Imagine this scenario. Harry wakes up on a typical workday, a Wednesday, in a mood—a frighteningly intense mood. A free-floating anxiety courses through his body, making him edgy and angry. When he gets up and goes into the kitchen, he hears his roommate opening a bag of chips to put a handful in his brown-bag lunch. The crinkling of the chip bag sounds like the roar of a jet engine to Harry; it’s that irritating. He wants to scream at his roommate to quiet down and just go away, now.
He keeps it together enough to let his roommate get on with his day, but these feelings scare Harry. He feels he may be losing control altogether. How can he concentrate? How can he work with others? Perhaps he should just go back to bed and curl up in a ball, but no, he’s been there before. That could take him in a downward spiral of indeterminate length, a deep, dark funk.
Harry stands there frozen in the kitchen, teetering uncertainly between alternative versions of hell, barely able to find a sliver of stable ground to walk on. He holds his head in his hands and starts to cry. He wonders yet again whether life is worth living. His friends and family and coworkers will react with a familiar surge of pain and fear when they eventually hear his latest tortured cry for help. In two days, his ten-year-old son will be coming for his biweekly weekend stay—or not. Harry’s pain will soon be rippling widely.
• • •
Harry’s story is based on a real person. His name has been changed and some details altered to preserve anonymity. It’s a story that is not unlike that of many people dealing with mood disorders and depression. It may resonate with your own experience, since we have all felt ourselves lose control of our emotions and moods, fearing that any form of equilibrium would elude us. We know people who do battle with fluctuating moods on a regular basis. Some are on medication, some are hospitalized, and some are using methods and developing skills to supplement or substitute for medication or therapy.
Because we know people by name—people who are our friends—or because we have grappled with an uncontrollably wild and potentially destructive mind ourselves, we think of these mental challenges and disorders as personal problems. But when you add up all the people going through this personal problem, you end up with a problem for all of us, a public health problem. It’s like traffic. It’s a personal problem when I can’t get to work on time, but the traffic that’s tied up every day citywide, eating up gas and causing pollution, is a problem for all of us, and we have to take it on together. Our collective mental health is one of those big traffic jams we need to look at from a larger perspective.
According to the National Institutes of Mental Health, in 2014, an estimated nearly 16 million adults aged 18 or older in the United States had at least one major depressive episode in the past year, approaching 7% of all US adults. And close to 10% of adults in the country are affected by mood disorders generally, more than the population of greater Los Angeles. And these are not just people having a rough day. Living with deeply unstable moods takes a toll. The World Health Organization estimates that depression is the leading cause of disability for people in midlife and for women of all ages. The most common approach for those who seek treatment for depression is anti-depressant medications, whose usage in the US doubled between 1998 and 2010 and increased fivefold from 1988. Of women in their forties and fifties, an estimated 23% take antidepressants.
Mindfulness has been demonstrated in many contexts to help people with mental illnesses and post-traumatic stress. The evidence base is small and the scientific study is in its infancy, but having practiced mindfulness meditation most of my life, I’ve come to believe that the habit of taking time to be with oneself and pay simple attention to what’s going on in your mind and body can be a powerful way to come to understand your emotions better, and to ride and regulate them. While I’ve never thought meditation brought instantaneous magical powers—such that someone like Harry, writhing in mental anguish in his pajamas in his kitchen, could simply sit down, meditate, and have his troubles go poof—early scientific evidence and anecdotal reports of meditators lead one to wonder whether mindfulness could be a means to provide mental healing and stability for the many millions of people suffering depression, other mood disorders, and mental health challenges generally. Could mindfulness, in fact, be the future of psychotherapy?
To take on this question I talked with two clinical psychologists and researchers who care deeply about mindfulness and therapy. In fact, Zindel Segal and Sona Dimidjian had recently finished a paper on the prospects for ongoing scientific study of mindfulness-based interventions (published in the October 2015 issue of American Psychologist). They asked what it might take for mindfulness to have a lasting impact on public health within our mental health systems, and in particular what kind of scientific research would be required. Segal is one of the developers and founders of Mindfulness-Based Cognitive Therapy (MBCT) and Dimidjian, who has taught MBCT for many years, including together with Segal, has collaborated with him to create Mindful Mood Balance, a program they are piloting that would allow people to take MBCT at a distance, using their phone, tablet, or computer.
In 2014, nearly 16 million adults aged 18 or older in the US had at least one major depressive episode in the past year.
Among his several distinguished positions, Segal is the Director of Clinical Training in the Graduate Department of Clinical Psychological Science at the University of Toronto Scarborough, so he is intimately involved in the training of a next generation of mental health clinicians. At our first lunch, down the street from the U of T, he wanted to talk about mindfulness not as something that would “replace” therapy and existing therapeutic methods and systems, but that would leverage the power of therapy by providing another “skills-based” approach with results supported by research. Segal is a great interlocutor, which is no surprise, since cognitive therapy is all about an inquiring dialogue about what’s going on in your mind. He began a little rhetorical conversation:
“What is therapy really good at historically?”
“Insight.”
“But are insights enough?”
“No, for real sustainable change to happen, the insights need to be married to skills that can be put into action—successively. And that is something mindfulness provides par excellence. We all love that moment of insight, and it keeps people coming back to therapy sessions. But the working-through part, where you encounter a challenge again and again and learn to embrace it, nonjudgmentally, that’s where you put the insights into effect in your life.”
Segal points out that he did not come to mindfulness as part of a personal life quest, so he doesn’t feel any need to proselytize for the practice. He came to it as a researcher and clinician hoping to find ways that more people could get better. In particular, his work focused on the problem of how people who had recovered from depression could still relapse easily if something triggered a sad mood, which in turn would bring on feelings of inadequacy—the downward spiral of depression. “The experience of depression can establish strong links in the mind between sad moods and ideas of hopelessness and inadequacy,” Segal told Sharon Begley for the book