Feb 5, 2018

Prescribing Mindfulness Allows Doctors to Ignore Legitimate Female Pain

Sarah Yahm
February 5, 2018

Prescribing Mindfulness Allows Doctors to Ignore Legitimate Female Pain.

This trend offloads the responsibility of care from the medical system to the woman. And its efficacy is questionable at best.

A few years ago, after a series of cascading injuries and illnesses that rendered me unable to type, drive, or sleep, I briefly became a professional patient. Like all of my professions, I took it seriously. I went to appointments armed with lists of well-researched questions written down neatly on my yellow legal pad, brought in the occasional medical journal article, and compiled detailed descriptions of my array of increasingly bizarre symptoms. My goal was to get my doctors to take me seriously so they would dive into the complexities of my case. I wanted to walk out of every appointment one step closer to determining the underlying cause of my mysterious condition and with concrete strategies to ameliorate my suffering so I could work, sleep, and live my life again. Inevitably, though, I instead was handed the same thing over and over—a prescription for mindfulness.

My primary care physician told me to download guided meditation MP3s from the clunky hospital website; my therapist insisted that I do deep breathing exercises even though they triggered my mysterious abdominal spasms; and the pain clinic declined to do “any interventions” at all, instead vaguely suggesting mindfulness. The pain clinic’s message was clear—after two appointments and a clean MRI, I was being dismissed. From now on, managing my pain was my responsibility, not theirs.

Before these medical problems, I’d had only benign feelings toward meditation. My parents, products of the 1960s, were always dashing off to the Omega Institute and Kripalu when I was a kid, and I meditated briefly in college to impress a boy who’d just returned from a gap year in India. I’d mostly thought of mindfulness as promising evidence that mainstream medicine was becoming more progressive, more open to alternative, adjunctive treatments, and more interested in the patient experience.

The reality, I now know thanks to years of being denied medical care and instead being prescribed mindfulness as self-management, is quite different. For me, the current obsession with mindfulness has become synonymous with my overall feelings of disempowerment within the medical system. In my experience, in clinical settings, mindfulness is frequently disempowerment framed as empowerment, a way of placing responsibility for suffering squarely on the patient herself and a way for doctors to wash their hands of problem patients.

And I say herself deliberately, because data indicates both that women underreport pain and that their pain is taken less seriously when they do report it. As I was researching this article, I posted on a popular freelancing forum for women, trying to see if this topic resonated with other people. Within a few hours there were more than 100 comments from members, many sharing personal stories about doctors pushing mindfulness in lieu of treatment or diagnosis, and with others defending the practice.

Lori DeBoer, a freelance writer and editor living in Boulder, Colorado, went to her primary care physician with two compressed discs verified by an X-ray, elevated autoimmune markers, and increasing joint pain. But instead of getting the prescription for an MRI, her doctor spent the brief appointment showing her yoga videos online and suggesting that she try meditation. She left the appointment feeling hopeless.

“I felt bad after my appointment like I’m being difficult because I want to be tested, to be diagnosed, to find out what’s going on with me,” she said. “I felt like I was somehow a bad person for not already doing meditation and yoga, like what’s wrong with me?”

DeBoer acknowledges that stress is a component in her physical condition, but those stressors are structural and external: “All my health-related problems started when my rent went through the roof and I had to work the equivalent of two jobs.”

No amount of meditation will fix the increased financial stresses created by gentrification in Boulder. But a prescription for meditation essentially asks DeBoer to internalize a social problem and solve it with mindfulness.

Like Lori DeBoer, Grace Alexander also had an objectively verified medical condition—spinal disc degeneration and cauda equina syndrome, nerve compression in the lumbosacral spine. She was bedridden with her left leg half-paralyzed, partially incontinent, “and in so much pain I couldn’t breathe. The solution was … be positive / meditate,” wrote Alexander. She does use mindfulness breathing techniques to help manage her pain, but those tools weren’t going to reverse her partial paralysis or her incontinence. She needed more aggressive interventions like surgery, medications, and injections to gain back her mobility. The mindfulness rhetoric felt familiar to Alexander, though, who grew up in an evangelical sect and as a child with intense migraines was taught that if she prayed hard enough and had enough faith her pain would go away, “and if you’re not better it’s your fault for not having enough faith.”

