—Thich Nhat Hanh, from the preface to Full Catastrophe Living by Jon Kabat-Zinn
Jon Kabat-Zinn got more than fifteen minutes of fame. He and his work were featured for almost an hour on the Bill Moyers PBS special “Healing and the Mind,” and Dr. Kabat-Zinn has been very busy ever since. He deserves the attention. For over ten years, Kabat-Zinn, a long-time Zen and vipassana meditator who is closely associated with the Insight Meditation Society and the Cambridge Insight Meditation Center, has been offering the healing power of Buddhist meditation to Western medical science. His dharma vehicle is the Stress Reduction and Relaxation Program at the University of Massachusetts Medical Center, where he teaches patients a series of eight-week courses based on his own training in Buddhist mindfulness meditation. The patients who are referred to his program often have chronic health problems, or else are not improving through their medical treatment, and many feel overwhelmed with fears and anxiety. A full description of the “stress reduction” program and its effect on those patients is summarized in Kabat-Zinn’s wise and popular book Full Catastrophe Living.
In the last year and a half, Kabat-Zinn has been involved in establishing similar stress reduction programs in inner-city neighborhoods and inside prisons. The important conclusion that might be drawn from all of Kabat-Zinn’s work is that, no matter what the context, when skillfully taught, mindfulness meditation can be a source of health and happiness and insight to all who practice, whether the Buddha comes along for the ride or not.
The following interview with Jon Kabat-Zinn was conducted in May of 1993, by Barbara Gates and Wes Nisker.
Inquiring Mind: With recent media attention, the work that you are doing is becoming an inspiration for people around the country and around the world who want to set up similar projects. When you founded the Stress Reduction Clinic, what were your goals?
Jon Kabat-Zinn: When I set out to do this work, it was with the intention of bringing the dharma into the mainstream world of medicine and health care. I wanted to try to create one little nucleus of a model that would demonstrate in a coherent way that, through rigorous and systematic training in mindfulness, people could build on strengths that they already had and do something for themselves that would improve their own health and well being.
IM: You’ve had remarkable results for a program in which people meditate for at most an hour a day over eight weeks. How do you account for this?
JK: The motive for coming in the first place is profound. Remember, people are not coming to learn meditation! They are not coming because they have concerns about “where I fit in the world” or about interconnectedness, or meaning. They are coming because they have cancer or heart disease or chronic pain. They are coming to relieve their suffering or to gain control in a new way. They have experienced the limits of medicine. And here we are suggesting that maybe there is something you can do for yourself that no doctor or anybody else can do for you. What they are facing is pressing and immediate, like something’s on fire. This, of course, is wonderful motivation to come to meditation practice.
The first thing that we observe over the course of eight weeks are major improvements in people’s symptoms, independent of what kind of medical problem they have. This includes not only physical symptoms, such as pain, heart palpitations, headaches, and blood pressure, but also psychological symptoms such as anxiety, depression, anger and hostility. There are dramatic changes in the majority of participants—certainly not everybody, though—over this period of time, just in terms of those kinds of symptomatic or, if you will, surface manifestations of their being.
But there are also deeper things going on that we’ve started to look at, such as how you hold the notion of “self,” issues of being a person in relationship to the world. There’s a lot of evidence that how you view the world and how you operate in it, based on your belief system, is an indicator of your risk for various kinds of illnesses further down the road. There’s evidence that mind states are, in fact, connected over a lifetime with physical disease. Particularly, people who tend to have high levels of hostility in our culture are much more susceptible to death from all causes, including cancer and heart disease.
It turns out that a lot of people in our society don’t think it’s valid to feel anger. So when someone “makes them angry,” their tendency—and their parents probably helped them a lot with this one—is to swallow it. Don’t show your feelings. Because if you show your feelings in the family, you’ll get put down more for it, maybe even be beaten. So you learn not to cry; you just hold it in. That turns out to be quite toxic in terms of physical disease. The other extreme, of course, is that you are one hell of an angry person and you go around letting it out everywhere on everybody. That turns out to be healthier than holding it in, but also pretty toxic. If you hold anger in, your risk of cancer is greater. If you let it out all over the place, your risk of heart disease is greater. And that’s just the beginning of what science is starting to look at in terms of the mind-body connection.
