Worcester, Massachusetts—that’s “wooster mass” to those who know it—is not for the faint of heart. It’s what is sometimes called a “post-industrial city.” One nasty wag called it “New England’s utility closet.” But it’s proud, like a fighter always making a comeback, a place where generations of people worked very, very hard in that staunch, New England mill-town sort of way. It is a place of strong ethnic identities and accents, and the tensions and attitudes that can come along with that. None of the top-ten Zip Codes for flyers about yoga, meditation, chi gong and feng shui would be found within its borders. And this is where Jon Kabat-Zinn started mindfulness-based stress reduction. Why? Not because he was a crusader, but simply because he was there and people were in pain.
The story has been told many times of how Kabat-Zinn ended up teaching people in a hospital function-room to eat a raisin as if for the first time, to scan each and every area of their body, to stretch, turn, twist, breathe, walk, and above all pay attention to moment after moment after moment. The son of an immunologist, he had trained at MIT as a molecular biologist but also practiced yoga. He was inspired by a talk at MIT by Philip Kapleau Roshi and went on to become a student of the Korean Zen master Seung Sahn. When he took some time off from his job in the gross anatomy lab at the UMass Medical Center to do a meditation retreat, it occurred to him while practicing that patients in a hospital could use some mindfulness. It was one of those so obvious but so brand-new realizations that happens to scientists in labs every day: take the mindfulness to the hospital because that’s where the pain is.
Mindfulness-based stress reduction was born in 1979. In the early years, it was a modest program. Then, in 1990, Kabat-Zinn put out his first book, Full Catastrophe Living, which contained detailed descriptions and instructions on all facets of the program he had developed in his stress-reduction clinic at UMass. It spurred a lot of interest, and then in 1993, Bill Moyers’ documentary Healing and the Mind featured ordinary folks practicing at the clinic, and inquiries soared. So it was no surprise when Kabat-Zinn’s second book, the shorter and more poetic Wherever You Go, There You Are, became an immediate bestseller in 1994. This year, both books have been re-released, along with the publication of his new work, Coming to Our Senses. There are also scores of papers and empirical studies demonstrating the program’s benefits; a handful of other books on related topics, including one on parenting that he and his wife Myla wrote together; and three sets of tapes to guide students and instructors through the program.
An umbrella organization exists to chart the course of mindfulness-based stress reduction (MBSR), called the Center for Mindfulness in Medicine, Health Care, and Society. However, it has little to no inclination toward proprietary control and doesn’t keep scrupulous track of how many people are teaching the techniques in how many programs. Suffice it to say that there are hundreds of MBSR programs across the world, thousands of teachers, tens of thousands of people trained, and billions of moments of practice logged in. Somebody somewhere is learning it right now.
America is notorious for churning out Elmer Gantrys, people with a cure-all for everything, who end up on talk shows and become larger than life. Jon Kabat-Zinn is modest. He’s too much of a scientist to rely on one perspective. He’s too interested in the work and the world to take his own story too personally. He says, “I could concoct this story a thousand different ways depending on my mood and what I want to convey, and none would be absolutely true. A quantum particle doesn’t have one path; it has a probability for an infinite number of paths.”
When asked what his innermost motivation has been, he will tell you it is “a love of science.” He goes on to say, “When science is at its best it asks deep questions about the nature of reality and then puts them to the test.” In Coming to Our Senses, he posits the Buddha as a great scientist and also unearths several of Albert Einstein’s more Buddha-like pronouncements, such as “the separation between past, present, and future has only the meaning of an illusion, albeit a tenacious one.”
Like any good scientist, Kabat-Zinn is a preternatural networker. More than that, he regards people themselves and all of experience as a centerless network. At the heart of his new book is the notion of -scapes, as in soundscapes, touchscapes, airscapes, smellscapes, and so on. Experience is just that, many intermingling sensory-scapes, where an exhilarating and terrific nowness reigns but where nothing to take personally can be found.
The message of his book, delivered with more passion and at greater length than he has done before, is that our interconnected network of networks needs attention. The soundscape is in danger from noise pollution and bloviated rhetoric, the airscape is endangered by noxious fumes and claustrophobic spaces, and the mindscape is endangered by our inability to stay with one thing at a time. We talked together for close to three hours and a new image struck his fancy: these -scapes that make up our experience are like national parks, precious resources that must be attended to, with mindfulness of what we are making collectively. Being mindful is not only about one person knowing how to eat a raisin.
