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Meditation, Medication, and the Middle Way

Mindfulness is everywhere, but we need to use it mindfully.

Spencer Selover/Pexels
Mindfulness means being present in the moment.
Source: Spencer Selover/Pexels

Mindfulness is everywhere. There are mindfulness courses, mindfulness messages on public transport, any number of books and apps, and an infinity of websites offering online resources for people who are either in search of their own minds or trying to escape from them—confusingly, both quests can come under the heading of “mindfulness.”

Mindfulness means being aware of the present moment. It means letting distractions drift past and focusing instead on our breath, our bodies, our surroundings. Mindfulness is a powerful technique for knowing our minds, stilling our thoughts, and living more intensely in the moment.

Too often, thinking about the past makes us depressed. Thinking about the future makes us anxious. The present moment is all we have. We need to live in it. This is what mindfulness means.

That being said, mindfulness is not the answer to everything. Too often, we can be mindless about mindfulness, casually advising others to be “more mindful” even when we do not really understand their problems, or thoughtlessly attributing our own unease to a “lack of mindfulness” when the truth is likely far more complex than that.

Mindfulness can lose its meaning very quickly. It can become a vacuous slogan or—worse still—an infinitely flexible concept that lacks any fixed meaning at all: “McMindfulness.”

These issues can be especially acute in people with severe mental illness, who often find that they need more than mindfulness in order to stay well. The relationship between psychiatric medication and mindfulness is especially fraught. If medications like anti-depressants affect the brain, do they impede true mindfulness? Or do they help achieve it? Is there a mindful way to use medication and other treatments for severe mental illness?

Several writers have addressed this issue. Buddhist psychiatrist Mark Epstein has written about pharmaceuticals and meditation, arguing that there is ignorance among meditators about the benefits of psychiatric treatments, and ignorance in the medical profession about the benefits of meditation. Certainly, someone whose mind is paralyzed by severe depression is unlikely to benefit from mindfulness practice or meditation and is well advised to accept any treatment that works for their condition. This includes medication if it seems like a reasonable choice in the person’s individual circumstances.

Jon Kabat-Zinn, creator of the “Mindfulness-Based Stress Reduction” program, agrees that medications play an important role in medicine. He warns against the casual, habitual, or mindless use of any chemicals (be they prescribed, legal, or illegal), but he also acknowledges the usefulness of certain tranquilizers and anti-depressants in specific circumstances. It is important to consider all options.

Buddhist writer Jack Kornfield also emphasizes the need to be open-minded about the use of psychiatric medication. The key question, Kornfield writes, is whether the use of any substance helps the person with their mindfulness or meditation, or whether it undermines their practice. In many cases, medications can bring great relief, but they must be used mindfully rather than mindlessly and with an open mind and heart.

To achieve this, there is wisdom in the Buddhist concept of the “Middle Way.” This is the idea that we should not devote ourselves entirely to the pursuit of either pleasure or asceticism, because both extremes are unskillful, lacking in balance, and ultimately unsustainable. We should, instead, chart a middle way between the two extremes, balancing pleasure with control, enjoyment with discipline. Although challenging, this “Middle Way” leads to balance, insight, and well-being.

In Buddhism, the “Middle Way” is achieved by following the “Noble Eightfold Path” which involves cultivating right understanding, right thought, right speech, right action, right livelihood, right effort, right mindfulness, and right concentration.

In psychiatry and psychology, this means taking a common-sense approach to the use of all forms of treatment, including psychiatric medication, often in parallel with mindfulness or meditation. There is nothing noble or empowering about preventable suffering. If a medication helps lift the crushing weight of depression, it can only enhance mindfulness and spiritual practice.

The same applies to anti-anxiety medication and anti-psychotics: Mindfulness is about focusing on the here and now, and this requires initiative, concentration, and effort. Mental illness impairs all of these abilities. Effective treatment enhances them.

Mindfulness can be an important part of this process for many people: teaching us how to sit with our negative emotions, how to let our distressing thoughts move past, and how to be genuinely present in the moment.

In the end, that is all that matters: being well enough and balanced enough to live in the present moment. That is the purpose of meditation: to make us alive to the moment.

The present moment is all we have. It is all we will ever have.

Life is a series of nows. We need to live them.

More from Brendan Kelly, M.D., Ph.D.
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