A doctor puts his mind to mindfulness
A few summers ago during a week-long vacation, I started playing a mind game. In the mornings, I would sit outside on a comfortable deck chair, surrounded by the shrill call of cicadas, and gaze across the lawn into the trees. After getting settled, I would close my eyes and bring my body to complete stillness except for the rhythmic rise and fall of my chest with each breath.
Then I’d embark on what I think of as a journey with my thoughts: noticing them nonjudgmentally and letting them pass through my mind like white clouds moving across the blue sky. I was practicing the very popular relaxation technique known as mindfulness.
I wasn’t sure if this practice was helping me relax, making me healthy or just wasting my time. Some days I felt almost pleasantly lost, tension-free while sitting quietly for 20 minutes; at other times I struggled not to think about an upcoming meeting for my next writing assignment.
Experts define mindfulness as a state of moment-to-moment awareness that emphasizes attention without judgment, without thinking, for example, that the sound of the cicadas is irritating or that the lawn needs to be trimmed or “Why did I say that to so-and-so?”
Meditation practices vary, but the scientific literature presents three general categories: Focused attention is when you concentrate on a word, sound or activity (such as breathing or slowly repeating a mantra such as “om”); open monitoring is when you just observe your thoughts (mindfulness meditation); and self-transcendence is clearing your mind of thoughts (Transcendental Meditation).
Doctors, including me, haven’t universally embraced mindfulness and other forms of meditation as a therapy for our patients.
Studies have shown psychological and even some physical benefits. One 2015 meta-analysis of mindfulness-based interventions, which considered findings involving more than 8,500 participants, found that the interventions produced a decrease in depressive symptoms, anxiety and stress levels, as well as enhanced quality of life and physical functioning.
A small study in the Journal of the American Medical Association found that veterans with post-traumatic stress disorder who participated in an eight-week mindfulness course experienced a modest but significant decrease in symptoms compared with those given group talk therapy. And a 2012 study found that Transcendental Meditation practiced over five years in a group of African American men and women with cardiovascular disease resulted in nearly a 50 percent lower rate of heart attack, stroke and death compared with a control group.
Still, other studies have shown meditation to be little or no better at decreasing anxiety than, say, listening to music or relaxing on the couch.
Yet neuroscience studies on meditation are intriguing. During meditation, our brain waves are distinctly different from those during sleep or an awake state. One study found that long-term meditators had greater volume of gray matter in the insula and prefrontal cortices, regions of the brain activated during learning, memory processes and emotional regulation. Another found a decrease in the volume of the amygdala region, which is involved in processing the emotions of fear. Scientists say it is unclear what if any meaning these brain changes have in someone’s behavior or life.
Other studies have shown that meditation may diminish cell inflammation. Most captivating is a 2011 study that showed that intensive three-month meditation retreats increased the activity of telomerase, a protective enzyme that is linked to the aging process. If confirmed, this may mean that meditation could help slow the aging of cells.
Doctors in other countries have incorporated mindfulness in their guidelines. In the United Kingdom, for instance, the government’s National Institute for Health and Clinical Excellence recommends mindfulness for patients who have had three or more episodes of depression.
Given all this, why do I not regularly recommend mindfulness or other meditation to my patients, while I do advise them to exercise, eat right and take their medicines?
Maybe it’s that I fear some patients may see it as a fringe religious or spiritual practice and that my colleagues may see me as much too “touchy-feely” or lacking substance or scientific grounding.
Once while teaching medical students I talked about meditation and proposed we try it. “Close your eyes . . . clear your thoughts . . . focus on your breath . . . ,” I said. Of the 100 students, a half-dozen got up and walked out of the lecture hall.
Why? I wondered. “You were trying to get inside my head,” one medical student told me later. “I can’t sit still,” another one said.
Yet I have come to think that encouraging patients to adopt meditation as a way to mental well-being is as important as encouraging them to jog as a way to physical well-being. Half a century ago, only a small percentage of the population participated in aerobic exercises such as jogging regularly. A person jogging in the neighborhood often was viewed as downright weird. Today, the number doing aerobic exercise has increased to nearly 50 percent of adults, thanks in part to encouragement from government, corporations and health providers.
Some medical schools, including those at Harvard, Georgetown and Emory universities, have begun to integrate mindfulness and meditation into their curriculum. The Army has a course in mindfulness-based mind fitness training. Public schools in San Francisco are encouraging mindfulness under a program called Quiet Time.” Even the top doctor in the United States, Surgeon General Vivek Murthy, practices meditation daily.
Today, our lives are filled with stressors, from work, home, financial pressures and digital devices. Mindfulness is a low-cost, medication-free way to manage and reduce the ill effects of stress.
I have grown less shy in recommending meditation — along with exercise and nutrition — for physical and mental wellness to my patients. Last week I recommended mindfulness and meditation to two patients: one a middle-aged man with HIV and hypertension who is doing well on HIV meds but with hypertension out of control, and another elderly man with depression and insomnia. They both looked at me quizzically as if they were saying, “Really?” They had heard about meditation but never linked it to their illness or expected their doctor to recommend it.
So I didn’t oversell it — not everyone likes the feeling of sitting quietly with their eyes closed without judgment and observing the thoughts in their mind. I hope at least some of my patients will give it a try.
Meanwhile, I have taken my own advice. I am still at it: sitting on the deck, focusing on my breath, watching my thoughts, clearing my mind amid the shrill end-of-summer calls of the cicadas. I think I have noticed an effect — I feel a deeper sense of acceptance in my life, without losing a passion or resolve to change things for the better.