56
ALTERNATIVE THERAriES. MAY/|UNE 2005, VOL, II, NO. 3
Conver'iations with [on Kahat-Zinn, i'hi
CONVERSATIONS
JON KABAT-ZINN, PHD
BRINGING MINDFULNESS TO MEDICINE
Interview by Karolyn A. Gazella • Pliotograpliy by MilliceiU Harvey
Jon Kabal-Zinn. I'hn. is Professor of Medicine Enwrilus al ihe
University of Massachusetts Medical School. Worcester. Mass,
where he was the founding executive director ol the Center lor
Mindfuhiess in Medicine, Health Care, and Society. He is the Jormer Director of the Center's world-renowned Stress Reduction
Clinic. Under his direction, the Center lor Mindjtilncss conducUd
mindfulness-based stress-reduction (MBSR) courses in the inner
citv and the Massachusetts state prison system. Today, more than
200 centers und clinics use the MBSR model, including 17 in the
Kaiser-Pernianente ,^'steni in northern Calijornia. Dr. Kahat-Zinn
reeeived his PhD in molecular biology from the Massaehitsetts
Institute of Technology (MIT). Cambridge. From 1979 to 2002. his
research foeused on the elinieal applieations of mindfulness meditation training for people with chronic pain and stress-related disorders. He is a founding fellow of the Feizer Institute, a Fellow of the
Society of Behavioral Medicine, and a niemher of the Board of the
Mind and Life Institute, a group that organizes dialogues hetween
the Dalai Lama and Western scientists to promote a deeper understanding of different ways to know and prohe the nature of mind,
emotions, and reality. Dr. Kahat-Zinn is a .sought-after lecturer and
an accomplished author. His latest hook. Come to Our Senses:
Healing Ourselves and the World Throngh Mindfulness. was
released in January 2005.
class, hard-core, data-driven scientist. He was a molecular
immunologist at Columbia University Medical School. My
mother was a prolific painter, but she never showed her work.
My father got a huge amount of recognition for his groundbreaking work in ininumology. and my mother never got any
recognition for her paintings outside the family and a small circle of friends. But she was an extraordinary painter and loved
art and music. She would take me to tbe Museum of Modern
Art and the Metropolitan Museum of Art almost every weekend io look at paintings. When 1 was very young, three to five
years old. I even attended art school at the Museum of Modern
Art. I don"t recall being particiihirly enamored with art as a
young child. I think I used up all of my artistic talent in one
clay elephant that I made when 1 uas five years oid. and never
went anywhere after that.
Aiternative Therapies (AT): Was there a series of events or crossroads that led you to take your particular professional path?
I think living and growing up in that kind ofa household,
what CR Snow, the British author and physicist, referred to in the
19.S0S as "the two cultures." influenced me greatly. There is the culture of the humanities and the culture of the sciences. They speak
different languages and have different perceptual frameworks for
understanding reality, but neither is complete without the other.
In fact, there are many more cultures than just those two. There
are all sorts of different wa)'s of knowing the world. And it's not
just the outside world that is important, but the inside world as
well. That, of course, didn't get as much credence in my family or
in my scientific training. 1 think growing up in a faniih' like that
gave me a profound love of learning and a profound love of seeing,
of appreciating the beauty in the light shimmering off ofa pond or
the many different colors in one flower.
Jon Kabat-Zinn, PhD: This is a wonderful line of inquiry. What
are the factors that determine how a person's life unfolds? It's
very hard to put my finger on i t ^ t o say, "yes. it happened
then." In retrospect, however, there are antecedents that were
instrumental in nudging me along a specific path, one of which
is that 1 grew up in a family in which my father was a world-
Another element that caused me to choose my professional path is a love for science and for the importance, in my
mind, of trying to understand the nature of nature, the nature
of reality, and the nature of ourselves as human heings. That's
uhat biology is all about—the study of life and living .systems.
