Is mindfulness making us ill?

| Life and style | The Guardian

http://www.theguardian.com/lifeandstyle/2016/jan/23/is-mindfuln...

Is mindfulness making us ill?

Its the relaxation technique of choice, popular with employers and even the
NHS. But some have found it can have unexpected effects
Dawn Foster
Saturday 23 January 2016 10.00GMT

am sitting in a circle in a grey, corporate room with 10 housing

association employees administrators, security guards, cleaners
eyes darting about nervously. We are asked to eat a sandwich in
silence. To think about every taste and texture, every chewing motion
and bite. Far from being relaxed, I feel excruciatingly uncomfortable
and begin to wonder if my jaw is malfunctioning. Im here to write
about a new mindfulness initiative, and since Ive never to my
knowledge had any mental health issues and usually thrive under
stress, I anticipate a straightforward, if awkward, experience.
Then comes the meditation. Were told to close our eyes and think
about our bodies in relation to the chair, the oor, the room: how each
limb touches the arms, the back, the legs of the seat, while breathing
slowly. But theres one small catch: I cant breathe. No matter how fast,
slow, deep or shallow my breaths are, it feels as though my lungs are
sealed. My instincts tell me to run, but I cant move my arms or legs. I
feel a rising panic and worry that I might pass out, my mind racing.
Then were told to open our eyes and the feeling dissipates. I look
around. No one else appears to have felt they were facing imminent
death. What just happened?
For days afterwards, I feel on edge. I have a permanent tension
headache and I jump at the slightest unexpected noise. The fact that
something seemingly benign, positive and hugely popular had such a
profound eect has taken me by surprise.
Mindfulness, the practice of sitting still and focusing on your breath

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and thoughts, has surged in popularity over the last few years, with a
boom in apps, online courses, books and articles extolling its virtues. It
can be done alone or with a guide (digital or human), and with so much
hand-wringing about our frenetic, time-poor lifestyles and information
overload, it seems to oer a wholesome solution: a quiet port in the
storm and an opportunity for self-examination. The Headspace app,
which oers 10-minute guided meditations on your smartphone, has
more than three million users worldwide and is worth over 25m.
Meanwhile, publishers have rushed to put out workbooks and guides
to line the wellness shelves in bookshops.
Large organisations such as Google, Apple, Sony, Ikea, the Department
of Health and Transport for London have adopted mindfulness or
meditation as part of their employee packages, claiming it leads to a
happier workforce, increased productivity and fewer sick days. But
could such a one-size-ts-all solution backre in unexpected ways?
Even a year later, recalling the sensations and feelings I experienced in
that room summons a resurgent wave of panic and tightness in my
chest. Out of curiosity, I try the Headspace app, but the breathing
exercises leave me with pins and needles in my face and a burgeoning
terror. Let your thoughts move wherever they please, the app urges.
I just want it to stop. And, as I discovered, Im not the only person who
doesnt nd mindfulness comforting.
Claire, a 37-year-old in a highly competitive industry, was sent on a
three-day mindfulness course with colleagues as part of a training
programme. Initially, I found it relaxing, she says, but then I found I
felt completely zoned out while doing it. Within two or three hours of
later sessions, I was starting to really, really panic. The sessions
resurfaced memories of her traumatic childhood, and she experienced
a series of panic attacks. Somehow, the course triggered things I had
previously got over, Claire says. I had a breakdown and spent three
months in a psychiatric unit. It was a depressive breakdown with
psychotic elements related to the trauma, and several dissociative
episodes.
Four and a half years later, Claire is still working part-time and is in and
out of hospital. She became addicted to alcohol, when previously she
was driven and high-performing, and believes mindfulness was the

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catalyst for her breakdown. Her doctors have advised her to avoid
relaxation methods, and she spent months in one-to-one therapy.
Recovery involves being completely grounded, she says, so yoga is
out.
Research suggests her experience might not be unique. Internet
forums abound with people seeking advice after experiencing panic
attacks, hearing voices or nding that meditation has deepened their
depression after some initial respite. In their recent book, The Buddha
Pill, psychologists Miguel Farias and Catherine Wikholm voice concern
about the lack of research into the adverse eects of meditation and
the dark side of mindfulness. Since the books been published,
weve had a number of emails from people wanting to tell us about
adverse eects they have experienced, Wikholm says. Often, people
have thought they were alone with this, or they blamed themselves,
thinking they somehow did it wrong, when actually it doesnt seem its
all that uncommon.
One story in particular prompted Farias to look further into adverse
eects. Louise, a woman in her 50s who had been practising yoga for
20 years, went away to a meditation retreat. While meditating, she felt
dissociated from herself and became worried. Dismissing it as a
routine side-eect of meditation, Louise continued with the exercises.
The following day, after returning home, her body felt completely
numb and she didnt want to get out of bed. Her husband took her to
the doctor, who referred her to a psychiatrist. For the next 15 years she
was treated for psychotic depression.
Farias looked at the research into unexpected side-eects. A 1992
study by David Shapiro, a professor at the University of California,
Irvine, found that 63% of the group studied, who had varying degrees
of experience in meditation and had each tried mindfulness, had
suered at least one negative eect from meditation retreats, while 7%
reported profoundly adverse eects including panic, depression, pain
and anxiety. Shapiros study was small-scale; several research papers,
including a 2011 study by Duke University in North Carolina, have
raised concerns at the lack of quality research on the impact of
mindfulness, specically the lack of controlled studies.
Farias feels that media coverage inates the moderate positive eects