And yet it is. The planet is not going to up and become mindful through spontaneous combustion. It happens when one at a time people notice that it is possible to step into what one stress-reduction participant, Sid Hall, calls “the childlike world, where you have that vivid sense of the world around you that you learned to forget and push away.” In the early pages of his first book, Kabat-Zinn lovingly introduced a cast of everyday characters—a truck driver, a nurse, a wrestler—and portrayed how they came in pain and began to emerge as more themselves over the course of a few weeks of paying simple attention. The pain was there, but so were they. These are not miracle-worker stories. There is, as Kabat-Zinn tells me, “no ultimate attainment. We have a koan, a journey with no arriving.”
The core program of mindfulness-based stress reduction consists of eight weekly two-hour classes and one daylong class. It includes guided instruction in mindfulness meditation and “mindful yoga practices,” exercises to “enhance awareness in everyday life,” daily mindfulness assignments lasting from forty-five minutes to an hour, and methods for improving communication. The program strongly emphasizes working with the body: body scanning and yoga exercises are thought to offer “full-body conditioning” to strengthen the body and release muscular tension. To help participants continue practicing, they take away two guided mindfulness tapes and a workbook.
The schedule may be adapted to differing conditions but the fundamental curriculum is a constant. The program is promoted to help people with a wide variety of conditions, including anxiety, gastrointestinal stress, skin disorders, high blood pressure, heart attack and many others; it is also for people who simply feel that “the pace of their lives is out of control or they’re just not feeling quite right.” Kabat-Zinn recently told Inquiring Mind that “Having seen over 16,000 medical patients in our stress-reduction clinic…we can safely say that pretty much any individual with adequate motivation can learn to be less reactive and less stressed by cultivating mindfulness.” He goes on to say that one’s “interior world” can be influenced in the process, which could lead to improvement in “blood pressure, the functioning of the immune system, emotional balance…and making healthier choices in one’s life.”
People entering the program seem to be reaching a beginning much more than an ending. Elizabeth Berlasso, a long-time meditator and psychotherapist who has been leading MBSR classes for several years, says that people start out very anxious. “They don’t have a clue what to expect, even though we’ve given them a thorough orientation,” she says. “They are not scared of meditation per se. What they are afraid of, what they really are stressed out about, is what they might find—what they will discover in the quiet about who they are. At some level, people know they have elaborate patterns to keep themselves as far away from that deep experience as possible. Once they start, though, the most potent result they get from sitting still is that they experience kindness towards themselves in a way they never have before.”
Alex Walsh counts himself a hard-driving, stiff-upper-lip kind of guy, who doesn’t suffer fools gladly. An investment advisor, he’s in an industry that puts a premium on a certain kind of aggressiveness and that carries with it the ongoing thrill ride of climbing and falling with the market. But a heart attack in his late fifties forced him to sit up and take notice of what was going on with his lifestyle. “I entered the training,” he says, “with the attitude, ‘I don’t know whether this is going to help me, but I’d better do it.’” When a roomful of about forty people started to say what brought them there, he recoiled. “I didn’t know these people. I didn’t know anything about these people,” he recalls. “I’m not particularly one who is fond of sharing intimate information with people I do not know. But when you start listening to story after story, you realize people are in tremendous pain. Walking through life, you encounter people constantly. A lot of them are probably hurting in ways you can only begin to imagine.”
Kabat-Zinn tells a story about an old MIT colleague diagnosed with leukemia who had to have a bone marrow transplant. “I hadn’t seem him for twenty years,” he says, “and he showed up in my office wanting to take the stress-reduction program. He was going to have to be in isolation for a long time for the procedure and he wanted to learn how to best make use of that isolation. After a few days, he said he felt closer to the people in the stress-reduction program than to his longtime colleagues. At one point, he told the others, ‘This feels to me like the community of the afflicted. We are here because each one of us is carrying a burden.’”