The subtext is, what can we learn by studying other organisms
that might influence how we know ourselves and how we can
Jon KabatZinn, PhD, .shown here outside his home in
Mass. works to bring mindfulness into the mainstream ofmedicine.
plume, (7<iO) (i.U-.mil or (1166) S2S-2%2:fax. (7601 633-3918: e-mud. uliernolive.thmipies^)
innerdotmniv.nm.
Recently. Alternative Therapies in Health and
Medicine interviewed Dr. Kahat-Zinn in San Diego, following a
presentation at the Scripps Centerfor Integrative Medieine.
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ALTERNATIVE THERAPIES. MAY/|UNt 2005. VOf. H. NO. 3
^2024:
57
cure a disease? At the same time, I was very intrigued by the
question of consciousness. Since consciousness conies out of
biology, the question is, what is the relationship of consciousness to biology? What influence do our thoughts and emotions
have, and how does all of this activity happen in the complex
nervous system, which includes perhaps 10 trillion neurons
and countless other cells?
Another turning point came when I was 15 years old and
my father took me to Europe on one of his sabbaticals. 1 attended a French high school in Paris. It turned ouf to be one of the
top three Lycees in the country. It was a real powerhouse, the
quintessence of the French educational system. And I didn't
know any French. I had gone to Stuyvesant High School in New
York City and got 100 (a perfect score) on the New York State
Regent's exam in lOth-grade geometry. Then I went to 11th
grade at the Lycee Henri IV in Paris and was shocked to learn
that I was five years behind in geometry and preffy much every
other subject, including Fnglish. It took me three months to
learn French, and it opened my mind. A different culture has an
entirely different way of looking at the world. There is a huge
amount of overlap, but when you think in French, you think different thoughts to some degree than you think in English. For
example. French has one-fifth the number of words that English
does. In fact, there is no French word for mindfulness. You have
to use five or six words just to say "mindfulness."
All of these things made an impression on me when 1 was
growing up. My idea was to become a basic scientist, a molecular hiologist. and just push fhe frontiers of understanding the
nature of living systems. But 1 was interested in the subtext of
the nervous system—in how we generate consciousness, how
we see. how we hear, and how we know. While I was studying
molecular biology at Mff. my horizons began to expand even
more. After all, it was Cambridge in tbe mid-19(i0s. It was a
period of amazing growth, social inquiry, :md discovery. You
could get an incredible education just hy going to seminars at
MIT and Harvard. You hardly had to be enrolled in school:
you could just attend all of these different seminars. Plus, it
was a time when every swami, guru, and meditation teacher
was coming to Cambridge, peddling their wares, so fo speak,
"t'ou could get an incredible parallel education by seeing what
all of these people froiTi other cultures had to say about the
power of the mind.
Philip Kapieau. author of The Three Pillars ol Zen. came to
MIT at the invitation of Houston Smith. I was walking down
the corridor at MIT one day. depressed because of the Vietnam
War. things not going well in the lab, and all sorts of other
things, and I saw a sign on the u all saying, "The 'Fhree Pillars of
Zen," a talk by Philip Kapieau. at the invitation of Houston
Smith. I had no idea what Zen was. I had no idea who Philip
Kapieau was. I had no idea who Houston Smith was. for that
mafter. But I went to that talk. Why, I can't really say.
Something told me there would be something interesting
tbere. and it bad to do with the nature of consciousness. At the
tinte, I did know that Zen was a form of meditation that came
58
out of the East. But on that particular afternoon. I didn'f want
to go back to the lab so 1 went to the talk. Very few people
attended the talk, maybe four or five out of all of MIT. Kapieau
just blew the top off my head. I had never heard anybody talk
like that. He told his personal story about being a reporter at the
Nuremberg War Trials and how, afterwards, he wound up sitting
in some freezing cold monastery in tbe middle of winter in
northern Japan, and after six months his ulcers went away. He
began to feel like a human being fbr the flrst time in his life. So.
I'm (aking this all in and it's quite amazing. He explained that if's
about paying attention to your own inner experience hy quieting
the mind, by investigating the mind through direct first-person
experience. Of course, from the outside it just looks insane, you
are just sitting there doing nothing. But if turns out that just sitting tbere doing nothing may be tbe hardest work in the world.
and it may be its own form of laboratory investigation.