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of mindfulness, and either doesnt report or underplays the

downsides. Mindfulness can have negative eects for some people,
even if youre doing it for only 20 minutes a day, Farias says. Its
dicult to tell how common [negative] experiences are, because
mindfulness researchers have failed to measure them, and may even
have discouraged participants from reporting them by attributing the
blame to them.
Kate Williams, a PhD researcher in psychiatry at the University of
Manchester and a mindfulness teacher, says negative experiences
generally fall into one of two categories. The rst is seen as a natural
emotional reaction to self-exploration. What we learn through
meditation is to explore our experiences with an open and
nonjudgmental attitude, whether the experience that arises is
pleasant, unpleasant or neutral, she says.
The second, Williams says, is more severe and disconcerting:
Experiences can be quite extreme, to the extent of inducing paranoia,
delusions, confusion, mania or depression. After years of training,
research and practice, her own personal meditation has included some
of these negative experiences. Longer periods of meditation have at
times led me to feel a loss of identity and left me feeling extremely
vulnerable, almost like an open wound, Williams says. As an
experienced mindfulness teacher, however, she says she is able to deal
with these negative experiences without lasting eect.
Rachel, a 34-year-old lm-maker from London, experimented with
mindfulness several years ago. An old school friend who had tried it
attempted to warn her o. He said, Its hardcore youll go through
things you dont want to go through and it might not always be
positive. I suppose sitting with yourself is hard, especially when youre
in a place where you dont really like yourself. Meditation cant x
anyone. Thats not what its for.
After a few months of following guided meditations, and feeling
increasingly anxious, Rachel had what she describes as a meltdown
immediately after practising some of the techniques shed learned; the
relationship she was in broke down. Thats the horrible hangover I
have from this: instead of having a sense of calm, I overanalyse and
scrutinise everything. Things would run round in my mind, and

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suddenly Id be doing things that were totally out of character, acting

very, very erratically. Having panic attacks that would restrict my
breathing and, once, sent me into a blackout seizure on the studio oor
that involved an ambulance trip to accident and emergency. Rachel
has recovered to some extent; she experiences similar feelings on a
lower level even today, but has learned to recognise the symptoms and
take steps to combat them.
So are employers and experts right to extol the virtues of mindfulness?
According to Will Davies, senior lecturer at Goldsmiths and author of
The Happiness Industry, our mental health has become a moneymaking opportunity. The measurement of our mental and emotional
states at work is advancing rapidly at the moment, he says, and
businesses are increasingly aware of the nancial costs that stress,
depression and anxiety saddle them with.
Rather than removing the source of stress, whether thats unfeasible
workloads, poor management or low morale, some employers
encourage their sta to meditate: a quick x thats much cheaper, at
least in the short term. After all, its harder to complain that youre
under too much stress at work if your employer points out that theyve
oered you relaxation classes: the blame then falls on the individual.
Mindfulness has been grabbed in recent years as a way to help people
cope with their own powerlessness in the workplace, Davies says.
Were now reaching the stage where mandatory meditation is being
discussed as a route to heightened productivity, in tandem with
various apps, wearable devices and forms of low-level employee
surveillance.
One former Labour backbencher, Chris Ruane, recently proposed
meditation for civil servants, on the basis that it would cut Whitehall
costs by lowering sick leave through stress, rather than making the
workplace and jobs less stressful in the rst place. The whole agenda
is so fraught with contradictions, between its economic goals and its
supposedly spiritual methods, Davies argues. Its a wonder anyone
takes it seriously at all.
Mindfulness has also been adopted by the NHS, with many primary
care trusts oering and recommending the practice in lieu of cognitive
behavioural therapy (CBT). It ts nicely with the Nutribullet-

