Mindful Medicine

An interview with Jon Kabat-Zinn

Jon Kabat-Zinn, Ph.D., is founder and director of the Stress Reduction Clinic at the University of Massachusetts Medical Center in Worcester, Massachusetts, as well as Associate Professor of Medicine in the University's medical school. The Stress Reduction Clinic is a unique and revolutionary approach to healing in the American medical establishment. Olympic athletes, corporate executives, judges, physicians, medical students, hospital employees, and Catholic priests have all benefitted from mindfulness training at the Stress Reduction Clinic.

Jon Kabat-Zinn was one of the earliest students of Zen Master Seung Sahn and was a founding member of Cambridge Zen Center. Over the years he has studied with a number of Buddhist teachers and incorporated their teachings, especially the practice of mindfulness, into his practice of medicine. His book Full Catastrophe Living (New York: Delacorte Press, 1990) was on the New York Times bestseller list.

The interview was conducted by Richard Streitfeld of the PRIMARY POINT staff.

Primary Point: What inspired you to start the Stress Reduction Clinic?

Jon Kabat-Zinn: Ever since I began practicing meditation, I have felt an enormous need to bring meditation into the mainstream, particularly in environments like hospitals. They function in our society as "dukkha" (suffering) magnets: they draw in people whose lives are out of control with pain and suffering. And it's not like everyone is satisfied and cured when they go home. Since the mind plays such an important part in people's experience of their bodies and what's possible in their lives, it seemed that a hospital would be a perfect place to train people in meditative awareness. They could optimize their inner resources for healing and take responsibility for their health.

PP: Do you think people are more likely to accept these techniques because they are presented in an official, "established" setting?

JK: Yes. If you want to bring the essence of meditative practice into a mainstream medical institution, there are ways that will slant your trajectory toward success just as there are other ways to do it that will slant it toward immediate rejection. If you go in talking about the Buddha and inviting masters with shaved heads for lectures, it's going to be perceived right away as some foreign cultural ideology - a belief system. Understandably so, it would likely be rejected.

PP: Most of the patients who go through the clinics report positive reactions. Is there anyone who can't seem to deal with it?

JK: Very few, actually. To enter the program, you must be referred by your doctor, so right away the legitimacy of this approach has been established. The clients are not being sent to learn to heal; they're not being sent to have their symptoms go away or to master them. They're being sent as a palliative, to help them become more calm.

And, we're very up front. We tell people what we do, and that it's going to be an immediate lifestyle change: you have to carve out forty-five minutes a day six days a week for formal meditation practice. We explain that in order to get the benefits of the stress reduction program you've got to make one hell of a commitment to yourself. If they're willing to make that commitment, they're already primed to go. Ninety percent of the people we see are willing to make that commitment.

PP: Then one reason your success rate is so high is that people know what to expect.

JK: Yes. We tell them right away that it's stressful to take the stress reduction program! If you want to accomplish something, a certain amount of energy and work is required. Many people have had their medical complaint for seven years or longer. If there's any hope to use their own inner resources of mind and body to mitigate the physical and emotional pain, it doesn't come from wishful thinking. There has to be a certain grounding of intense work. That's the price of admission. And people love it, because they've never been talked to that way!

PP: They appreciate the honesty.

JK: Absolutely. We're saying, look, we don't know you, but life's trajectory has dropped you into this office at this point. 'Me doctor says you're here for this and this, but you're more complicated than your symptoms. We don't know what will come out of going through this program for eight weeks, but the chances are that if you start paying attention to your life and begin to look at it without the tinted glasses you've been wearing, look more directly, there will be an opening.

PP: What are the general results?

JK: Some people make more "progress" than others. But we really try to adhere to a framework of "non-doing." We're not that interested in progress. We're not even sure that we know how to recognize it. Many people experience symptom reduction while others have certain insights. They may be subtle and don't go off with neon lights, but they change one's relationship with, say, one's body or spouse. Even in some of the cases that we might scientifically label "failures," because they don't change in the ways that the majority do, people continue to practice. People whose pain hasn't gotten any better are practicing with the original guided meditation tape five, ten years later. When I ask them, "Why? This isn't helping your pain at all," they respond 'That's alright. It's still better when I do it than when I don't."

PP: Besides the techniques, what else do people come away with?

JK: A lot of people drop the formal practice but maintain the mindfulness in daily living. They've developed it as a life skill. In times of great stress or pain, they know how to go to their breathing, to use it to calm down and broaden the field of perception, so that they can see with a larger perspective.