The laboratory of your own life may be at least as valid to
look at as the laboratory of other people's brains or nervous
systems, or as designing experiments in the lah to test one
thing or another, which is a third-person orientation. But the
first-person orientation is, "Who am I?" Why not bring scientific rigor to tbat kind of inquiry? Wh}' not use all the instruments at our disposal—our multiple senses? I would say there
are more than five of them—including the capacity to refme
awareness. Perhaps we can then find a way to come to some
kind of greater integrity' and balance in our lives. So it's not just
about accomplishing great things and pushing back the frontiers of science, but also living your own life with a degree of
balance and well-being that might influence not only physical
health, but also mental and spiritual health.
So these were all threads that got woven into a tapestry
that looks like it is the story of Jon Kabat-Zinn. But there are
many different threads in anyone's story, and many different
ways we might tell our stories, so it is hard to put your finger
on what is behind all tbe narratives, something deeper and perhaps truer. Although it may be important in some respects to
share one's story with the world in some way, what's more
important is living your life as if it really matters. The underlying message in the work of the past 25 years in the stress-reduction clinic and the Center for Mindfulness is that it is not about
the story of the personal pronoun, of "I" and "me." but about a
deeper knowing tbat we are capable of. that comes out of
silence, stillness, clear seeing, and embodied wakefulness, a
knowing ihat doesn't take the vagaries of life so personally.
AT: What is the emphasis of your work right now?
Dr. Kabat-Zinn: I view this work of "coming to our senses," the
title of my latesf book, as being very real in our own lives and
minds. It is a core element at the heart of healing. Eor that to
happen, we have to cultivate intimacy with aspects of our being
that we don't even know are possible, one of which is stillness—being silenf and dropping underneath onr stories and
underneath and in between our thoughts, and again, not tak-
ALTERNATIVG THERAPIbS. MAY/|UNE 2005, VOL 11. NO. 3
CnnversaliLiiis vxith Ion Kabat-Zinn. PhD
ing them personally or as the truth of things when they are only
opinions and interpretations. We bave the innate capacity for a
more accurate seeing, for learning, growing, healing, and transformation across our entire life span. \bu are the authority and
the author of your own life. If you are always paying attention to
other people's lives rather than your own, you are missing not
only the point, you are missing your life. The challenge is to live
your life as if it really matters. And to be conscious of how you
conduct your life—from what you eat and drink to the newspapers you read and the television programs you watch, to how
you are in relationship
with everything, with
those you love, with
nature, with your body,
with the world.
some people have been investigating this subject in different ways.
A leader in the fleld is the late Francisco Varela, Co-Founder of
the Mind and Life Institute, a group that conducts periodic dialogues between Western scientists and the Dali Lama and other
contemplativeson tbe nature of reality, mind, life, and so forth.
Francisco emphasized the key importance of mindfulness or
mindful awareness within tbe discipline he called neuro-phenomenology, within fhe framework of cognitive neuroscience.
From fhe start, the nature of first-person experience and the
nature of awareness has been at the heart of these conversations—including the public
meeting we held at MIT in
2003, called "Investigating
the Mind." We are going to
be holding another public
dialogue in Washington,
DC, in November 2005,
also on Investigating the
Mind, emphasizing the
science and clinical applications of meditation.
EING PRESENT IS
NOT THAT SIMPLE. WE HAVE TO
WORK TO GET BETTER
AT BEING PRESENT WE
DO THAT BY CULTIVATING MINDEULNESS—
MOMENT-TO-MOMENT
NON-JUDGMENTAL
AWARENESS.
,
Everything has an influence on us in ways that
can influence our mental
health and well-being.
The challenge is. can we
live more consciously? In
a sense, mindfulness and
mindfulness-based stress
reduction (MBSR) are
really about the art of conscious living. That would
also include MBSR's "kissing cousin," mindfulnessbased cognitive therapy.
