OPED: Mindfulness — symptom or cure?

Jacob M. Appel
Tribune News Service

Mindfulness has rapidly become the new mantra in mental health. The vaguely defined self-improvement method draws upon Buddhist and Transcendental traditions to emphasize focus on the present moment and radical self-acceptance.

Jon Kabat-Zinn, one of its earliest and most prominent champions, has described it as "a way of befriending ourselves and our experiences." What was once a niche movement has metastasized over the past decade. Colleges and medical schools now encourage mindfulness to reduce stress. Corporations offer mindfulness training to increase employee well-being. If the flyers posted around my workplace are to be believed, one can learn the basics of this panacea with only 15 minutes of training.

Advocates of mindfulness argue that it works — to reduce depression and anxiety and to improve overall psychological welfare. Yet "does it work?" may be the wrong question.

It is important to acknowledge that, depending on your outcome measures, mindfulness meditation does appear to manifest some clinical results. An analysis published in 2014 found "moderate evidence" for improved anxiety, depression and pain. Several studies have shown roughly similar efficacy for mindfulness therapies and medication for depression, although both interventions only benefit some patients some of the time. What is unclear is whether mindfulness, in its attenuated westernized form, actually resolves underlying causes of dysphoria or merely masks them temporarily — the psychological equivalent of painting white roses red.

As an emergency room psychiatrist, I find myself pondering the most fundamental and disturbing of questions: Why are so many Americans so unhappy? We live in the wealthiest society in the entire span of history, privileged with peace and freedom and relative opportunity. One in six Americans now takes psychiatric medication, principally antidepressants and anxiolytics. Six percent of college students contemplate suicide annually. In our nursing homes, mood-altering medications are doled out like sugar water. Can we really expect enhanced self-reflection to rescue us from this maelstrom?

I find the patients I treat are unhappy because they are disconnected. Nineteenth century French diplomat Alexis de Tocqueville once admired Americans for their relentless joining of voluntary associations; now we are a nation who (to quote the title of Robert D. Putnam's seminal indictment) goes "Bowling Alone." As we expand our number of online "friends," sociologists report dramatic declines in our social and kinship networks. My grandparents, on a rough day, could call upon countless relatives and neighbors for support. Increasingly, according to data from the General Social Survey, more Americans have nobody — not a single human being — with whom to discuss important personal matters.

As we have become more isolated, we also have become more narcissistic. Analysis by Jean Twenge and Joshua Foster showed a substantial increase in this trait among college students between 1982 and 2009 as measured by Narcissistic Personality Inventory scores. Since the street homeless are strangers to us, it is easier to step over them. We have become, in a sense, an entire society of Kitty Genovese's proverbial neighbors. We ask not what we can do for our country or our neighbors or those less fortunate because we lack bonds beyond ourselves. Instead, we sit at home alone, grumbling, asking the talking heads on the television what our country can do for us.

Rather than a cure for this social detachment, pandemic mindfulness may be a symptom. We should not be surprised that an increasingly narcissistic, isolated culture produces a mental health movement that encourages us to look inward. Nor should we be surprised if such self-focused tendencies make matters worse. There is not a lot of research comparing the efficacy of mindfulness training to participating in bowling leagues or volunteering in soup kitchens. But at least if you volunteer in a soup kitchen, you have accomplished something beyond the walls of your own psyche. That should offer food for reflection.

— Dr. Jacob M. Appel is a psychiatrist and bioethicist.