Hearing the circumstances of just a few of the people coming to one class, one realizes how true this rings: a couple of people just say, “I’m stressed out and I just need to figure out what to do about it”; another knows he’s speedy and feels he’s missing out on so many things, including quality moments with his children, who are growing up too fast; another is going crazy trying to be Supermom; a small-businessman who has always been physically fit has just had a massive heart attack and needs to know why; another couple of people have serious, chronic illnesses and one of them would like to stop letting the illness rule his life; another one referred by a psychiatrist needs to connect with her body; and yet another is heartbroken from a relationship that just ended and wants to relate with his mind and emotions in a new way. This list can go on and on, and hearing these stories cuts rather close to the bone: suffering is everywhere and also infinite in its variety. We are all the same person in pain. We are all “carrying a burden.”
Kabat-Zinn talks about how etymologically our English word “suffering” indeed means to carry a burden. That it is the basis of Buddhism’s first noble truth. From the beginning, Kabat-Zinn felt that using explicit Buddhist terms—such as calling pain, suffering or stress by the Sanskrit word dukkha—would be off-putting and carry baggage that already-burdened people did not need to bear. “Dukkha-reduction” probably would not have taken the medical community by storm, in any case. As he says, “People are just suffering. They’re not looking for enlightenment or meditation or to become Buddhists or to give up their culture or any of that.” Marion Stork recently began teaching mindfulness-based stress reduction, after years as a meditator, because she thought it was a way to reach people who would never come to a meditation center. She says many people she encounters in the program “would never go to a therapist or pick up a book, never mind go to a Buddhist meditation center. But if a doctor says, ‘I’m recommending this,’ they say matter-of-factly, ‘OK.’ Once they do the training, it’s completely up to them what path they follow, but if they connect with it—not everyone does—they may be quite willing to go to a class or take a program at a meditation center. Many people simply come back and take the course over again, or take related courses.”
Kabat-Zinn is trained in Buddhism and espouses its principles, but he does not identify himself as a Buddhist. “People don’t need any more identifications than they already have,” he says. “If you present the dharma as Buddhism, one half may love it and tell great Zen stories or romantic Chinese Chan stories or exotic Tibetan Vajrayana stories and be sucked into this whole orbit of how wonderful Buddhism is. The other fifty percent may be completely turned off, feeling that some Buddhist evangelist is trying to sucker them into a belief system and on top of that, they probably want money.
“The challenge we are faced with in mindfulness-based stress reduction is how to make use of a vocabulary, structure and format that will invite people into the deep practice of meditation in a way that lets the practice be American. That has happened in every country Buddhism has ever gone to. There are many differences between the Buddhist traditions, yet the heart of it is dharma. At this stage, for Buddhism to become Buddhism it may have to stop being Buddhism. Meditation is not a collection of techniques that belongs to any group. It is a way of being. After all, the Buddha was not a Buddhist.”
“Doesn’t institutional Buddhism offer some kind of protection against its teachings being perverted by personal aims?” I asked him. He responded that the teachings could be perverted inside or outside of Buddhism, as far as he could tell. One can practice, he says, and “create a gigantic CV of wonderful, wonderful experiences, but actually be following a completely spiritually materialist trajectory.” When he was beginning his program, he talked to many knowledgeable Buddhists he respected about how he had to “protect the dharma” from harm as he spread it to people outside of a Buddhist context. Their response to him, he says, was universal: “You can’t protect the dharma; you don’t need to protect the dharma; the dharma takes care of itself.”
Despite his strong feeling that Buddhism is a reification that may need to get out of its own way, he is not in any way strident about it or even remotely “anti-Buddhist.” He honors many Buddhist teachers and is in ongoing dialogue with them. He has met with the Dalai Lama a number of times and is deeply involved in the Mind and Life Institute, which has been holding dialogues for the past eighteen years between scientists and the Dalai Lama. He thinks this collaboration has been particularly fruitful and notes with delight that His Holiness is the keynote speaker at this year’s Society for Neuroscience meeting, which will be held in conjunction with the next Mind and Life dialogue in November in Washington, DC.
On a more intimate note, he recalls interactions with his teacher, the late Seung Sahn (known to his students as Soen Sa Nim), with obvious admiration and a discernible sense of the teacher’s presence. Our discussion of Buddhism and not-Buddhism reminds him of his teacher pushing him into being a teacher. “I said to him,” he recalls, “‘Soen Sa Nim, I’m here to learn how to practice from you. I’m not interested in being a teacher; I want to be the student.’ And he said ‘If you are my student, then this is how you will learn to be a student, as you teach.’ And I said, ‘But I don’t know anything. I don’t know what to do. I wouldn’t know what to talk about.’ And he said, ‘Aawwwwww,’ as if he really deeply understood what my issue was, ‘no problem, you only talk about area you understand. Don’t talk about area you don’t understand.’”