There is also a growing
number of other mindfiilness-based interventions,
including mindfulnessbased eating interventions for people with
eating disorders and addictions. Our work in .MBSK is based on
the conviction that human beings are miraculous beings, and
we have infinitely more capacity and dimensions associated
with our brains and our ner\ ous systems, u ith our deep intelligences—and I emphasize the plural—that we usually simply
ignore. Even the educational system emphasizes on!\' certain
aspects of development, such as critical thinking, but it doesn't
emphasize somatic experience or intuitive experience or the cultivation of compassion or, for that matter, self-compassion or
empathy and all sorts of other aspects of being human—including perhaps the most fundamental of all—awareness itself,
which is an innate capacity we share by virtue of being human.
And yet. there are no courses that I know of in the educational
system that explicitly refme and cultivate awareness.
There's also relatively little research investigating what
awareness is and how it comes about. This is, in part, because it
is so difficult even to conceptualize. It's like the eyeball trying
to look at itself and understand wbat it is. But from a biological
and neurological standpoint, it is wonderfully interesting, and
Conversations with Jon Kabat-Zinn,
AT: And these are for
healthcare professionals?
Dr. Kabat-Zinn: Yes, and
neuroscientists. In fact, it
will be held in conjunction
with the annual meeting of
the
Society
for
Neuroscience, for which
the Dali Lama is gi\ing the
opening keynote address.
Never before bave these
uni\erses been so poised
for mutual exploration, opening up the possibility of exploring
profound contemplative experiences and capacities and how
they might interface with science and medicine to increase our
understanding of tbe mind itself, and of our humanity. These
conversations take place at the highest levels of scientific rigor.
This is not some kind of airy, fairy, new-wave, spiritual self-congratulatory effort. We are talking about a valid scientiflc inquiry
that expands the domain of what it means to be human, what it
means to be a scientist, and how to use one's mind in multiple
channels to investigate the nature of the mind itself.
AT: From a practical standpoint, why is if important for a
healthcare professional to practice mindful medicine?
Dr. Kabat-Zinn: It goes back to the Hippocratic oath: "First do
no harm." Human beings are very sensitive beings. We are sensitive to relationality. the relationships we are in with each
otber and tbe world. One of the most profound ways to harm
another person is to disregard him or her. That is particularly
AfTl^KNATiVE THEFIAPIES, MAY/JUNE 2005, VOL If NO. 3
59
wounding if the person is already vulnerable because he or she
has some kind of health problem. Patients go to their doctor
because either something is worrying them or they are in pain.
It's part of the Hippocratic commitment to real!)' be present for
a person who is in a vuhierable state.
But being present is not tbat simple. We have to work to
get better at being present. We do that by culti\'ating mindfulness. Mindfulness, as I define it operationally, is moment-tomoment, non-judgmental avvarene.ss. It is cultivated attention
in a particular way, namely, on purpose in the present
moment—and. I emphasize, non-judgmentally. As a rule, this
kind of attention, although we are all capable of it and use it
sometimes, has to be cultivated through practice for it to
become at all robust and reliable, it is not just a good idea
because without specifically nurturing it, left to our own
devices, we so easily get carried awa\' by streams of tbought. by
how busy we are. by what's happening with the previous patient
we saw or tbe next patient. It is very difficult to just he with a
patient unless you are trained to watch out for all of the ways
your own mind can subvert you, interrupt you, or divert you to
some other place. The patient, of course, is an extremely sensitive instrument for detecting our attention. Patients know when
we are not paying attention to them. That is the core reason fbr
cultivating mindfulness. A large part of it is learning how to listen, how to see and hear heneath surface appearances.
rather than at the patient, typing the whole time, so his or her
attention is already split. Many doctors multitask. This can
make patients feel disregarded. If there isn't an empathic connection, patients may not feel comfortable telling doctors
what's really on their mind and what tbeir fears and concerns
are. The doctor gives them the impression he or she doesn't
have time to hear it anyway. Valuable diagnostic information
often does not get into a patient's chart because the patient
doesn't feel comfortable telling the doctor what's really going
on. Our former Chief of Medicine at UMass, Dr. James Dalen,
who became Dean at fhe University of Arizona School o(
Medicine, used to say tbat if you want to know what's going on
with the patient, ask the patient. But then, you also have to listen. Mindfulness reminds us of the Hippocratic oath so that we
don't unwittingly betray the very calling of medicine, it also
helps us bring the art and tbe science of medicine together in
the 21st century.