What we are finding in the stress reduction clinic is that people who are exposed to relatively intensive mindfulness practice, in a relatively short period of time will not only have changes in symptoms, like anger and hostility, but changes in other things that aren’t supposed to change when you are an adult, such as the personality measures known as a sense of coherence and stress hardiness. These are ways of measuring how you view yourself in relationship to the world. Our patients change in the direction of a greater expansiveness, a greater sense of meaningfulness, and of seeing the world as a challenge and as comprehensible. People who have been through the program often begin to make more of a commitment to the nitty-gritty aspects of daily life, and become more comfortable with change. They begin to see change as more of an opportunity than a threat. These are profound changes which are occurring in a short period of time. And the interesting thing is, we’ve now done a number of follow-up studies that show three years later that those changes are maintained in the majority of people. And at least half of the people are still practicing on a regular basis, formally, for at least fifteen minutes per day, three times a week.
IM: Amazing! It would be interesting to find out how many people who come out of the spiritually oriented Buddhist meditation retreats are still practicing. And that raises the question, do you think there is a difference between teaching mindfulness as you do and teaching dharma?
JK: I believe that on the deepest level we are teaching dharma. But obviously we don’t frame it that way. We try to stay as far away from all of the trappings of Buddhism as possible. Because in our setting it’s not effective to deliver meditation in that way. Not that we attempt to hide the source. What we’re really trying to do is to create an American Dharma, an American Zen. I’m not exactly sure what that means. It’s as though all of us who are involved in the practice are in some way or other experimenting in our own lives to discover what the essence of our commitment to meditation and a life of mindfulness is, and how it best translates into our culture. It feels like one big unfolding dance that we are all participating in.
IM: Since he first taught courses in this country, Thich Nhat Hanh has been urging American dharma students to discover an American Buddhism. Maybe your work is part of that new vehicle.
JK: Well, my Zen training was certainly helpful to me in that regard. I felt a certain irreverent emphasis in Zen gave me permission not to get trapped in the forms, and not to go overboard on the guru-devotional route. Koans like “If you meet the Buddha in the road, kill him” suggest that the essence of the practice has to be lived, and has to be continually regenerated and recreated. Yesterday’s answer, or last moment’s answer, won’t suffice for this moment. The essence of clear mind has to be appropriately generated and embodied in each moment, each unique situation. If you are interested in helping people wake up, you use the traditional forms only insofar as they help get the message across.
IM: So, give us an example of how you translate the fundamental Buddhist teachings to people who aren’t particularly interested in Buddhism. Clearly, you talk about the First Noble Truth. How do you talk about it?
JK: When I use the term “the full catastrophe” to describe what many people are facing in their lives, that’s one way of formulating the theme of dukkha. Dukkha almost completely transposes with our word stress. In fact, in his writings Ajahn Maha Bua of Thailand uses the word stress directly for dukkha. One of the interesting things about stress is that it is non-specific: Everything is stressful; “bad” things are stressful and “good” things are stressful too. Getting married is stressful; getting divorced is stressful. Getting burned is stressful; getting chilled is stressful. We call what we do at the hospital “stress reduction” simply because it’s a gigantic umbrella under which you can hold all of human experience, the human condition itself, and begin to approach it, work with it systematically—through the cultivation of mindfulness.
IM: So how do you talk to people about stress?