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chugging, clean-eating crowd, because it doesnt involve any tablets,

says Bethan, a mental health nurse working in east London. My main
problem with it is that its just another word for awareness.
Over the past few years, Bethan has noticed mindfulness mentioned or
recommended increasingly at work, and says many colleagues have
been oered sessions and training as part of their professional
development. But the move towards mindfulness delivered through
online or self-help programmes isnt for everyone. Its ne, but
realising you have depression isnt the same as tackling it, she says. I
dont see it as any dierent from the ve-a-day campaign: we know
what we should be eating, but so many of us dont do it. We know that
isolating ourselves isnt helpful when we feel blue, but we still do
that.
Part of the drive is simple cost-cutting. With NHS budgets squeezed,
resource-intensive and diverse therapies that involve one-on-one
consultations are far more expensive to dispense than online or group
therapies such as mindfulness. A CBT course costs the NHS 950 per
participant on average, while mindfulness-based cognitive therapy,
because its delivered in a group, comes in at around 300 a person.
Its cheap, and it does make people think twice about their choices, so
in some respects its helpful, Bethan says.
But in more serious cases, could it be doing more harm than good?
Florian Ruths has researched this area for 10 years, as clinical lead for
mindfulness-based therapy in the South London and Maudsley NHS
foundation trust. He believes it is possible to teach yourself
mindfulness through apps, books or online guides. For most people, I
think if youre not suering from any clinical issues, or illness, or from
stress to a degree that youre somewhat disabled, its ne, he says.
We talk about illness as disability, and disability may arise through
sadness, it may arise through emotional disturbance, like anxiety.
Then, obviously, it becomes a dierent ballgame, and it would be good
to have a guided practice to take you through it. This runs counter to
the drive towards online mindfulness apps, delivered without
supervision, and with little to no adaptation to individual needs or
problems.
But for Ruths, the benets outweigh the risk of unusual eects. If we

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exercise, we live longer, were slimmer, weve got less risk of dementia,
were happier and less anxious, he says. People dont talk about the
fact that when you exercise, you are at a natural risk of injuring
yourself. When people say in the new year, Im going to go to the gym
out of 100 people who do that, about 20 will injure themselves,
because they havent been taught how to do it properly, or theyve not
listened to their bodies. So when youre a responsible clinician or GP,
you tell someone to get a good trainer.
Certain mental health problems increase the risk of adverse eects
from mindfulness. If you have post-traumatic stress disorder, there is
a certain chance that you may nd meditation too dicult to do, as
you may be re-experiencing traumatic memories, Ruths says. Once
again, its about having experienced trainers to facilitate that. Weve
seen some evidence that people whove got bipolar vulnerability may
struggle, but we need to keep in mind that it may be accidental, or it
may be something we dont know about yet.
Of course, people may not know they have a bipolar vulnerability until
they try mindfulness. Or they might have repressed the symptoms of
post-traumatic stress disorder, only for these to emerge after trying the
practice.
How can an individual gauge whether theyre likely to have negative
side-eects? Both Farias and Ruths agree there isnt a substantial body
of evidence yet on how mindfulness works, or what causes negative
reactions. One of the reasons is obvious: people who react badly tend
to drop out of classes, or stop using the app or workbook; rather than
make a fuss, they quietly walk away. Part of this is down to the current
faddishness of mindfulness and the way its marketed: unlike
prescribed psychotherapy or CBT, its viewed as an alternative lifestyle
choice, rather than a powerful form of therapy.
Claire is clear about how she feels mindfulness should be discussed
and delivered: A lot of the people who are trained in mindfulness are
not trained in the dangers as well as the potential benets, she says.
My experience of people who teach it is that they dont know how to
help people if it goes too far.
There is currently no professionally accredited training for

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mindfulness teachers, and nothing to stop anyone calling themselves a

mindfulness coach, though advocates are calling for that to change.
Finding an experienced teacher who comes recommended, and not
being afraid to discuss negative side-eects with your teacher or GP,
means youre far more likely to enjoy and benet from the experience.
As both Claire and I have found, there are alternative relaxation
methods that can keep you grounded: reading, carving out more time
to spend with friends, and simply knowing when to take a break from
the frenetic pace of life. Meanwhile, Claires experience has
encouraged her to push for a better understanding of alternative
therapies. No one would suggest CBT was done by someone who
wasnt trained, she says. Id like to see a wider discussion about what
mindfulness is and on what the side-eects can be.
Some names have been changed.

Dawn Fosters new book, Lean Out, is published by Watkins.

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Mindfulness Meditation Mental health Health Psychology
Health & wellbeing

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