AT: Are we any closer to getting mindfulness training into
medical schools?
Dr. Kabat-Zinn: I think so. It is gradually entering mainstream
medical education, and some places are accepting if more
cjuickly than others. I recently heard of two places where MBSR
is being incorporated into residence training programs. And
Another part of learning is recognizing that all interactions, especially in medicine, are in some way intimate communications. If you are not aware that a patient values your words
as a physician, as an authority figure, you may influence the
patient in ways you had not intended. Just with tone of voice and
choice of words, you are sending the patient signals about his or
her diagnosis or prognosis. You may be broadcasting all sorts of
things you are not even aware of, just through your soma. your
own body language, For example, and we teach this in medical
school, do not talk to the patient with your hand on the doorknob. If you are feeling rushed or impafient. deal u ith it inwardly
because otherwise you are showing severe disregard to the
patient. How can we titrate that in a way that is manageable and
sensible? That is the art of clinical medicine. It is what used to be
called good bedside manner. It is a teachable, meditative art.
AT: Is your philosophy that even if a healthcare professional
has only 15 minutes fbr the patient, he or she can make the
best of those 15 minutes by being mindful?
Dr. Kabat-Zinn: I don't want to give the impression that I am
in favor of making the medical encounter shorter and shorter.
Short office visits are disrespectful to the patient and maddening and stressful for both the physician and the patient. The
movement to make the clinical encounter as short as possible is
a travesty in many ways because it doesn't give the patient time
to even say why be or she is there. I know this from first-hand
experience with my mother and my own experience with physicians. Often, the doctor is looking at the computer screen
60
ALTERNATIVE THERAI'IES. MAY/JUNE 2005, VOE. il. NO. 3
Conversations with Jon Kabal-Zinn.
it's not just mindfulness per se. It's also, fbr example. Dr.
Rachel Remen's course on the healing art. which is spreading
through medical schools like crazy because it's so compelling
and beautiful. It's about understanding your own interiorifies
so that you can be emotionally intelligent in front of the
patient, way beyond merely doing a skillful clinical assessment
or diagnosis or treatment. Remember that it's the interaction.
the relationship, that is most important. If you are practicing
great medicine but bave an emotionally myopic reiationship with
the patient, it may become iatrogenic in one way or another.
I want to add that if a docfor has only 10 minutes. 10
mindful minutes is actually a huge amount of time because
there are an infinite number of moments in 10 minutes to a
first approximation. There is the same number of moments to a
first approximation as there are in an hour. So it is important
to make the best use of the moments you have, outside of time.
and to be aware of what's important: the quality of your listening and the quality of your embodied presence, rather than just
getting through a checklist in those 10 minutes. This can make
even a 10-minute encounter extremely satisfying for the
patient, or at least take the edge off tbe brevity of it. Sometimes
it helps even to acknowledge that explicitly.
MSBR is now being used in medical centers and clinics
and hospitais around the country and around the world. And
as it becomes more widely available in hospitals, doctors will
ConviTsations wiili Jon Kabat-Zinn,
be able to say after a 10-minute encounter with a patient, when
appropriate. "We have a program where you can actually train
in cultivating aspects of your own being that might be valuable
complements to what I can do to help you move toward greater
levels of health and well-being. It's called the Stress Reduction
Clinic, and if you are open to it, I'd like to refer you there so
that you can do your part, in partnership uith us, to cultivate
aspects of your being to which you [nay not have paid much
attention, but that might have a profound effect on your mental and physical health. Tben I will check back uith you Irom
time to time to see how it's going." Can you imagine how healing and how stress-reducing thaf would be for a physician?
Patients who are not doing well or have psycho-social stress
and problems or are falling through cracks of the system for
whatever reason could be sent to a place where they couid train
to tap into tbeir own interiority and tap their own deep inner
resources for learning, growing, healing, and transformation.