JK: We emphasize that it’s not the stress per se that is the problem. What is important is how you hold it, how you position yourself with it, how you respond to it. Like dukkha, it is a perceivable fact if you look deeply into experience. But then, the question is, “Now what? How do I handle it?” The other Noble Truths go on to assert that there is a way to understand this dukkha and to work it, and that Way will take you through it and out beyond it. And that’s what we are basically offering people in the Stress Reduction Clinic—the invitation to experiment with the possibility that there may be things that you can do for yourself, that no one else can do for you, that can free you from some of the biggest prisons that you create for yourself or that your body can lock you into. That doesn’t mean that you are going to meditate your tumor away, or that you will live forever, or that you won’t yell at your teenager. But it means that you will hold your experience in a way that will be somehow wiser and freer.
Now, I want you to know that I don’t really see what we are doing as just stress reduction or stress “management.” We just call it stress reduction. There is a big difference. I really see it as dharma, as I said before. I am completely open to the possibility that this might be a major delusion. Maybe we’re watering down the true dharma and trying to justify that to ourselves. I actually ask myself that every day, and I don’t believe that’s the case.
IM: So, do you attempt to talk to the people in your program about the Buddhist concept of “no self”?
JK: No, I don’t go anywhere near the traditional Buddhist formulation of it, because people just don’t understand it, and it can actually generate an enormous amount of unnecessary fear. But when people say, “I really can’t stand this pain,” I say, “Who is it that’s saying that?” Or I’ll say, “When you say ‘I’, how many different ‘I’s are in there?” Then I might jokingly say, “Well, maybe there’s a whole platoon in there! One ‘I’ may want to go to the movies, but another ‘I’ doesn’t want to go to the movies. One ‘I’ feels one way about something, but then another ‘I’ doesn’t feel that way at all.” In this way we try to get at the notion that, in fact, none of us has all the answers about who we are. And that realization can give people a lot of space. It can be a very liberating experience for people to get to a point where they actually see for themselves—by watching their thoughts—that ‘I’ am not my thoughts, that ‘I’ is just another thought. Approaching no-self in that way doesn’t smack of Buddhism at all. It doesn’t have anything to do with any ideology or philosophy. It’s just an observable fact.
IM: As I listen to you, I wonder about the sacred context of the practice. Are you suggesting that it’s not necessary?
JK: Not at all. It is more a matter of what is skillful means and also how big you are willing to let the sacred get without getting attached to particular forms. For me, all moments of silence are sacred space. The breath is sacred, the body is sacred. About Buddhism itself, I’d say, we wouldn’t even be having this conversation if the sacred context didn’t exist. The more traditional spiritual context of Buddhism is what got us interested twenty-five years ago or so. Many of us, including Allen Ginsberg and Gary Snyder and you and I, and a lot more people we know and love, became engaged in meditation and in dharma because it came through to us in that way.
IM: But I think we entered it with more of a desire for a romantic or mystical experience….
JK: Exactly. Seeking enlightenment of some kind or other.
IM: What you do attracts people in a different way to a path that just might lead them in the same direction.
JK: Absolutely. That is my conviction, anyway, and the whole point of our work. There are many different ways to connect up to what is deepest in oneself; but, ultimately, they all come down to mindfulness. My feeling is that there is a way to take perhaps 80% of what might be valuable in the traditional Buddhist teachings and articulate it in such a way that people won’t be repelled by it. Why not then use it? There are things that I’ve learned on the cushion, that I think anybody could use—my parents, for instance, and my children. But they’re not necessarily going to go out looking for enlightenment. I really believe that mindfulness practice is universal. We need to develop new ways to allow it to express itself. And then to trust that, if it’s as powerful as we all believe it to be, and perhaps have tasted it to be in some small way, then the power of it is not coming from us in the first place. So that power will express itself through anyone walking on the face of the earth, given the right conditions. And we can sometimes influence those conditions favorably.
IM: Meditation is a technology that’s been highly refined over the course of 2,500 years. There’s almost nothing else like it on the planet. Prayer may serve that purpose for some people, but meditation is probably more accessible and acceptable to people in our culture.
JK: Partly it is because it doesn’t require a divinity. There is also an injunction not to become attached to authority. And to me, those things are absolutely essential if you are going to be encouraging other people to be “lights unto themselves.”
