The Prescription is Meditation

Lawrence Pintak profiles

Jon Kabat Zinn

Published for free distribution by Auspicious Affinity P.O.BOX 8738 Pejabat Pos Kelana Jaya 46796 Petaling Jaya Selangor, Malaysia. Email: auspice@tm.net.my Tel/Fax: 603 7806 5118 Copyright 2002 Shambhala Sun Magazine Originally published in Shambhala Sun MagazineSeptember 1999 Reprinted with permission from the Shambhala Sun Magazine: www.shambhalasun.com. Text version retrieved from http://www.shambhalasun.com/Archives/ Features/1999/Sep99/KabatZinn.htm First printing3000 copies (2003) All Rights Reserved. No part of this book may be reproduced in any manner without written permission from the publisher. Cover art design Jotika Book layout Chan Lai Fun Printed in Selangor, Malaysia

Jon Kabat Zinn

Lawrence Pintak is a writer, broadcaster and newspaper editor based in Massachusetts who reports regularly on issues of the body, mind and spirit. He can be reached at pintak@acunet.net.
A special note of thanks and appreciation to Shambhala Sun for their kind permission and assistance.

rom the inner city to the executive suite,

in hospitals and prisons, Dr. Jon Kabat-Zinns meditation courses are helping thousands handle illness stress, anger and addiction. Lawrence Pintak profiles the man who has brought meditation to the American mainstream.

John Coolidge was alone with his mind. Paralyzed and rendered deaf by a disease that had attacked his nervous system, Coolidges eyes were his one link with the world. And now to protect his eyes, the doctors had decreed that each night they must be covered with gauze. He was left totally isolatedunable to feel, unable to move, unable to hear, unable to see, unable even to breathe without the respirator which kept him alive. The good news was that my mind worked fine. The bad news was that my mind worked fine, says Coolidge, looking back on the experience. Through the long hours of the night, Coolidge lay awake and alone, too terrified to sleep. For some, it would have been a prescription for panic. But John Coolidge knew to seek refuge in the one physical sensation he had lefthis breath.
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I had been taught a meditation technique in which you watch your breathin goes the good air, out goes the bad. The ventilator was moving my chest up and down, and it was the one solid thing I had going for me, he recalls. For Coolidge, the simple act of concentrating his awareness on the flow of air into his body provided the anchor that kept his mind under control. Awareness, concentration and control. This is the mantra of a movement which is today helping thousands of Americans cope with pain and the emotional stresses which, medical science is proving, contribute to disease. The foundation of this movement was laid twenty years ago by an MIT-trained microbiologist who believed science did not end at the laboratory door. Exposed to martial arts, yoga and Zen meditation as a student, Dr. Jon Kabat-Zinn came to realize that Buddhist yogis and Western researchers had much in common.
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They were all inquiring about the nature of reality, the nature of the mind, the nature of being human, says Kabat-Zinn, and I just didnt see a big dividing line between one way of inquiring and another. Kabat-Zinn took a sabbatical from medicine to head the Cambridge Zen Center, and the deeper his practice became, the more convinced he was that meditation could play a crucial role in the healing process. The key was proving it. This was unbelievably powerful stuff that no one was looking at from a scientific point, says Kabat-Zinn, a compact man with the face of a Brooklyn street fighter. But then I came to see that research had been done for years by meditators and yogis. As author of the best-selling FULL CATASTROPHE LIVING, Kabat-Zinn literally wrote the book

on using the mind to help heal the body. He

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was one of the first people who took Eastern