Kabat-Zinn teaches the way a good scientist teaches, by learning. He instinctually collaborates. Very approachable, he knows many people and many people know him. It’s not possible to catalog all the connections, and they keep growing. The National Institutes of Health held a daylong symposium last May called “Mindfulness Meditation and Health,” as part of a larger seminar series. Nearly ten times as many people showed up for the symposium than for any other program in the series. Last June, Mind and Life held a weeklong retreat at the Garrison Institute for young scientists interested in doing research on the influence of meditative practices on neuroscience, behavioral science and clinical medicine. Last December, Kabat-Zinn traveled to China at the behest of the CEO of the Hong Kong Hospital Authority, who had contracted SARS and learned mindfulness to help him deal with his time in quarantine. He liked it so much, he invited Kabat-Zinn to come to train his whole medical staff. During the training, Kabat-Zinn projected on a screen images of four large calligraphies executed for him by Kaz Tanahashi. When he showed them the one for mindfulness, to them it said “thinking.” When he asked if any of the four hundred people in attendance had read the Tao Te Ching, not one hand went up. He was bringing coals to Newcastle, and found they were actually needed.
Movements often suffer from an excess of dependency on a central figure—whether the central figure desires that or not. Mindfulness-based stress reduction is strong and will continue for a very long time, one senses, because it does not orbit around any one person or organization. Marion Stork, for one, was impressed by what Kabat-Zinn said at the end of the intensive she took with him. He told the group. “You can go back and teach and call your program Mindfulness-based Stress Reduction. I don’t want to trademark this. I want people to take it, innovate with it, make it your own practice, so you can teach what you know.”
She also enjoyed meeting one of Kabat-Zinn’s main colleagues and collaborators, Saki Santorelli. Santorelli has worked with Kabat-Zinn in the stress-reduction clinic since the very early days. He became its director in 1995, and after Kabat-Zinn retired in 2000, he also became director of the Center for Mindfulness. His book, Heal Thy Self: Lessons on Mindfulness in Medicine, addresses how health care can be influenced by mindfulness and how patient and practitioner can interrelate, rather than one mechanically curing the other.
In speaking about the work of the center, Santorelli says that it focuses on education, clinical care, research and outreach, and is about transporting “meditation and mindfulness from the familiar territory of the monastery and meditation hall into the nitty-gritty diversity of everyday human affairs.” While requests for some form of quality assurance have caused the center to start a certification program, one does not need the certification to teach MBSR. According to Santorelli, “We didn’t invent mindfulness. We don’t own it or hold a patent.”
Another colleague, Fernando de Torrijos, met Kabat-Zinn at the first Body & Soul conference in Boston in 1994. Since de Torrijos had just moved to Worcester, where his wife was from, they decided to get together. Over lunch, Kabat-Zinn asked him to direct the inner city program the clinic had begun two years before. The program is offered in Spanish and English and will soon be adding Portuguese to serve a growing Brazilian population.
“Worcester,” de Torrijos says, “was a thriving city in the nineteenth century, but for a long time many industries were closing down and leaving the city.” Even though it is the second-largest city in New England and only forty-five miles due west of Boston, it is still outside the orbit of the high-tech revival that rejuvenated the metropolis.
The inner city clinic began with a grant from the Nathan Cummings Foundation, but when that expired, Kabat-Zinn pledged income from professional training programs to support the clinic for five years. It was hoped, de Torrijos says, that the program could become self-sustaining, but “that has been very difficult,” he concedes. He does his work now in a large, full-service community health center that sits in the middle of a group of housing projects. The health center was interested in having the stress-reduction program because it would add a self-care component to their program of “managed care,” a term that refers to methods for controlling the use, overuse or inefficient use of health care services. Although “managed care” can hide many evils, de Torrijos feels his clinic provides a missing link in health promotion for a segment of the population that is disproportionately unhealthy. Poverty makes you sick.