A lot of what has heen considered "alternative medicine"
has reached a point where it is perceived as having much more
virtue and value rather than being perceived as a liability because
it is strange. Today. 1 don't think anyone thinks meditation is
weird, whereas 25 years ago, virtually everybody in the mainstream tbought it was weird. Twenty-five years ago. the idea of
bringing meditation into medicine got a reaction kind of like:
"Wait a minute! We have spent the last 100 years trying to fmd
AETERNATIVE THERATIES, MAY/JUNE 2005, VOL 11. NO. 3
61
a scientific foundation for medicine, which was, to a iarge
degree, just voodoo before tbat. And now all ot the sudden,
yoga and meditation are fmding their way in, pulling the deep
foundation out of the rational scientific framework of medicine." But nou: that view is very much in abeyance. People now
recognize that the words medicine and meditation sound very
similar, and that's because the)' come from the same root. And
they share something profbund: the root of medicine and meditation is the Latin niederi. which means "to cure." But the deep
Indo-European etymological root is actually "to measure."
Now, what does medicine liave to do with measuring, or for
that matter, what does meditation have to do with measuring?
Nothing, if you think of measurement as holding up an external standard and measuring how iong a tabie
is or the volume of water
in a bottle. But this is
more the Platonic
notion that everything
has its own right inward
measure. So medicine
would be tbe restoration
ofa human being's right
inward measure througb
surgery, drugs, and
other medicai interventions. And what is meditation then? Meditation
is the direct receiving of
right inward measure—
the measure of our
thoughts, the measure of
our emotions, the measure of our body sensations, and embracing aii
that in awareness. It
means to know right
inward measure intimately through our own direct, first-person experiencing of it:
to know tbe bodyscape, the soundscape. the mindscape, the
breathscape, the beartscape. And you can only know that territory by cultivating intimacy with it. So meditation and medicine are actually linked at the hip very, very far back in the root
definitions of these words. I think sometimes we would do better in medicine to teach medical students the meaning of words
so they can keep in mind that this is a calling. Medicine is a
magnificent enterprise and one of tbe greatest achiexements of
human culture, and it is continually growing and changing.
Science is continualy transforming medicine in little and big
ways. And tbat includes the discoveries of neuroscience. and
now, hopefully the "inner work" of meditative practices and
their understandings of the mind and fhe body. All of this is
contributing to changing medicine in our time.
think, " \ o w I have to be completely aware at every single
moment." But it's not about that. It's not about self-consciousness; it's about consciousness. Tbere are many interesting, technical questions about how to become more mindful, but I want
to emphasize that becoming even a tiny bit more mindful is
good. You do not have to be totally mindful at every hour of the
day and night. That is merely an ideal, based in thought, which
can become an impediment to understanding and motivation. If
you make that into a goal, you will most likely hecome rapidiy
discouraged. Such striving is not in the spirit of mindfulness at
all. All we need to do is become a tiny bit more mindful in this
moment. That can wind up having a profound effect on the
quality of the next moment, and the adventure unfolds, just
NEED TO
KNOW MORE
ABOUT THE
SCIENCE OE COMPASSION, THE SCIENCE Of
EMPATHY, THE SCIENCE
OF ACCEPTANCE AS
WELL AS THE ART OE
COMPASSION, THE ART
OE EMPATHY...
AT: How critical is this to
fixing our broken healthcare system?
Dr. Kabat-Zinn: I agree
with you that the healthcare
system is broken. My friend
and colleague, Dr. Ralph
Snyderman, who just
stepped do\i7i from his position as Chancellor of Duke
University Medical Center,
said when speaking about
medicine that the chassis is
broken and the wheels are
falling off. The sysfem is
broken, but fhe knowiedge
base is not broken. The
beauty of the Hippocratic
oath is not broken: that is
incredibly vital. We do not
need to exaggerate fhe problems in medicine, but rather to
remember that the system of medicine is not medicine. The
more we can break our attachment to particular interest groups
that keep medicine \'ery tightly constrained, the more effectively
medicine can grow into the medicine of the 21st century,
grounded in the most beautiful science, and in the most beautiful elements of the art of medicine that are known and can be
scientificaily studied. From tbat point of view. I am not really
worried about medicine because it is never going to run out of
customers, and every person who works in medicine is going to
at some point or other be a customer as well. That should give
us pause to treat eacb patient as if he or she was our own parent
or our own child. I think mindfulness. along with a lot of other
things, has the potential to aid or catalyze the transformation of
medicine into its larger self
When I talk about becoming more mindful, people tend to
62
like learning to waik. There
is a lot of falling on one's
butt and on one's face.