disciplines and began to measure their effects from a clinical perspective, says Garrett Sarley, executive director of the Omega Institute in Rhinebeck, New York, one of the countrys leading centers for mind-body seminars and retreats. For a doctor to go out and forge that path took a great deal of courage. Mindful breathing is the core of KabatZinns brand of body-mind medicine. Mindfulness is a way of living your life and holding all of experience, he says, sitting in his office at the Center for Mindfulness in Medicine, Health Care and Society at the UMass Medical Center in Worcester. These kinds of practicesmindful yoga and meditationactually have effects on the body that are in the direction of greater health and well-being. In the two decades since Kabat-Zinn founded the Mindfulness Center, more than 10,000 patients have been through his stress reduction programalmost all referred by
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physicians and other health care professionals. Countless thousands more have taken classes at the more than 240 mindbody stress reduction clinics that have sprung up around the world, many created on KabatZinns template. Dramatic reductions in physical and emotional symptoms are common among course participants suffering from a broad range of chronic diseases and medical problems, even as their ability to handle pain and stress increases. It was at such an eight-week program that John Coolidge learned to watch his breath, three years before the auto accident that left his pelvis crushed and triggered the onset of Guillain-Barre syndrome, a traumarelated disorder that causes paralysis by attacking the lining of the nerves. It felt like I was dying in phases, recalls Coolidge, shortly after he was released from
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six months of hospitalization. I basically

meditated my way all through it. My folks would literally see my heart rate and respiration rate go down on the monitors. You could literally see the relaxation electronically. Before the ordeal was over, Coolidge would use the techniques for more than just stress management. As feeling slowly began to return to his limbs, the lumbar punctures that tracked his recoverytests in which electrically charged needles were inserted into the nervesbecame increasingly painful. It was like getting hooked up to an electric fence for an hour, he recalls with a shudder. Once more, Coolidge resorted to meditating on his breath. It absolutely helped to offset the pain, he says of the breath meditation. Youre still aware of it, but it doesnt control your thinking. The pain or the fear doesnt have to be dominant. That doesnt mean it disappears, but it doesnt have to be the only thing going on.
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Would Coolidge have survived if he had not gone through the Kabat-Zinn program? Probably, but he suspects the experience would have been much worse. The meditation allowed me to concentrate the fight that was in me on productive areas, he explains. I was able to fight the disease, the paralysis, the pneumonia, and not at any time fight the fact that I was in those circumstancesnot spend any time being angry. Holding on to how it should be, rather than how it is, is a huge energy drain for most of us, instructor Florence Meyer tells a stress reduction class assembled on the second floor of the Joseph Benedict Building at UMassMemorial Hospital. Meyer is seated crosslegged on a meditation cushion. Two dozen people, a mix of corporate executives and blue collar workers, professionals, and middle-class grandmothers,
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doctors and psychologists, are scattered

around the crowded room, some on cushions on the floor, others perched on chairs that line the walls. They have one thing in common: they are all trying to copewith stress, with pain, with disease. Have you ever heard how they trap monkeys in India? Meyer asks, beginning a story that is a staple of the course. They put out a box with a hole just large enough for the monkey to fit his hand in. Inside is a banana. Once the monkey grabs the banana, he cant get his hand out. All he has to do is let go of the banana. But he doesnt, and hes trapped. What are the things we hold on to that trap us? she asks the group, which she has just led in a 40-minute silent meditation. We all have things we dont have control over, says Meyer, one of nine staff members who teach both students and other instructors from around the country. But there is always
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something we can controlwhen we are going to give something energy and when were not. Control. The word echoes through the classrooms and literature of the Mindfulness Center. Most days are like playing Beat the Clock, says Susan, an emergency room nurse who, like many in the room, is struggling to handle the pressures of work, family and life. I used to lose control and escalate with the people I work with. Now I can step aside, take a few breaths and continue my work in a calm manner. Judy, who is juggling two jobs to get by, says the pressure had become too much the previous day, and she finally broke down in tears. If you had connected with what was going on, you could have made a choice, Meyer reminds her. She recounts for the
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group the steps toward facing stress mind-