IM: And that’s what must be the most powerful draw of your program. People are realizing that they can do just that. Since your recent attention in the media, you must be hearing from a lot of people who never would have considered meditation before. How are you dealing with this whirlwind of interest?
JK: Most of the calls we are getting are from people who saw the Moyers program and related to the patients who were in it. They said, “That’s me.” And they called up. In response, we set up a phone bank with six open lines, and we had it staffed by our former patients and interns eight hours a day for three weeks. We got over 1,000 calls in that time. Our people just sat there and talked to callers from all over the country and Canada who were in pain themselves, who had cancer or who had heart disease and were touched by what they saw. The callers wanted to know: How do I connect up to this? How do I do this? They were asking people who had been through our program, people who practiced, people who could tell them, “I have cancer too. I know what you’re talking about.” So, that was very beautiful. Two-thirds of those calls were from people who were suffering from various kinds of physical and emotional stress. The other third were from health professionals, doctors, psychologists, nurses, saying, “I have got to learn this thing tomorrow. I want to do this with my patients. I want to change the way I work.”
IM: Have you been pleased by the results of the publicity or has it created difficulties for your ongoing work?
JK: It’s a mix of the two. For years we had a wonderful time doing our mindful little work. It really felt like “small is beautiful.” And no one seemed to know or care what we were doing. Now, with all the publicity, everybody seems interested all of a sudden. Some of this is just the usual short-lived hype, but a lot of it is very deep and genuine. So I want to try to be as responsive as possible to people’s desire to learn what mindfulness is, because our original aim was to try to bring mindfulness into the mainstream of society. So I can’t very well complain when that starts to happen. The challenge for those of us who work in the clinic is to take it on, but to deal with it in a way that fosters our own growth and the deepening of our own practice. And that’s what I’m in the middle of doing personally. It’s a lot like riding a wild bull.
Somehow, when people see it on television, they “get it” in a way that they just didn’t get it before, even if they already knew about the clinic. So there is an element of excitement and enthusiasm that may be somewhat superficial. People immediately want to “do it,” put it in place, make it happen—without realizing that there is a whole foundation that needs to be dug up and laid down. The whole idea of meditation is not to rush into things, and not to speed around doing the next wonderful thing your mind comes up with, but to live a more conscious life. The biggest danger in all the publicity is that people will make meditation into just one more trip and miss the essence of it completely. And in the process of making it into some kind of trip, they’ll actually denature it. In our professional trainings we want to work most with health professionals who are already deeply into the practice. A lot of people want to rush in and start teaching mindfulness out of enthusiasm, but not from the depth of their own inner being and practice.
IM: What gets lost?
JK: Just everything. The wisdom, the compassion, the appreciation for silence and stillness and non-doing get lost in the energy, the agitation and the excitement of something “new.” Americans would love it, of course, if we could just give it out in a pill form. “Hey, I don’t want to meditate for forty-five minutes a day. Just give me a pill I can take once a day. A mindfulness pill.”
IM: What a challenge to distill Buddhist practice and bring it to a broad public—without losing the essence!
JK: When I was with the Dalai Lama for the Mind & Life 3 conference in Dharmsala, one of the participants attacked what he was calling “the secularization of the dharma” through the kind of work that I do. He was basically saying that we were taking some half-baked, reduced version of Buddhism and putting it out there as the total thing. He argued that such occurrences contribute to the decline of religion by secularizing it so that its sacred power is lost. I thought to myself, “If that were true, I would quit tomorrow.”
At one point, the question got put directly to His Holiness, “Is it wrong action to teach Buddhism without the Buddhism, so to speak? In places like hospitals and schools and prisons where it’s obvious that people don’t want to become Buddhists and equally obvious that people are suffering tremendously?”
His Holiness responded that there are four billion people on the planet, and only one billion of them are Buddhists. He queried, does that mean that we should ignore the suffering of the other three billion? To me he was saying that if we know anything, what we know has to be universal enough to embrace everybody on the planet.