AfTERNATiVE THERAPIES. MAY/IUNE 2005. VOL 11, NO. 3
I am now one of several senior advisors to a group known
Conversations wilh lun Kabat-Zinn,
as the Consortium of Academic Health Centers for Integrative
Medicine (CAHCIM), which formed a number of years ago
with eight medical schools that were doing cutting-edge work
in the mind-body area of integrafive medicine on the research.
education, or clinical front. Now the con.sortium is up to 27
medical centers and the n u m h e r is growing annually.
Mindfulness is at the very heart of this enterprise and at the
root of integrative medicine itself So this is anotber piece of
evidence that a commitment to mindfulncss is growing within
medicine and healthcare. The original idea was not just that
engaged faculty would come together to explore the potential
for transforming medicine, but that we vvould also involve our
chancellors and deans and other people at the top levels of our
institutions and expose them in the deepest of ways about what
integrati\e medicine and mind-body medicine are ail about,
not just conceptually butexperientially. The heart of this enterprise is not limited to a conceptual framework for educational
reform and refining research directions and clinical practice.
important as those agendas are. it has even more to with the
orthogonal dimension of interiority that involves wakefniness.
presence, comfort, silence, stillness, and the new dimensions of
seeing and being, as well as tbe boundless creativity that can
emerge out of the psyche of human heings througb self-examination and self-knowing.
AT: Can you give us your insight on the mind-hody medicine field?
Dr. Kahat-Zinn: You could say that this field of mind-body
medicine, and the larger umbrella of integrative medicine, are
in tbeir infancy. We are not talking about alternative medicine.
We are not talking about complementary medicine. We are not
talking about mind-body medicine, we are not talking about
integrative medicine, we are not even talking about participatory medicine—we are really talking about good medicine, period. Good medicine is something tbat is always growing, a
moving target. To some degree, we do have to live witb the
dinosaur features of the past. but. at tbe same time, there is the
possibility of us coming to our senses and waking up and fashioning a medicine tbat will serve us all.
In a recent paper, we showed that people with psoriasis
who meditate while receiving ultraviolet treatments heal at
four times tbe rate of control subjects who get oniy the light.
This results in the meditators needing fewer treatments, which
translates to cost reduction. In another study, in collaboration
with Dr. Richard Davidson of the Laboratory of Affective
Neuroscience at the University of Wisconsin, a clinical trial of
MBSR in a work setting, we showed that people undergoing
MBSR training showed shifts in the activation of certain
regions of the prefrontal cortex, which is consistent with more
effective handling of difficult emotions under stress and corresponding increases in immune responsivity compared with
wait-list control subjects. We have anecdotal evidence from 25
years of clinicai practice in the Stress Reduction Clinic that peopie who participate in MBSR have fewer emergency' visits and
Conversations with Ion Kah;U->!iiiii. I
fewer hospitalizations or are discharged from the hospital
faster—aii things that can he studied systematically. In fact, we
are currentiy conducting a study looking at three diagnoses in
terms of cost benefit of participating in the MBSR program.
These are difficult studies to conduct, and there needs to be
more of them. The Nationai Institutes of iieaith (NIH) heid a
day-iong symposium in May 2004 called "Mindfuiness
Meditation and iieaith." More than 500 people attended. As
far as i know, it was a first for the Nii-I. At the end of tbe symposium, an NiH physician and researcher stood up and said.