fully: Be aware of the feeling. Go to the breath, even if its just for a moment. Re-connect with yourself. The cause of the stress may not go away, but thats okay. You can now make a choice how to react. It was an amazing thing that I was able to get control of my stress, affirms Linda King, a self-confessed Type A personality who was able to discontinue her high blood pressure medication after taking the course. It sounds very simpleits all about centering yourself and breathingbut physiologically it has a tremendous effect on the body. Ive seen a number of people go into that course and come out more insightful, better able to deal with their symptoms, and sometimes actually having less symptoms, confirms Dr. John K. Zawacki, a UMass gastroenterologist who has referred many patients to the program.
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Documenting those changes has been a prime goal of the Mindfulness Center. What that group didand thats where they really should be applaudedis they took seriously the need for well-done, randomized studies, says David Larsen, president of the Washingtonbased National Institute for Healthcare Research, which has helped create courses in spirituality at some sixty medical schools. Theyve really made a difference, so that now you even have insurance companies funding this type of effort. Theyre a model for the rest of us. Kabat-Zinn and his team have published more than a dozen detailed studies on the effects of mindfulness meditation in major peer-reviewed medical journals. Unless you are writing up these kinds of experiences in the medical literature in ways that are
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scientifically valid and reproducible by other

places, then its just, I hear they do great things over at UMass Medical Center, but it wouldnt go any deeper, says Kabat-Zinn. Overall, controlled clinical studies carried out by the center have documented symptom reductions of between 29% and 46% among class participants. Breaking it down by condition, people with heart disease experienced a 45% reduction in symptoms; high blood pressure, 43%; pain, 25%, and stress, 31%. Those are the kind of numbers that get the attention of health care providers trying to control costs. Insurance companies and HMOs like Tufts are now picking up at least some of the cost for about a quarter of the programs participants. From our personal experience, we have found their studies to be well-designed and robust, says Dr. Tehseen Salimi, director of medical services for Cigna Healthsource Massachusetts, which is funding a trial
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program documenting the effects of the mindbody stress reduction course on patients suffering from three specific ailments. But insurance companies arent paying for meditation classes out of the goodness of their hearts. Lowering someones blood pressure enough to get them off medication, or helping an ulcer patient redirect his stress, means fewer costs for them. For example, a Kabat-Zinn study published last autumn reported that the skin lesions of psoriasis patients who listened to meditation tapes while undergoing light treatments cleared up four times faster than those who did not. The implication is that the mind can actually enhance the healing process by a factor of four, and if people need fewer treatments, it costs less, Kabat-Zinn explains. Participants in the stress reduction classes do more than just sit watching their breath. They are taught simple yoga movements and
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introduced to a body scan technique

borrowed from Vipassana meditation, in which they are guided through a process of shifting the focus of their awareness to different parts of the anatomy. The point of it all is to be present in your body, as the instructors constantly remind their students, in order to see events with more clarity and directness and thus consciously control what is controllable, and release the rest. Most people dont listen to their bodies at all, says a medical doctor enrolled in a recent course. Theyre so busy doing whatever theyre trying to do, theyre not thinking about what their bodys telling them they should or shouldnt do. Each student in the course, which meets three hours a week for eight weeks, is given a set of guided meditation tapes and expected to do at least forty-five minutes of practice each night.
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Its not a cure-all. Its not like some magical thing, insists Bob, a stressed-out Metrowest executive who was on tranquilizers and suffering from irritable bowel syndrome before taking the course. I remember some people saying, I feel ripped off, I thought this was going to be awesome and it wasnt. I think thats because people think that someone else is going to fix their lives for them. What I found is its really hard work, but its worth it. But it is no panacea. Thats evident in the haggard face of a young mother who arrives late to a class at the Mindfulness Centers inner city campus at a UMass hospital in one of the poorest areas of Worcester, a moribund industrial city in central Massachusetts. The reek of stale cigarette smoke clings to her like a dirty blanket. She cant be more
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than thirty years old, but worry has etched