“Exercise, proper diet, rest. These are all excellent indicators for good basic health,” he says, “but if people don’t have something that brings them to self-awareness of the importance of taking care of themselves, no matter how many presentations, lectures or brilliant talks you give to the population, they will go home to neighborhoods where they have few resources, not much support, and high stress caused by crime and other conditions. They won’t take care of themselves. If we empower them by teaching them mindfulness, people start to remember that being human is something wonderful.” Kabat-Zinn notes that people taking this program are coming from “a difficult starting point. We’re not taking people the entire distance to anything in eight weeks…but if you’ve heard one person say, ‘I did this and my pain went away,’ or ‘I handled a very difficult situation in a positive way,’ that’s potentially life-changing.”
De Torrijos’ work is not limited to Worcester. He has been instrumental in bringing mindfulness-based stress reduction to the Spanish-speaking world. He consulted with Kabat-Zinn in the creation of Vivir Con Plenitud Las Crisis, the Spanish translation of what he calls “the MBSR bible,” Full Catastrophe Living. He’s taught programs in Spain, Mexico, Argentina, the Dominican Republic and Puerto Rico. In the work he is doing in the inner city, which has been the subject of several research papers, he hopes to develop a model that can be exported to community health centers the world over.
The main disease he sees is despair. One woman came into his program from a shelter for battered women. “In the intake interview,” he says, “her eyes were dead. They had no shine, no brightness. Her life was completely over. I told her, as I’ve told so many others, ‘We can live through all kinds of abuse—physical, social and sexual. We may be living under a bridge. But as long as we breathe, there is more right with us than wrong with us. You have no clue where to go in your life and all the light is obscured by clouds of sadness. Little by little, step by step, we will clear them away and let the wisdom and compassion in your heart come to the surface.’ She replied, ‘Please tell me where I can find that.’”
The woman brought her young son to the program and put him in child care. De Torrijos noticed that he never spoke. He had been traumatized by seeing the abuse his mother suffered. At the end of the fifth week, she went to pick him up, and to her surprise, he spoke to her.
“People need to believe again in the importance of life and living,” de Torrijos says, “no matter what the condition of their body or their pocketbook. As long as we breathe, everyone has something important to do.”
Larry Horwitz is another old friend, collaborator, fellow raconteur and sounding board for Jon Kabat-Zinn. Horwitz was a businessman cum money-raiser cum environmental advocate who had become so depressed that he decided in his late forties to try a meditation retreat. A mutual friend thought they would make a good match: Horwitz had taken to meditation practice with a vengeance and Kabat-Zinn’s activities were growing to the point where he needed strategic planning. “That was in the mid-nineties,” Horwitz says. “We were going to work together for three months. We haven’t stopped yet.”
Horwitz, Kabat-Zinn and others have put their heads together many times trying to figure out how to bring mindfulness into more areas of “the nitty-gritty diversity of everyday human affairs.” The Massachusetts justice system has been one area, including both judges and prisoners, both of whom, ironically, have to sit idly with no easy means of escape for long periods of time. Teaching elementary and high school students has been a new frontier in the last few years. “Teaching young people requires some adaptation,” Horwitz says, “but they’re very fast learners. If I had learned this at fifteen instead of forty-five I would’ve been a lot better off.”
The Center for Mindfulness is part of the division of preventive and behavioral medicine at the University of Massachusetts medical school, which influences what the center will focus its budget and small staff on. “As part of an academic medical center,” Horwitz says, “we are well positioned to do professional training and research, and our program in Worcester serves as a lab. There is also a lot of leverage in training many others to do this work rather than trying to do it all ourselves.”
Regarding the ongoing pressure to put more of a Good Housekeeping Seal of Approval on the stress-reduction program, Horwitz says that “the prerequisite for teaching MBSR—a solid grounding and commitment to mindfulness practice—is far more important than the training itself. I know people who’ve had very little training in teaching this program and I’m confident they are very good teachers because it’s coming out of their practice. By the same token, someone could take the training whose practice is weak and they probably wouldn’t be a very good teacher.”
Since 1998, Kabat-Zinn and Horwitz have been doing yearly retreats for “leaders and innovators in business and nonprofit organizations,” based again on the leverage principle: “bringing mindfulness to individuals who have an impact on significant numbers of people.” Horwitz says it took them a while to get their minds around this project. “The first draft of a brochure that Jon did for this was just awful,” he says. “He was naturally trying to express how mindfulness could fit into business, but we quickly figured out that we don’t need to know about business. We know mindfulness and that’s what people are coming for. They know far better than we how to apply it.”