IM: Recently you have been branching out into the inner city and the prisons where there is indeed incredible suffering. What led to these programs?
JK: We work in a big modern university medical center which is very much middle class and white. That’s not to say that there aren’t people of color that come through and that there aren’t people on welfare and Medicaid. But the majority of the population in our clinic, and about whom we’ve published our studies, is white working class and middle class. Now, I’m acutely aware that the Buddha taught people independent of social caste. Many who followed him to the forest were people without education or material wealth. And the dharma was profoundly valuable in their lives, and not just in the lives of the aristocrats and the well-educated. It seemed to me that it was important to try to demonstrate, from the point of view of health care and medicine as much as from the point of view of dharma, that mindfulness practice really is universal. In terms of stress reduction, why not go to the people who are experiencing the highest degrees of psychosocial stress in their lives, namely living on the economic edge in multiethnic, multicultural situations on the street or in the prisons? I wanted to find out if we could teach mindfulness to these people in a way that would speak to them, so that they might be drawn to practice and perhaps find benefit from it.
I believe in my heart that, if you have a mind and you have a body, meditation is relevant. For the most part, we’ve found in our prison and inner city programs that, under the right umbrella, framed in the right way, and integrated into the community in the right way, people take to mindfulness practice like ducks to water.
IM: In your inner city program, how would your describe the community?
JK: It’s the South Main Street community of Worcester, Massachusetts, which is maybe 40%–50% Hispanic, 40% poor white, and 10% black. There is a growing Southeast Asian population. And there are a lot of drugs on the street. We’re working with people across the age range. In fact, we are seeing a lot of elderly Hispanic women as well as younger people.
IM: And how do you connect up with participants?
JK: We set a program up through the community health center, Family Health and Social Services, which has been in the neighborhood for twenty years or more. I proposed to them that we develop a joint project, a stress reduction clinic in the inner city. Their doctors and nurses and social workers—who have been in that community for a long time—would refer people to the clinic.
We got a two year grant from the Nathan Cummings Foundation in New York to test our idea. Thanks to the grant, we have been able to offer the program free of charge. And we provide free on-site mindful day care in both Spanish and English so that while the parents are in the class, their babies are held and their kids are cared for in a way that really honors who they are as beings. Then we provide free door-to-door taxi transportation. So there are fewer excuses than usual for not coming.
But it’s still hard to get people to come in the beginning. We invite sixty people to come to a focus meeting. Maybe twenty-five people show up. And those twenty-five people who show up get a presentation of what the program is about, and time to ask questions and discuss their participation. We start the eight-week series of regular classes the next week. Usually, twenty to twenty-two will show up for that first class. After that, we have a dropout rate between the beginning and end of 50% or less. For that community, this is a fantastic positive response.
Our grant is ending in December, but we’re trying to keep the program alive. Presently we have a number of community leaders who have enrolled to see what it’s about. We want to integrate as much as we can into the community so that it’s not just known to the health center but to all the social service agencies in the area.
IM: What about the prison program?
JK: It turns out that in Massachusetts there are some forward-looking people in the prison and criminal justice system who really appreciate mindfulness. And they found us. Now we’ve developed a very good working relationship. We’re introducing classes in a whole range of medium- and minimum-security prisons in Massachusetts. And it’s happening. George Mumford has been at it for two and a half years, and we got major funding to expand his work as of last January.
I taught in Norfolk prison for eight weeks this past winter and it was one of the most amazing experiences of my life—meditating with my eyes closed on the floor with thirty guys, many of whom are in there for doing things you wouldn’t even want to put into words. But there was a sense of energy in the room that was really wonderful. They were ready to work. We sat long and hard. We did a lot of yoga. Half the men didn’t understand English, but someone always volunteered to do simultaneous translating into Spanish. It felt like giving food to starving people. These people have probably never had a good educational experience in their lives, one that really excited them. Now they are having it and having it around the deepest questions about what it means to be a person. And what it means to come back from having done things about which you might have deep regret and for which you are paying a very heavy price.
