In recent years there has been a lot of discussion about the use of Buddhist-inspired meditation for dealing with mental health issues. In my experience, meditation can be helpful at times, but not when I am in the middle of a severe episode of anxiety or depression. Research corroborates this, and studies have found that it’s not necessarily mindfulness that we need when we are really struggling.
A while ago I was chatting with a good friend about the benefits of mindfulness practice for mental health. He has struggled with depression and anxiety to varying degrees for at least twenty years, and I have suffered the symptoms of OCD (on and off) for around 15. We talked about how, in Buddhist meditation, we learn to let our thoughts ‘just be’, whilst neither engaging with nor repressing them. Gradually we learn to let them drift by like leaves on a stream or clouds in the sky. The principle behind this is that thinking is something completely natural and inevitable: trying to stop your mind from having thoughts is a bit like trying to stop your heart beating or your lungs breathing. Yet we no longer have to get caught up in our thoughts. We can free ourselves from the ‘trance of thinking’ and see more clearly how things actually are, staying in the present, moment by moment. My friend recommended a Buddhist meditation book to me called ‘Thoughts are not the Enemy’ and I started thinking about the problems with meditation practice when you’re dealing with OCD.
Now, I fully agree with the premise that we are not our thoughts, and that, ultimately, we do have an element of choice about whether we believe them or not. But to say this to someone in the throes of severe OCD (or any other mental health disorder, for that matter) is pointless. When your brain is telling you repeatedly that you’re an evil psychopath who wants to murder people, or that you are actually a closet paedophile in denial, sitting quietly on a cushion doesn’t really cut it. The front line treatment for OCD is a type of cognitive behavioural therapy called exposure and response prevention (ERP) which involves repeated exposure to a sufferer’s core fears. This might involve giving the person a kitchen knife and asking her to sleep with it beside her bed, or telling the young man terrified that he’s a sick pervert to hang out in the kids’ play area in the park. Treatment usually takes between three and twelve months before a patient becomes ‘habituated’ to their scary thoughts and realises they are not a genuine threat. The OCD sufferer was never going to hurt or abuse anyone; it was all just fear caught on loop like a broken record. Anyway, the point here is that the end goal is the same: to develop the ability to take our thoughts less seriously, but the path to that insight is necessarily different depending on your starting point.
Another problem with prescribing meditation to people dealing with serious mental health episodes is the potential for misinterpretation of various elements of Buddhist thought that tend to be taught alongside the practice of mindfulness. For example the idea that we alone are responsible for our mental and emotional wellbeing, and that nobody and nothing outside of us can make us happy. This may be true on some level, but when you’re at rock bottom with OCD or depression, it’s likely that you are already isolating yourself and telling yourself that you’re not good enough, too needy, a burden, and so on. When we are suffering deeply often what we need most is a safe place to be, someone to bring us cups of tea and blankets, evidence-based psychological interventions and an appointment with a psychiatrist. Buddhist teachings don’t emphasise this. And why should they, given that they first appeared two and a half thousand years ago and were never intended to be a set of mental health recovery tools? Yet the way they are presented is vague and alluring enough to attract lots of people who are in pathological states of emotional and/or mental pain. In my view, this is at best unhelpful and at worst potentially damaging.
One of the problems that materialised for me when trying to meditate during my most intense OCD episodes was that I ended up inadvertently using mindfulness as a compulsion of sorts. The meditation instruction to ‘just observe the thought. Don’t cling to it. Let it go’ is about as much use as a chocolate teapot when your brain is in a state of crisis. So I’d try to count my breaths, or focus on different parts of my body, or do metta (loving-kindness) meditations. These practices would distract me for a while and I’d be temporarily reassured that I could eliminate my intrusive thoughts. So I forced myself to meditate each day, determined that I would get rid of my obsession. None of this was mindful, or kind, or focused in the present moment, but it was all I could manage.
Jon-Kabat Zinn and his colleagues, who developed the 8-week MBSR (Mindfulness Based Stress Reduction) course for treatment of recurring depressive episodes, say that it’s probably not going to be productive to try and meditate when you’re currently experiencing clinical depression. The practices suggested in MBSR are most effective when you’re not ill, and though they can be helpful in warding off potential downturns in one’s mental state, they are specifically not recommended for anyone in the midst of a depressive episode.
My point is that meditation is not a cure-all, and should actually be avoided in certain circumstances. Indeed, the thing that profoundly changed my experience of OCD and my relationship to my thoughts was (and still is) ERP, the only real evidence-based psychotherapeutic treatment for my disorder, along with a hefty dose of sertraline. I still practise meditation semi-regularly, but as an adjunct to the other things, and not as a front-line tool when I am in an anxious OCD-induced mess.