deep hollows in her frail face, adding a decade of age. Her movements are sharp, nervous. She holds her trembling hands firmly in her lap, as if consciously forcing them not to reach for the next cigarette in the chain. Do you manage to do the daily practice? a visitor asks her during a brief break. Sometimes, she hesitantly replies, eyes shyly straying toward her questioner. Not much. I have a little daughter, so its hard Pause. and were homeless. They arrive here shaking; sometimes life and hope arent present in their eyes, says Fernando A. de Torrijos, director of the inner city program. The doctors dont know what to do with them, so they send them here. Drug addicts, alcoholics, victims of abuse. All the pain of inner city life is present in the class, which many participants take two or three times. I feel like I am bound by chains
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that I cant break, says Louise, a woman of indeterminate age who struggles to form the words. She appears mentally handicapped, but experts say the symptoms are actually a legacy of years of abuse, followed by lengthy incarceration in a mental institution. They tore me down, she says. We can use meditation to be present in our situation and use that awareness to break out of our chains, explains instructor Melissa Blacker, a psychologist who was a grief counselor before joining the Mindfulness Center. But can they? Is there a point at which the burden is just too great? They come from such a difficult starting point, Kabat-Zinn acknowledges. Were not taking people the entire distance to anything in eight weeks. But a lot of the work that we do is planting seeds. Even if you drop out, if youve heard one person say, I did this and my pain went
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away, or I handled a very difficult situation

in a positive way, thats potentially lifechanging. The inner city classes are free to those who dont have insurance and cant afford to pay, the vast majority. Referrals come from clinics, support groups and shelters in the city. Free taxis and child care encourage attendance. Instructors make frequent follow-up calls to those who miss classes, which are also held in Spanish. Still, since its inception, only 600 of the 2,000 participants have actually completed the inner city course. John, an on-again off-again drug addict, is one whos made it through the program. He has been an intermittent participant since 1992 and has attended every session for the past two years. Battling a potentially deadly Hepatitis C infection, coping with depression, fighting pain, he is on a toxic cocktail of prescription drugs even as he struggles to stay clean. Since he has stuck with it, the
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meditation class has brought his soaring blood pressure down 10 points. Its life or death, but its not easy, he says, the words coming in manic, machine-gun bursts. If I dont do this, then I will have a heart attack and die. The desperation is apparent in his voice. It takes a lot of practice and I have to practice for the rest of my life. It has to become automatic and thats what Im working on. Its one of those things that works when you work at it, confirms Sarah, a legally blind diabetic who has attended the course once before. This time she has brought her husband, whose heart is severely damaged. When I use it, I find myself more calm, relaxed, mellowbetter equipped to face the world. But, she is asked, does it change the difficulties that surround her? No, but it helps me to respond rather than react, and respond
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in a more appropriate manner, calmer, she

adds with a laugh, rather than just plunging into things. Fifty miles and a world away, the attorneys at Boston legal powerhouse Hale and Dorr are also learning to respond more calmly. Last autumn, forty of the mega-firms 360 lawyers attended an eight-week course held right in the firms elegant State Street offices. They found that it improved their ability to respond to many of the challenges and stresses they encounter, reports Brenda Fingold, a partner in charge of training and development who organized the course. Theyre more focused, better listeners and have more energy. Still, its hard to picture a high-powered lawyer stopping to breathe mindfully in the heat of a courtroom battle. Youd be surprised, says John Hamilton, a senior partner who is now taking one of the firms monthly refresher classes. Lawyers
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for a long time have done that, stepped back and taken a breath, but this is a more focused and deliberate way of doing it. Its amazing how refocused you can get. Its like a muscleif you keep working at it, it really does prepare you to go into battle. What is true in the courtroom, participants in the Centers corporate retreats claim, is also true in the boardroom. What the practice does is help you bring attention or awareness to whatever is going on. That can be a major financial transaction, management decisions, employee issues or situations at home, says David Friedman, CEO of the Sandy River Group, a chain of long-term care facilities. But isnt $4,000 per personbefore room and boardfor a week of meditation at the corporate retreat programs tough to justify on the bottom line? Its mindfulness, but its also good business practice, insists
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Friedman, who has introduced mindfulness

