Two part article on cognitive therapies, mindfulness, Garner etc., 2025, Long Covid Advocacy Substack article

A very useful piece that points out the potential misuse and definite over selling of ‘mindfulness’ in the medical context. It expresses, more eloquently than I could, points I have been trying to make for a number of years.

When I developed ME/CFS I had had well over a decade of experience of a range of meditation techniques in both the context of yoga and of Buddhism and was training as a yoga teacher. Although I now use some meditation techniques as a coping mechanism in some contexts people should be aware that there are contraindications for both meditation and Hatha yoga, and both can be triggers for PEM if not practiced with real care.

In the context of the classical Hindu literature, mental health issues are a significant red flag for practicing meditation and anecdotally I am aware of a number of instances of significant mental health related episodes arising in association with mediation, including one attempted suicide.

 

(Edit to add: This western medicalised version of) mindfullness is being used as a tool of oppression. Instead of trying to change the external factors that contributes to suffering, we are told that it is actually internal factors that cause or maintain the suffering, and that it is our job to not react to the external factors. The external factors do not matter. That is very convenient for those benefiting from the external factors being the way they are.

 

As the Long Covid Advocacy blog points out that this narrow application of mindfulness is a misuse of the technique that arises from its selective abstraction from the context(s) that originally developed it. For example in the context of Buddhist meditation mindfulness is only one of a range of practices including for example developing goodwill to self and others or various forms of right action aimed at changing the world for the better.

 

I always kind of saw the BPS/Mindfulness as Medicine admitting defeat and basically being like “We can’t solve this problem, so best we can do is brainwash you into thinking you don’t have a problem, or alternatively if that fails convince you that you can only solve the problem yourself and therefore the blame for it rests on you when the problem inevitably isn’t solved”

 

Thank you. I should have been clear that «mindfulness» referred to the western medicalised version.

 

I don't enough about MBSR or MBCT, but meditation is indeed an intense activity that I wouldn't recommend to ME/CFS patients. That said, deriding "decontextualized" mindfulness as McMindfulness seems unwarranted. Theravadan writing compares mindfulness to calm bowl of clear water that reflects but not reacts. That is something useful in chronic illnesses. It certainly is not a medical therapy to improve the symptoms, but it's still a useful coping method that allows you to simply accept your condition and reflect rather than stress over it. I often see patients in early phase, and some throughout, obsessing every little symptom and thereby making things worse than they should be. Turning IBS into panic attack for example or an unexplained neurological symptom into insomnia, etc. They could use mindfulness to severe the stress and obsession from their predicament.

On a personal note, I suffer from unexplained sharp pain on my thigh a few times a year that keeps me awake all night long. Once I decided to be just aware and not react, I was able to relax between the attacks and squeeze in some sleep. It certainly didn't lessen the pain, but I wasn't as dazed as I would've been otherwise in the morning. That's a win in my book.

 

I’m no expert, but I think you’re missing the point of the post. You have to also consider what would be required for someone to be able to not react to their circumstances. Just telling someone to try not to react can go very wrong very quickly. That’s why, as the post describes, mindfulness is not regularly practiced by regular people buddhists, as opposed to munks, etc. that have access to guidance and follow-up.

Besides, there are probably more efficient and less harmful ways to help someone «react less» (negatively). Like simply showing them compassion and empathy, or even just being with them to support them when they allow themself to engage with the reactions in periods.

I also find the characterisation of something like an «obsession» to be unhelpful, because it often implies that the thoughts are unreasonable. I don’t think it’s so clear cut. In many cases, the reactions are strong, but perfectly reasonable and frankly be expected given the totality of the circumstances. That obviously doesn’t mean that it might not be easier for the person if they were able to, for any reason, get to a point where they have a less severe reaction.

 

This is really the root of the problem. Aside from being falsely framed as being the most powerful thing in the known universe, it's become wildly popular because of the belief that it's completely harmless, that it can do no harm to anything or anyone.

