percent rated their pain as greatly improved after taking the stress reduction program, and 60 to 72 percent reported moderate or great improvement. These improvement rates are maintained for periods of up to four years for most participants, and many keep up a regular meditation and yoga practice on their own.
When we sat down to talk last spring at his home in a suburb west of Boston, Kabat-Zinn was in the midst of an eight-month sabbatical, assessing his life, the program he started, and where both were going. The home is modest and appears lived in. Its obvious a family resides here (his wife, Myla, and he have three children, ages 10 to 19); there are crayon drawings on the refrigerator, school lunch menus tacked to the wall, well-worn toys, books, furniture, dogs. At the age of 49, Kabat-Zinn (he added his wifes last name to his own when he married) looks as fit and youthful as I remembered him. He exudes a no-nonsense urban street wisdom softened by sensitive, twinkling eyes and an open smile. He speaks with the soft R of a native New Yorker and with the precision of one who has explored the many shades and nuances of words.
There is no big ego here. In fact, he will not like that I am writing this much about him when he would prefer the focus remain on the Stress Reduction Clinic. But I have this theory about microcosms and macrocosms. In the corporate world its called the top-down management theory. In other spheres its called as above, so below. The point is that a program, company, organization, or system is only as good, only as conscious, only as imbued with integrity as the person at the top. By this measure, I already trust the integrity of the program. From the beginning Kabat-Zinn had this unpopular idea that he wanted to be both a scientist and a humanist. At Haverford College he majored in chemistry and comparative literature. His role model was C.P. Snow, the British novelist and molecular physicist. Later, working on his Ph.D. in molecular biology at the Massachusetts Institute of Technology, he recalls, I thought you could connect mind states to neurological parameters.
By then it was the mid-60s and the Vietnam War was hot and heavy. Actively involved in the antiwar movement, he helped start the Union of Concerned Scientists and a graduate student group, both of which still exist. At about this time he started taking a yoga class in the basement of a church in Harvard Square while also studying karate. Reading Philip Kapleaus The Three Pillars of Zen, he started practicing Zen meditation and evolving his own philosophy. What impressed me was that you could take charge of your life through a disciplined practice and through cultivating a familiarity with the workings of your own mind, he now says.
--- Continued in Mainstream Meditation.2 --- Continued from Mainstream Meditation.1
I found hatha yoga to be one of the great gifts to humanity, he continues. There is no better way to understand the workings of the body. That, along with Buddhist meditative practice, is the absolute core that informs every aspect of our work in the Stress Reduction Clinic. Hatha isnt about turning your body into an elaborate pretzel; its about living your life in balance between ha and tha, between self and totality, atman and brahman, so that everything in life is a manifestation of yoga.
He found that combining hatha with Zen mindfulness enabled him to add a new dimension to my practice, to look more deeply, with more heightened awareness inside my own body, with more patience and insight. Meanwhile, the idea of devoting himself to what he increasingly saw as the pinpointed, very specific, competitive, time-consuming world of science was losing its appeal. I wanted to make my meditation my work and my work my meditation.
So he took a detour to teaching, first as a substitute in junior high school. I thought yoga should be taught in schools, especially to teenagers, who are so alienated from their bodies. I used it to wake them up; sometimes I would talk to them while standing on my head on the desk. I had to do something to keep their attention. It turned out they loved doing yoga themselves. It captured their imagination and grounded them in their bodies, fairly rare experiences at that age.
Later he taught biology to nonscience majors at Brandeis University in Waltham, Massachusetts. He called the class the biology of consciousness. At the pivotal age of 30 he decided the academic environment was not where he wanted to be.
On his first long retreat in the Buddhist vipassana, or insight meditation, tradition, Kabat-Zinn found himself thinking about how to integrate some of the lessons he had learned in the previous year. The teacher was Robert Hover, known in vipassana circles as a rigorous drill sergeant. I can remember sitting on my butt in a freezing cabin at 3 a.m. trying to sit still and taste equanimity while experiencing levels of pain I had never felt before, Kabat-Zinn recalls. Many of the notes he took on that retreat about how to deal with the mind, the body, and pain became integrated into the Stress Reduction program years later.
On the practical side of his life, though, as husband and now father, he needed a job. In the fall of 1976 he accepted an offer to become a postdoctoral fellow in the anatomy department at the UMass Medical Center in Worcester, because he would get a chance to teach anatomy and dissect human bodies, a rare chance for a yoga teacher to encounter the structures of the body and see how muscles and ligaments, nerves, bones, organs, blood vessels are interconnected. He started talking about the inner architecture of the body in his yoga teaching.