training to some of his own senior managers since taking the course. I cant give a cost-benefit analysis, but I know anecdotally that its well worth the money were spending on it, says Hamilton of Hale and Dorr, which is about to sponsor a second eight-week in-house course. And whats good for private industry just might be good for government. A four-year mindfulness training program that KabatZinn and his team ran in the Massachusetts prison system brought notable reductions in the level of hostility and confusion among prisoners who took the coursethat is, until funding was pulled in the heat of the 1996 gubernatorial campaign. State Spent Bundle on Yoga for Cons, read a Boston Herald headline that torpedoed the program. Weld to KO $900G Prisoner Meditation Program. The paper reported that a study had found the program to be virtually worthless, Kabat25

Zinn recalls ruefully. We couldnt respond because we hadnt processed the data at that time. The detailed response will come in a paper soon to be published in a major criminal justice journal. Based on 1,000 prisoners who took the course, the team documented a 38% increase in self-esteem and a 9% drop in hostility among women, and a 28% increase in self-esteem and 7% decrease in hostility among men. The larger implication is that if you are less hostile you are less likely to beat on others, Kabat-Zinn explains, getting excited, and if youre selfconfident you might be more likely to get a job rather than rob somebody and get addicted to drugs. That ultimately translates into reduced recidivism rates. Seated in his hospital office decorated with medical degrees and mandalas, KabatZinn eyes his meditation cushion and reflects
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on his past twenty years in mind-body

medicine: Its exciting and sobering that these two different worlds have come together. The book hasnt been written about what is ultimately possible. Mindfulness meditation may have its roots in an ancient tradition alien to most Americans, but what Kabat-Zinn and others like him have done is strip it down to an essence everyone can understand. Its the heart of Buddhist meditative practices, the heart of Sufi practices, the heart of all spiritual practices, he says. Were pointing to something that lies in the heart, not out there in history. Is it Buddhism, or, as some critics claim, another example of Buddhism-lite? Its not like were trying to create Buddhists, insists Kabat-Zinn, whose instructors come from backgrounds that include Buddhism, Sufism, Yoga and Theosophy. Were trying to take that fundamental universal lawfulness that comes out of the Buddhist tradition and
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see how that is relevant to our lives as regular Americans who arent interested in becoming anything else, but might really be interested in becoming who we actually are. Which means, he says, his clients arrive with a very different set of expectations. None of them comes with the baggage that people often bring to a meditation center, like, Ill get enlightened, or Ill sit at the feet of the guru. People are coming because of their sufferingits as pure as you can get. Kabat-Zinn calls it American Dharma: Ive always thought that its about time that we make Buddhist practices commonsensical and part of the American repertoire, so that theyre not foreign, theyre not Asian, they are American. Jon is a really good example of somebody who is working very hard to be a translator in the pure sense of the term, without watering down the teaching, says
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Sharon Salzberg, a founder of the Insight

Meditation Society. Somebody might get involved in Buddhist teaching to address the problem of their headaches, and then they find out some things about themselves and the capacity of their minds and their ability to have compassion. That can be more transforming than they ever imagined, but their initial entre is something to do with their health. And while some students do go on to study more advanced Buddhist practices, for most it is the fact that the teachings are reduced to their essence that makes them most valuable. You dont have to go off on a retreat to a cave and do this, argues Hale and Dorrs Hamilton. Its very practical. Its great to have a practice and sit on a cushion and get whatever you can from that, observes Friedman, the CEO. But for me, the real value is integrating it into my everyday life. I get excited about the fact
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that breath is something I always have with me, agrees Janet, a Massachusetts housewife. That I dont need an extra bag for it, that I dont need to pay for it, that I dont need to ask somebody for it. Its a tool I just have and I can call on it whenever I need it. John Coolidge, whose breath helped him survive the isolation of paralysis, can testify to that.

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