Medicalization and Mindfulness

Editor's note: This article is reprinted with permission from Health Insights Today, an electronic publication of Cleveland Chiropractic College.

The past several years have seen a veritable explosion of research on mindfulness. Research abstracts we've published in each issue of Health Insights Today under the heading "Mind-Body News" have increasingly reported on studies about mindfulness interventions. These are utilized to help everything from depression to quitting smoking; from posttraumatic stress disorder to insomnia; from decreasing opioid use in people with chronic pain to increasing telomerase activity (a measure of biological aging); and from anxiety to stroke recovery to attentional task performance among jailed youth.

What Is Mindfulness?

According to the Psychology Today website, mindfulness is "a state of active, open attention on the present. When you're mindful, you observe your thoughts and feelings from a distance, without judging them good or bad. Instead of letting your life pass you by, mindfulness means living in the moment and awakening to experience." Applied on a day-to-day basis, this often includes a daily practice of entering a quiet meditative state where one practices mindfulness, an approach utilized for chronic pain patients by Jon Kabat-Zinn, PhD, at the University of Massachusetts Medical School and popularized in his best-selling books, Full Catastrophe Living (whose title comes from the film, "Zorba the Greek") and Wherever You Go, There You Are. It also involves using the state of mindfulness throughout the day (eyes open, during normal activities) to manage stress and enhance awareness.

Mindfulness has been shown in numerous studies to improve many aspects of health. Moreover, it is essentially a self-care method that need not involve dependence on a doctor or practitioner. So, why would anyone have a problem with this?

According to a provocative article by Kristin Barker, PhD, of the University of New Mexico, the fast-growing mindfulness movement is contributing to the medicalization of life. Drawing from the seminal work of Ivan Illich, perhaps the greatest rebel philosopher of the 20th century, whose books included Medical Nemesis: The Expropriation of Health, Deschooling Society and Tools for Conviviality, Barker laments that "Western societies continue to frame ever more personal and social problems as medical in nature."

What Is Medicalization?

According to Barker, medicalization occurs when we define a problem in medical terms, usually as an illness or disorder, or use a medical intervention to treat it. Significantly, the term medical as used by Barker includes not only conventional medicine, but also the full range of complementary and alternative health care approaches. She adds, "We have also witnessed the medicalization of risk, where the problem being medicalized is not a disease, per se, but a heightened potential for a disorder." She continues, quoting Irving Zola, that there is increasingly a "belief in the omnipresence of disorder," which, coupled with the "impossible" goal of optimal wellness, is indicative of a trend that profoundly disempowers the average person who falls under its spell.

Who Is Responsible?

Among her chief concerns is that, aside from leading us to define the typical problems of life as risk factors, dysfunctions, or diseases, she believes that the mindfulness movement, with Kabat-Zinn as its chief proponent, may be pushing people to blame themselves for their own illnesses.

"It has been duly noted that the flip side of emphasizing personal responsibility for well-being is a tendency to blame individuals for becoming sick." She notes that while Kabat-Zinn occasionally warns against blaming the victim in this way, this is presented "in tandem with a long litany of research findings and anecdotes that accentuate a causal relationship between negative attitudes and poor health outcomes, and positive attitudes and good health outcomes."

Barker doesn't dispute that taking increased responsibility for one's health can be a good thing. But she says that the extended reach of the mindfulness model into all aspects of our lives "represents an ambitious form of medicalization by promoting a therapeutic transformation in one's very being. Individuals must manage, monitor, and regulate their physical, mental, and spiritual well-being as part of an enveloping lifestyle, thereby turning health into an ambitious and ongoing moral obligation."

Why Should This Matter to Health Professionals?

Barker's article is a frontal assault on a principle many of us take to be fundamental – that concern with our health should occupy a position at the front and center of our lives. As health professions students and later as doctors, we've spent years with health (our own and that of our patients) as a consuming interest and passion. We work with it day in and day out. Barker certainly isn't saying that health doesn't matter, but she raises a point worth considering – that health can become an obsession, overriding other parts of our lives that may deserve equal or even greater emphasis.

When I read Ivan Illich's books years ago, I was struck by the way he saw the same things others had seen, but thought about them in new ways. For example, in Medical Nemesis, he was among the earliest to decry the medicalization of suffering and death. He wasn't just doing this from his perspective as a priest and a philosopher; he was also taking social science to deeper level. Reading his books profoundly enriched my worldview.

I believe Kristin Barker's article on mindfulness also asks us to look more deeply at the less visible implications of our thoughts and actions. We don't have to accept all her points to benefit from the conversations they have the potential to stimulate. For example, I certainly don't accept her implication that pointing out the potentially damaging effects of the mind on the body is always synonymous with blaming the victim.

But the questions she raises remain. Are we subtly or overtly encouraging our patients to prioritize health above all other aspects of life? Are we allowing our single-minded professional focus on health to spill over into a way of relating to patients that glorifies an obsession with health?

For example, if we have a patient who selflessly devotes her or his life to serving others, but whose health suffers from a resultant inattention, do we see this as a moral failing on their part? Do we try to guilt them or shame them into lifestyle changes? And is there a better way to achieve the same goal? It may be that asking ourselves these questions is of great importance.