"Given the budget priorities. I propose that we rename the NIII
the National Institutes of Disease." This was coming from
somebody who had been working there his whoie career, i
don't think that we need to get info poiemics about the NiH—
it is one of the most incredible institutions on the planet; they
are doing and supporting extraordinary work. But I think he
was sa\ ing that the Nil 1 could devote more resources to investigating the nature of healing and health as opposed to the
nature of disease. It is a matter of balancing resources and aiso
contributing to envisioning what rational, 21st'Century medicine would look like, Presumabh', that would responsibly take
the controversial elements of the mind-body connection into
account as weil as its potential, as patients want to have more
alternatives. The NIH in general, and The National Center for
Complementary and Aiternative Medicine (NCCAM) in particuiar, have made great strides in putting a scientific foundation
under otber forms of medicine and investigating them to gain a
deeper understanding of the human organism and how it can
he encouraged to maintain health across the entire life span.
AT: What excites you the most about fhe future of mindfuiness
in medicine?
Dr. Kabat-Zinn: One thing that excites me is tbe huge interest
among neuroscieniists in meditation and the papers that are
coming out about it. Another is the growing work of the Mind
and Life Institute, where i serve as a Board Member and ViceChair, We recently instituted what will be an annual summer
research institute. We invite graduate students, post-doctoral
fellows, and faculty members in universities and research
institutions around the world to come and train in a meditative enviroimient for one week with tbe faculty of the Mind
and Life meetings. We engage in diaiogue with peopie from
various contemplative traditions, long-term meditators and
yogis, and have conversations across these discipline boundaries in ways that embody the deepest third-person investigative possibilities. And simultaneousiy, participants get a taste
of the first-person dimension of direct meditative experience,
because tbat direct first-person experience can inform the scientists" study designs, coilaborations, and decisions about
what to work on in ways that will potentiaily extend the
boundaries of neuroscience and good medicine way beyond
where they are right now. That would be tremendousiy instrumental to aspects ofpsycholog}' that reaily have not been studied
ALTERNATIVE THEIIAI'IES. MAY/|UNE 2005, VOL. 11. NO. 3
63
mucb until now. Compassion, for instance, is hardiy a subject of
investigation in the psychological literature, but medicine is
based on compassion. So we need to know more about the science of compassion, the science of empathy, the science of
acceptance, as well as the art of compassion, tbe art of empathy,
the art of acceptance, and for that matter, the potential of what
ue might call wisdom fbr enhancing health and well-being, of
both individuals and of the society as a whoie. the hody politic,
you migiit say. Perhaps we are aii learning to draw effectively
from the weil of the multiple dimensions of our human capacity
fbr investigation and knowing, both inwardly and outwardly,
inciuding from the the dimension of our not knowing, in ways
that have integrity and kindness. This would allow us clinically
to meet our patients where they are. out of the fullness of our
being as well as with our clinical expertise, and thus optimize
the potentiai for connection and healing and minimize the
potentiai for ignoring whaf is most fundamentai in medicine,
the sacred quality of the encounter itself
what excites me. The imaginative approaches that are being
taken and researched are truly inspiring, and bode weil for a
more mindful and more heartful medicine and heaithcare in
the fufure. These practices are now making their way into business, the legal profession, and education at all ieveis, from elementary school to graduate school, i find these developments
hugely promising and see them as potentially transformative
and healing of our society and its institutions, i am aiso hugely
inspired by the work on so many fronts of my colieagues at the
Center for Mindfulness at the UMass Medical Schooi, who,
under the wise leadership of Dr. Saki Santorelii. my long-term
colleague and friend, are offering, among other things, a rigorous certification trajectory for health professionais in MBSR.
and who now host an annual conference on Mindfulness-Based
Interventions in Medicine and Health Care that brings people
to Worcester, Massachusetts, from around the world, to one of
the most inspiring gathering of people committed to bringing
mindfulness into the world that 1 have ever seen.
And finally, the depth of the work of ciinicians and scientists around the country and around the worid engaged in
MBSR. MBCT. and other mindfulness-based interventions is
More information is available at: www.umassmed.edu/em and
www.mindandlife.org
M.A. and Ph.D. degrees in
Psychology or Human Science
v^ith a concentration in
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