PP: People somehow internalize, not simply the technique, but where it's coming from.

JK: Exactly. And that's our emphasis. We don't want a group of imitators when we get through with them, nor a group of super-meditators who are all tripped out about meditation. What we want are people who are basically strong, flexible, and balanced, and have a perspective on their own inner being that is accepting and generous.

PP: Do you feel that the foundations of the program are Buddhist principles?

JK: Without question. Mindfulness is often spoken of as the heart of Buddhist meditation. It was one of the major teachings of the Buddha, ramified through all of the different traditions of Asia. We try to teach in a way that combines intuitively the best of the Vipassana orientation with the most accessible and least cryptic of the Zen energy. The combination is quite wonderful.

We use the breath as a major focus of awareness, and then we integrate it with a range of different experiences. Then we get mindfulness of breathing with emotional waves as they rise up in the mind and the body, mindfulness of sounds and thoughts and feelings and external situations that may be threatening or joyous or whatever.

The techniques are secondary to the cultivation of what in Zen would be called "clear mind." In order to have a certain clarity of mind, you have to develop a certain amount of calmness. We're trying to cultivate calmness and concentration in a context of clarity, perception, and mindfulness.

PP: Do people become dependent on you?

JK: Most of the people we see don't trust themselves at all when they first come in. They don't trust their own bodies, they don't trust their own experience. Usually they want someone else, like the doctor, to be the authority. We work very hard not to fall into that. The temptation is very great to be the guru, the great expert in meditation. In fact, we are constantly working to mirror back to them not to make us into somebody special. If anybody's special, we're all special.

We teach the need to trust your body, even if you feel that it has betrayed you with cancer. We teach the need to know those parts of yourself that are more right with you than wrong with you. You begin to discover that there's an awful lot right with you, just by virtue of having a body and having the breath go in and out.

People do start to experience a greater sense of caring for others, grounded in a revolutionary newfound caring for themselves.

PP: It sounds like there is a transformation.

JK: Yes. I don't want to overstate the case. The two fundamental things that most people get out of the program, independent of symptom reduction, are these. First, the breath is an ally and can be used to calm down and see more clearly. The other, related discovery, is that you are not the content of your thoughts. You don't have to believe them or react to them. That's incredibly liberating.

PP: Are any of these experiences comparable to what we call awakening or enlightenment in Buddhist practice?

JK: A lot of people come to the meditation centers with a lot of baggage, a lot of expectations. They already "know" about enlightenment, and they want it. That's a big impediment. The people we see, they don't know about enlightenment, they don't WANT it! They're coming because of their suffering; it's a situation made to order for Buddhist work.

Comparing it with various levels of enlightenment experiences is difficult: we don't work with people for very long eight weeks, and then they can come back and recharge their batteries. People do have small experiences of going beyond themselves, of transcendence. We've had several people who have had knock-your-socks-off enlightenment experiences, of the self falling away and so forth. You know it immediately, because the vocabulary that they use is so unusual in describing it. But we don't set this as a goal in people's minds. It's more a question of developing one's own inner wisdom for right living and right awareness.

PP: I've heard some stories about just how strongly people are affected.

JK: There was a famous trial in Massachusetts a few years ago. The defense lawyer was a long-term Vipassana student. After the jury had been selected, the judge delivered instructions on how to listen to evidence. It was pure mindfulness teaching: moment-to-moment, dispassionate, non-judgmental awareness - listening mind. The lawyer approached the judge later and asked, "Where the hell did you get that?" The judge replied "Oh, I'm taking the stress reduction class at the U. Mass, Medical Center, and it seemed we could use a little more mindfulness in our judicial proceedings."

PP: And what about the medical students themselves? As more and more of them take this course, how do you see them taking it into their work?

JK: One of our ulterior motives is to transform the way medicine is practiced. We don't have a health care system; we have a disease care system. We are trying to influence doctors and medical students in the direction of mindfulness: mindful practice of medicine, mindful communication with people who are hurting, mindful encounter with the patient as a whole person. It's almost axiomatic that people have to cultivate awareness in their own lives, in their own bodies, if they are going to be able to develop empathy and compassion for the people they see.

Source: http://www.kwanumzen.com/primarypoint/v08n2-1991-summer-jonkabatzinn-mindfulmedicine.html