This circular logic permeates the way mindfulness is currently being prescribed in medical settings: If it doesn’t work for you, it’s because you’re too anxious and too invested in your pain, which is in fact more evidence that you need to practice mindfulness. And we’re back to the trope of the hysterical female pain patient.

How did this all get started? Mindfulness was the brainchild of Jon Kabat-Zinn, a molecular biologist and meditator, who in 1979 decided to combine his two passions. He approached the University of Massachusetts Medical Center with what he called a mindfulness-based stress reduction program for chronic pain patients. Much to his surprise and delight, instead of being dismissed outright as a crazy hippie, the doctors at the medical center embraced him, thrilled to offload their trickiest patients onto him. Zinn’s program—a rigorous 10-week, supervised, daily meditation and yoga practice—was for patients who had failed all previous treatment, with the goal of helping to reduce the stress and suffering created by living with chronic conditions. Since that initial trial, mindfulness has become the darling of pain clinics and primary care doctors across the country. But most mindfulness interventions in medical settings bear very little resemblance to Kabat-Zinn’s expensive, supervised program, which doesn’t seem to ever be covered by insurance and is only rarely reimbursed. Today, mindfulness has become a container for a series of radically disparate practices, which makes the data about it relatively meaningless. It’s also grown, by some estimates, into a $4 billion industry and has moved from medical settings into the corporate world, the military, professional sports, and education.

Although I was informed by my pain clinic that there’s a lot of new evidence “behind these self-management strategies for chronic pain,” the scientific data is actually quite preliminary. In 2017, an international consortium of prominent neuroscientists and mindfulness researchers co-authored an article called “Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation,” arguing that scientists need to do more rigorous research before applying mindfulness and meditation in clinical settings. First, they write that the terms need to be more clearly defined—mindfulness, as we’ve seen, can range from downloading MP3s to Kabat-Zinn’s supervised gold standard. Meditation has also been known to generate intense negative psychological states, even occasionally leading to temporary psychosis and hallucinations, and is therefore specifically not recommended for certain mental health disorders. Because this consortium of researchers does believe in the power of meditation and mindfulness to alter the brain, they believe it needs to be applied carefully, systematically, and responsibly. They also remind us that scientific research is not conducted in a vacuum, and researchers and clinicians are not immune to the positive hype surrounding mindfulness at the moment, which might lead to confirmation bias within research studies and premature clinical applications. They fear that those premature clinical applications could alienate people from an otherwise potentially helpful practice and also prevent patients from receiving other more effective, first-line treatments for their particular conditions. In my experience, and that of the women I interviewed, this is already happening.

Another aspect of this situation worth unpacking is the fact that doctors are not known for their early, open-minded adoption of alternative medical practices. So why have they been so quick to embrace mindfulness? I have a few theories. The first ones are the most obvious—some people really like meditation and find it useful, insurance companies don’t need to approve it, it’s cheap, and it has few obvious downsides. But I don’t think these are the main reasons mindfulness has become so prevalent in pain clinics around the country. Instead, I think the real cause has to do with the fact that for decades, narcotics were the mainstay of chronic pain treatment. But today, amid a roiling opioid crisis, doctors are understandably increasingly reluctant to prescribe opiates to their patients (even at their patients’ own expense). And there are few other mainstream solutions, so mindfulness provides physicians with an easy out, a way for doctors to feel like they are providing their patients with some form of treatment without contributing to the addiction crisis.

But I think it goes even deeper than this very practical and perhaps even somewhat understandable reason. Mindfulness also happens to fit into a rhetoric of personal responsibility that has long infused American health care. Although ostensibly mindfulness originates in Eastern practices, Kabat-Zinn successfully reframed an Eastern practice in Western terms when he transformed meditation to mindfulness. Mindfulness fits in quite successfully with bootstrapping American values—through self-management, self-control, the right attitude, and daily practice, you can take control of your own life and illness. Of course the flip side of that logic is that if your pain is still debilitating, it’s your fault for failing to follow the protocol correctly.


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