IM: Tell one anecdote from that Norfolk class.
JK: Sometimes in meditation practice I like to give a Zen shout in the middle of a sitting. To wake people up. It intuitively comes up when the time is right to do it. But I didn’t feel that I should shout in prison without warning, because you might have guards with guns come down on you in no time. I was in the classroom alone with the inmates, although there were TV monitors. So I told the class, “Sometime during the next half hour of this sitting, I’m going to shout.” Ten minutes later, I went around correcting peoples’ posture. I hadn’t shouted yet. One African American inmate who had put out some serious resistance to the class since the beginning was sitting there shaking. I whispered to him, asking what was going on. He whispered back, “I can’t take this. I’m a nervous wreck.” I said, “Why?” He said, “I’m just waitin’ for the shout.” I said, “Listen, don’t worry about the shout. You just stay with your breathing. Whenever the shout comes, the shout comes.”
I did shout, finally, and later it opened up an unbelievable discussion. All these big guys who had done heavy-duty things to wind up in prison were saying things like, “People have been shouting at me my entire life. I can’t stand it.” Many talked about how traumatic their arrest experiences were, and how violent. I never thought all that would come out of one shout. The shout was just to give them sense that if you jump, it’s because you’re not really right there. But these guys were jumping a half hour before I even gave the shout. It turned out to be a wonderful way to tap into the underlying feelings that these men carry all the time, feelings that have never been appreciated, never even heard by themselves or others. It was beautiful.
Teaching in prison is great training for meditation teachers. You can’t go in there and bullshit. If you do, you are dead. Maybe not literally, but the word goes out in the yard so fast that you just can’t operate. It doesn’t work to be a tough guy either. No dissimulation is possible.
IM: So after the hospitals, the inner city and the prisons, where do you go from here? What is your vision for where mindfulness might be taught next?
JK: I can tell you one story about taking mindfulness to the public schools.
I’ve been going to Salt Lake City for the past three or four years—since my book came out—because the largest hospital in Utah set up a stress reduction clinic modeled on ours. I’ve been going out there, meeting with their patients and with the hospital staff, then doing two day and three day public workshops on mindfulness. A year ago at a workshop, a fifth grade public school teacher came up to me and said, “I really want to bring this into the classroom.” And I said, “I don’t think that’s such a wise idea. This is Mormon country. People have strong misconceptions about what meditation is. And if they hear you are doing meditation with their children in a public school, it could create a lot of problems.”
But she didn’t listen to me. She went ahead and did it under the umbrella of stress reduction and mindfulness. When I was out there last, she had been teaching mindfulness for about five months. She asked the kids to write about “what mindfulness and stress reduction have done for me.” And the kids wrote things like: “Now when kids tease me I realize that just because their mind is waving, my mind doesn’t have to wave,” or “Now I find I’m coming more from my heart than from my head,” or “I’m less sarcastic.” The kids weren’t just writing down things the teacher had written on the black board. What they wrote was heartfelt, not just one or two sentences, but several pages. I read all thirty of them. She selected the five “best,” and those kids got to attend a two-day meditation retreat I was leading. There were five hundred adults and five eleven-year-olds and their teacher. They sat in the front row. And they really sat . . . for two days. It was amazing! That teacher’s passion, her energy for it, figured out a way to make this happen. Nobody else’s advice was really necessary, and certainly not mine!
IM: That sums it up in a story and answers the question about where we are going. Who knows? Somebody with that kind of passion could take the dharma into any of life’s arenas.
JK: That’s right. All that we’ve been doing in the Stress Reduction Clinic is demonstrating that, in one place, it’s possible to do this kind of work in one particular way. It’s not the only way. There is no one right way. We’re basically saying to people who have been sitting for years and want to bring their practice more into the mainstream world: Trust more in yourself, take a few more risks, and see what your intuition says about how mindfulness and this kind of approach might make a difference in your world, wherever you are.