Despite the fact that all the harms from this ideology are the exact same as with any pseudoscience, how it delays, sometimes indefinitely, actually solving problems. Homeopathy is also harmless. So is acupuncture, for the most part (as long as needles are well-cleaned). In fact pretty much all alternative medicine is just as 'harmless' as mindfulness and mind-body ideology.

And this is entirely irrelevant, because the true harm comes from when it displaces professional expertise. Basically, it's exactly the same problem as why Steve Jobs died (refusing effective treatment for a treatable cancer in favor of alternative pseudoscience), but taken on a population level. The harm caused by this delusional obsession with psychosomatic models is the exact same as if homeopathy occupied the same role. Or any other alternative medicine pseudoscience. The harm is in what it prevents from being done, very far from harmless.

Tens of millions of people have effectively have our lives completely ruined by this ideology. There is no way to say that it's harmless, it's in fact one of the most harmful ideologies in human history, with a death and misery toll comparable to full-scale continental warfare.

But for each individual? Sure, entirely harmless. As long as, embarrassingly, no one looks at the whole picture. That is, as long as no one takes a holistic view of the situation. Which, sadly, only the victims are capable of doing. Because to clinicians, even to most researchers in this space, they only think in term of the one patient currently in their room. They think of nothing else, I have never once seen any serious assessment out of psychosomatic ideology that goes beyond the simple context of one patient, and what to do with them before moving on to the next one.

Also a big part of the problem. It's all hype with zero criticism. All its failures are hidden, covered up in broad daylight. A sign of a dysfunctional system.

Jay Gould was one hell of a smart man. A rare true skeptic.

 

I agree--I've often seen the caricature of someone who "obsesses" over unexplained symptoms and the reality is that unexplained symptoms are very distressing, especially if you are early enough in the illness that you haven't had time to observe the dynamics and adjust to them. If I am someone early in my chronic illness journey and I simply have not arrived to the point of realizing that modern medicine can't do anything for me yet, the suggestion of mindfulness to avoid "distress" is the most unhelpful thing in the world. I'd be focused on finding an answer and a treatment for my new symptoms. Even the most rational person isn't going to react kindly to a sentiment that comes across as "well they're never going to go away so try some deep breathing so you don't freak out about it."

Sure, in the complete abstract, it might be useful for some theoretical person "obsessing" over new and distressing symptoms early in their illness to use a technique that helps avoid panic attacks. But honestly, I've very rarely seen that advice applied in a way that isn't dismissive at best or harmful at worst. Using mindfulness effectively requires a lot of self knowledge--e.g. having experience to know when the symptom should be ignored vs. when it might actually be worrying, knowing your own personal capacity for something as energy-draining as mindfulness, etc. It's very hard to say as an outsider if mindfulness ever will be effective for someone else, and there's very few ways to even suggest it to someone else that don't come across as trivializing.

 

Also a couple points.

Something I’ve found common in pwME was that we originally thought we were suffering from Panic Attacks and were diagnosed as such but later realised this is just an extreme version of the “Wired” feeling often triggered by overexertion.

And that “Mindfulness” can make someone “obsess”, I’ll use the word “focus”, more on their symptoms than not. A lot of us rely on continual cognitive distraction otherwise our symptoms are too much, mindfulness somewhat forces us to suffer through our symptoms and very like might make people focus on them more not less.

 

It also teaches you to ignore very necessary feedback in the form of symptoms from doing more than you can tolerate. Some symptoms need a reaction. So neither distractions nor mindfulness are appropriate in those circumstances.

 

Oh, he’s one of the « personality causes cancer»-people! Yet he also has this quote:

Where he paints himself as a victim because «his truth» contradicted «beliefs».

 

What does mindfulness even mean?

This discussion reminds me of "What About Bob?" Hilarious and wickedly observed comedy starring Bill Murray as Bob Wiley and Richard Dreyfuss as the ambitious Dr Leo Marvin.