Kabat-Zinn says that ninety-nine percent of CEO’s will read the first sentence of their brochure (“Meditation is not for the faint-hearted, nor for those who routinely avoid the whispered longings of their own hearts”) and throw it in the garbage. “We’re looking for the one percent who read on,” he says, “and we find that they are starving for silence and nondoing.” Some of the people from this retreat have become quite dedicated; others probably have a “vague, distant memory that they ever did it,” Horwitz says. One woman who is “a very bright, hardworking, entrepreneurial founder of a law firm” told him, “When we started the raisin-eating exercise for the second time, I saw the raisin and thought, ‘Oh God, I’m eating a raisin again!’ and just then I realized how often I have this same lack of attention when my thirteen-year-old comes to tell me something and I think, ‘Oh I’ve heard this before.’”
When asked what has made MBSR flourish, Horwitz says it’s “the fact that Jon has a very deep commitment and passion for practice and he has been able to distill out the Eastern trappings that have been a problem for some—not for him—and yet genuinely adhere to the heart of practice.”
In 1989, as Full Catastrophe Living was nearing publication, Thich Nhat Hanh sent a one-paragraph preface. Kabat-Zinn was delighted—and then he read it. The word “dharma” appeared four times in the eight lines of text. He says, “I thought, ‘What the hell am I going to do?’ I studiously avoided using any words like that. I did not want our work to be thought of as just one more weirdo meditation thing. But what he wrote was so beautiful and such a blessing, I felt maybe I could stretch the envelope, because 1990 was very different from when we started in 1979. Maybe the world was ready and a few mentions of dharma wouldn’t turn people off. Well, apparently it hasn’t.”
He is now willing to call dukkha, dukkha. In Coming to Our Senses, he presents explicit Buddhism in many places and talks about his own journey. He has a chapter on emptiness and the Heart Sutra, but the Buddhism is also woven into a much larger web of language and associations from many sources and fields. This book is his magnum opus. It epitomizes Kabat-Zinn’s joining of the arts and sciences, what “C.P. Snow called ‘the two cultures,’” he says. It makes for far too neat a narrative; nevertheless, it is true: his father was a scientist and his mother was an artist. The two cultures merged at his breakfast table. For him, what joins them is that they are ways of knowing, and if we are to heal the world, as his subtitle says, we must come to know the world better. And mindfulness is the key. It is nothing more than the practice of life itself.
But in healing the world, we cannot fall into the old doctor-patient dichotomy and treat the world as an object to be fixed. He does not have any detailed prescriptions to offer for the world’s problems—trusting that there are many who can discover those—but he is emphatic that we cannot simply treat the world as the good old world, the one in which we are subject and it is object. In fact, the very existence of that all-too-familiar conceptual terrain may indeed be the disease of the world. In the closing pages of Coming to Our Senses, he writes, “…mindfulness is not some magical elixir or cure…the answer to all life’s problems. But cultivating intimacy with how things actually are is the first step on the path of healing, whether we are talking about a person or a nation, or all nations and all beings.”
If stress reduction was the jumping-off point for Kabat-Zinn, what it has led to is far more…orthogonal. This is one of his favorite words and it is the linchpin for his discussion about the dimension we habitually live in and the many other dimensions that elude us. “For the most part,” he writes, “we dwell mostly accepting the appearance of things and create quasi-comfortable explanations for ourselves about how things are and why they are that way.” But, he says, if we listen to insistent murmurings of “disaffection” in the background of that reality, they challenge us to ask who we really are and we open a door to a more relational and interconnected reality. We awaken from a “consensus trance” and into a dimension that offers myriad ways of seeing and responding. We emerge out of flatland and into “a third spatial dimension at right angles (orthogonal) to the other two.” To illustrate it while we are talking, he points to the Tanahashi calligraphy that literally means turning. “That’s it. One slight turn and the whole world opens up. The difference between being on autopilot and realization is paradoxically quite small.”
When Kabat-Zinn was twelve, he spent the summer at Woods Hole, one of the world’s premier research facilities. He and his pals used to hang out in a clubhouse drinking Cokes, having