Still committed to making his meditation his work, on another vipassana retreat in early 1979 he realized it might be possible to set up a clinic at the medical center to help people in pain or with stress-related disorders by teaching them yoga and meditation.
Testing his ideas, he went on rounds with an orthopedic surgeon, asking how he treated patients dealing with all varieties of pain-related problems. Usually, he sent them for physical therapy, but often that didnt seem to be enough, in part because the patients didnt seem to be active participants in the process, expecting others or an exercise to make them feel better. Kabat-Zinn and the surgeon discussed how valuable a clinic might be that challenged people to mobilize their inner resources for healing and especially by experiencing deep silence and relaxation and experiencing firsthand, through mindful yoga practice and other forms of meditation, the potential power of the relationship between mind and body. This would give the physician something entirely new to offer these patients. Some doctors told him they spent 80 percent of their time with chronic pain patients functioning more as psychiatrists than as physicians.
I saw a big vacuum, he says. At the time there was no real way for patients to learn how to deal with their pain in a long-term rehabilitative manner. I suggested there might be something we could do as a complement, not a substitute, for whatever medical treatment they were already receiving. The idea was simply to get local doctors to refer to us the patients for whom they couldnt provide much more help. Some doctors sent us their most difficult cases, but it turned out the chronic pain patients were among the most highly motivated, precisely because they had been frustrated for so many years by the traditional medical approach.
Though he never hid the fact that the program was based on yoga and meditation practice, Kabat-Zinn realized that he had to develop a vocabulary that was not threatening or inherently a turnoff to people from the mainstream whose first reaction might be: Are you crazy? Youre not going to get me down on the floor contorted into a pretzel, watching my navel, chanting some bizarre mantra.
The terminology eluded the rest of the profession as well. Psychosomatic medicine was what they were calling the field of study that explored physical ailments that may be mentally induced, but the implication always seemed to be that the pain was only in ones head. Mind-body therapy sounded too airy-fairy. Behavioral medicine more appropriately approached it. Preventive medicine came even closer. These were principles that went back to Hippocratesthat the body and mind were never separatebut it seemed the medical profession had forgotten its roots and lost the words to define it, says Kabat-Zinn.
Using a vocabulary that includes such words as wellness, relaxation, mindfulness or stress reduction does not dilute the process, he explains. The words serve as an arrow through to the essence, to the true heart of meditative practice. The main objective was and is to make it accessible to everyday people and not generate unnecessary resistance or reaction. Virtually everybody relates positively to stress reduction. Their automatic response is I could use some of that. My books are an attempt to provide commonsense meditation manuals for mainstream Americans. It took only the first eight-week cycle for Kabat-Zinn, the referring physicians, the medical center administration, and especially the participating patients to know the program would work.
The success of the Stress Reduction Clinic at UMass goes beyond what it does to change peoples attitudes about their relationship to pain. It has fundamentally transformed the traditional medical communitys relationship to such alternatives as yoga and meditation.
Dr. Judith Ockene, professor of medicine and director of the Division of Preventive and Behavioral Medicine at UMass Medical Center and Kabat-Zinns boss since 1983, admits that for a long time medicine was not concerned about preventing illness but in dealing with disease once it occurs. Health care is not health care; its disease intervention. She continues: Behavioral intervention, which goes hand in hand with preventive medicine, was not a well-accepted part of mainstream medicine. It was looked at skeptically by traditional medicine.
To wit, she notes that when you ask health insurers if theyre willing to reimburse for preventive counseling, theyre not there yettheres still no real coverage for prevention. And Im not convinced this will happen easily.
However, she is quick to affirm the support of the stress reduction program among physicians in her hospital and within the medical community at large. Now the Stress Reduction Clinic is covered by many insurance companies and HMOs. Clearly each year more and more divisions within medicine here and community hospitals throughout the country are asking for the involvement of the Stress Reduction Clinic, says Dr. Ockene. In fact, there are very few who have not approached us. Its actually hard to meet all the demands of colleagues. That has been extremely rewarding. More than 15 hospitals and clinics in the United States and one in Canada now offer mindfulness training in the context of stress reductionall based on the model of Kabat-Zinns program.
The interest has been especially keen since the Bill Moyers television special. In the weeks following the first PBS airing in 1993, the clinic received a thousand phone calls, from both prospective patients and health professionals interested in replicating the program or learning how to introduce mindfulness practice into their work. The implications of that degree of hunger is profound; theres an obvious desire to make the work available to as many people as possible. But how do you maintain quality control?