Like the fictional Dr Marvin's fictional "baby steps", mindfulness as CBT seems another fashionable gimic to sell self help books and build reputation and talking therapy practices among affluent social sets in suburban USA.

Why people follow fashions like a swirling murmuration of starlings following each other is another question entirely, that is one for social evolution scientists to muse upon.

However a more insidious connotation which occurs to me is the heirarchical context of these practices in their original location. These were monasteries and a lot of them essentially schools for the young, part of the apparatus of government, education and cohesive nation building.

Buddhist theocracy often portrayed as the height of compassionate wisdom, may or may not be so depending on how it was implemented but as a means of control kept populations, sometimes marked by male excess sex ratio, from degenerating into the kind of gang war seen in China and Tibet under Mao, Cambodia under PolPot and currently in Mayanmar.

The evident heirachicalism of both theocracies and revolutionary armies is very similar to Christian monastic theocracies and the academic heirarchy derived from them. Its widespread recurrence attributable to human nature, due again to social evolution.

Importing mindfulness and other monastic techniques into psychotherapy brings an unspoken legacy of the heirarchical context in which the methods developed and attitudes appropriate to group leadership by any individual propounding these techniques, are unconsciously transferred along with the technique because of its origin and mystique. This synergises with the professional business of building reputation, influence and income which is so natural to human nature. Given their origin such attitudes can convey a conformist if not cultish tendency.

I think democracy and the enlightenment make it possible for people to develope and speak their minds as individuals and the best educational institutions and individuals seek to to achieve this and rise above conformism and the danger of cultishness which our natural social impulses create. Whereas less established and regulated institutions and less elevated individuals sometimes employ conformism and cultishness to maintain control, which runs the risk of vying for power between different groups as a natural corollary, in a recapitulation of human instincts for tribal warfare which are our genetic legacy from millions of years of evolution.

I think we should be very wary of what we do as a society to promote so called peace of mind and should seek to educate individuals beyond the need to conform to groupthink yet enable us all to cooperate respectfully within the philosophy of democracy, which is a delicate balance. From this perspective mindfulness is a double edged sword and its not so much what you think you are doing as the way that you do it.

 

A simple criterion I use is whether I have control over the situation. We are programmed to anticipate, obsess and panic, but there is no point if there is nothing you can do to change the situation. Mind can override the evolutionary programming to some extent if the programming only makes the situation worse.

How?

That's also something you don't have control over. Theravadan Buddhism teaches you that the dependency on externalities is an impediment to wellbeing and true happiness. Support is no guarantee to free yourself from the "second suffering". It can in fact can bring about the third suffering if you don't have the support that you expect.

Sure, it's perfectly reasonable for people to panic and stampede out of the theatre on fire. Doesn't mean that that's what they should do.

 

That is not what I meant, so I’ll try to expand on it: my question is what would be required of a person to not be able to react to things. Not what should or should you not react to.

From the post:

It’s irrelevant what any kind of Buddhism teaches you, when discussing if the western medicalised version of mindfullness should be encouraged for chronically ill people.

How is what you «should» do relevant to this discussion? And who even get to define what anyone «should» do in any given situation? And how is this a comparable situation to chronic illness?

 

You simply decide. That's only requirement. Does it take some practice? maybe. Training? No.

The post makes issue of conflating mindfulness with meditation. Seems like you are conflating too.

That is not what I'm discussing. I'm talking about mindfulness, not medicalized whatever that conflates mindfulness with meditation. Of course Buddhism is relevant. That is where the concept of mindfulness originates, medicalized or not. That's the point of the article after all.

Huh? If you are still talking about mindfulness, it is you that decide what to do about your situation. Feel free to expand if that's not what you were asking.

It is comparable since there is nothing you can do about in either situation. You can't put out the fire; you can only react/not react to your best benefit.