Ive thought a lot about this, says Kabat-Zinn, sitting in his kitchen, sipping herbal tea. I started out doing one thing in one place to see if the medical community was ready for something I felt wasnt a dilution of Dharma but a translation that would be accessible and acceptable, with an emphasis on universality, not on a sect or lineage. If you try to clone it, you will lose the essence. To me, that is anathema. Instead of creating a McDonalds of mindfulness and franchising it across the country, we instead encourage people who want to do this kind of work to go as deeply as possible into the practice themselves and then develop their own programs, perhaps using ours as a model. We are working with hundreds of health professionals who want to bring mindfulness into their lives and into their work and are willing to experiment with what it means to teach out of your practice. We encourage them to do the most creative thing they can think of and trust their heart.
The challenge now for Kabat-Zinn, his staff, and the administration is how to run a successful Stress Reduction Clinic without suffering major stress symptoms themselves. And thats why Kabat-Zinn was hanging out at home and doing long meditation retreats during his sabbatical. He returns to his original intention: Our ideal is to make the work the meditation practice, to find harmony and mindfulness within the full catastrophe of the work experience. Leaving his home, I have no doubt that he and his colleagues will get where they want to go. And that wherever they do go, there they will be.
Perry Garfinkel, a writer based in Oakland, California, is the author of In A Mans World (Ten Speed Press, 1993) and a frequent contributor to the New York Times. He has been covering social and psychological trends for over 20 years.
Resources
Stress Reduction Clinic, University of Massachusetts Medical Center, Worcester, MA 01655; (508) 8561656.
Cardiac Risk Reduction Center, Brigham & Womens Hospital, 850 Boylston St., Chestnut Hill, MA 02167; (617) 2780770.
Mind/Body Medicine Clinic, 2440 E. 5th St., Tyler, TX 75701; (903) 5922202.
Awareness and Relaxation Training, Cabrillo College Stroke Center, 501 Upper Park, DeLaveaga Park, Santa Cruz, CA 95065; (408) 7229005. For correspondence: 338 Rider Rd., Corralitos, CA 95076.
Stress Management Clinic, Rehabilitation Institute of Pittsburgh, 6301 Northumberland St., Pittsburgh, PA 15217; (412) 5219000.
Awareness and Relaxation Training, Santa Cruz Medical Clinic, 2025 Soquel Ave., Santa Cruz, CA 95062; (408) 4585530.
Life Transition Therapy, 110 Delgado Compound, Ste. A, Santa Fe, NM 87501; (505) 9824183.
Department of Psychology, Toronto Hospital, 200 Elizabeth St., Toronto, Ont. M5G 2C4, Canada; (416) 3403950.
SIDEBAR
Can Anybody Meditate?
I get asked this question a lot. I suspect people ask because they think that probably everybody else can meditate, but they cant. They want to be reassured that they are not alone, that there are at least some other people they can identify with, those hapless souls who were born incapable of meditating. But it isnt so simple.
Thinking you are unable to meditate is a little like thinking you are unable to breathe, or concentrate, or relax. Pretty much everybody can breathe easily. And under the right circumstances, pretty much anybody can concentrate, anybody can relax.
People often confuse meditation with relaxation or some other special state that you have to get to or feel. When once or twice you try and you dont get anywhere or you didnt feel anything special, then you think you are one of those people who cant do it.
But meditation is not about feeling a certain way. Its about feeling the way you feel. Its not about making the mind empty or still, although stillness does deepen in meditation and can be cultivated systematically. Above all, meditation is about letting the mind be as it is and knowing something about how it is in this moment. Its not about getting somewhere else, but about allowing yourself to be where you already are. If you dont understand this, you will think you are constitutionally unable to meditate. But thats just more thinking and, in this case, incorrect thinking at that.
True, meditation does require energy and a commitment to stick with it. So then, wouldnt it be more accurate to say I wont stick with it, rather than I cant do it? Anybody can sit down and watch their breath or watch their mind. And you dont have to be sitting. You could do it walking, lying down, running, or taking a bath. But to stay at it for even five minutes requires intentionality. To make it part of your life requires some discipline. So when people say they cant meditate, what they really mean is they wont make time for it, or that when they try, they dont like what happens. It isnt what they are looking for or hoping for. It doesnt fulfill their expectations. So maybe they should try letting go of their expectations and just watching.
Reprinted from Wherever You Go, There You Are. Copyright 1994 by Jon Kabat-Zinn. Published by Hyperion.
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