Is Mindfulness Doomed to Become a Fad?

Is mindfulness already a fad or doomed to become one? I started thinking about this recently after reading a blog post by Dr. David Allen, who wrote: "The latest fad in both psychotherapy and self help is 'mindfulness.'" While I agree with his article's point that it's better to help people change their environment if the environment is causing them distress, I thought calling mindfulness a "fad" seemed overly dismissive.

Mindfulness is certainly becoming more popular. Multiple therapies have been developed in recent decades that incorporate it, including mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and dialectical behavior therapy (DBT). Jon Kabat-Zinn's mindfulness-based stress reduction (MBSR) program predates those therapies and has resulted in numerous books, CDs, and workshops. Google has a mindfulness class called Search Inside Yourself, and there's even a mindfulness conference for tech types, Wisdom 2.0.

Has it all gone too far? To find some objective evidence, I used Google Trends to compare mindfulness with some other therapies that people may search for online.

Mindfulness certainly appears to be ascending rapidly, while the other therapeutic modalities show a slow but steady decline in search interest. But does this constitute a fad? Google defines "fad" as "an intense and widely shared enthusiasm for something, esp. one that is short-lived and without basis in the object's qualities; a craze." Here's the Wikipedia entry about fads:

A fad is any form of behavior that develops among a large population and is collectively followed enthusiastically for a period of time, generally as a result of the behavior being perceived as popular by one's peers or being deemed "cool" by social media. A fad is said to "catch on" when the number of people adopting it begins to increase rapidly. The behavior will normally fade quickly once the perception of novelty is gone.
[…]
Though the term trend may be used interchangeably with fad, a fad is generally considered a quick and short behavior whereas a trend is considered to be a behavior that evolves into a relatively permanent change.

I turned to Google Trends again, this time comparing mindfulness to a few things that definitely struck me as fads: low carb diets, acai berries, and twerking (which granted may be more of an Internet meme).

As you can see, mindfulness thus far has not behaved like these other fads. The low-carb craze was at a peak when Google first came to life in the early 2000's, dropping rapidly but having mini-peaks each new year as people explore dieting options. Searches for "acai" and "twerking" took off, but then fell fairly rapidly, though it seems the tails can stretch on for years. This graph seems to concur with my professional experience: when I ask my adult patients about their knowledge of mindfulness, out of 10 people, only 3 or 4 have ever heard of it, and out of those, only 1 might have a vague notion of what it means.

The enthusiasm for mindfulness is certainly more prevalent amongst therapists and academics than the general population, as shown by the rapid increase in Pubmed articles containing "mindfulness:"

I believe that this interest by itself does not constitute a fad, as long as the research bears fruit. Time will tell, and based on my own experiences in using mindfulness-based approaches with my patients, I'm optimistic that the evidence base in support of mindfulness will only continue to grow. More worrisome is the possibility that corporate America may be (mis)using mindfulness to make its workers more productive and less stressed, rather than creating less stressful work environments. Other people more knowledgable about mindfulness than I have written thoughtful articles about the commercialization of mindfulness and its implications. I especially recommend Beyond McMindfulness by Ron Purser and Beyond McMindfulness: A Thoughtful Reply by Elisha Goldstein.

And then there's this depiction of mindfulness in the popular culture:

You can certainly be forgiven for looking at the Time cover and thinking, "how can that not be a fad? Or at the very least a trend?" I would argue that mindfulness is neither of those things, since it's a concept that is so helpful for well-being, has been in use for thousands of years, and the idea of being present and focusing on the here-and-now is central to many therapeutic interactions. I would argue that mindfulness is analogous to physical exercise, which is also important for health. Nobody calls exercise a fad. But specific commercialized forms, endorsed by celebrities, overselling the benefits and underselling the necessary effort, can certainly constitute fads. Putting Photoshopped blondes meditating on the cover of Time to sell magazines? I certainly hope that's a fad.

Louis C.K., Mindfulness Guru?

Note: The last couple of months have been very busy for me, so I apologize for the infrequency of posts. Now that things have gotten back to normal, I hope to resume posting weekly.

Louis C.K.'s recent appearance on Conan has already been linked to on multiple sites, with most of the headlines reading something like "Louis C.K. on why kids shouldn't have smartphones." Check out the video below if you haven't yet see it:



C.K. is one of my favorite comedians, and this clip shows why. Like many comedians, he often says things that people are thinking but are too afraid to say themselves. Here, he puts a voice to many things that I as a child psychiatrist would love to say to parents, but have a hard time finding a diplomatic way to do so.

To me, what he said is not about "hating cellphones" or "kids shouldn't have cell phones." His riff is much broader than that. He starts out talking about parenting, and how parents give in to their kids and get them phones because "all the other kids have the terrible things." Of course, this happened long before cell phones became common, and gets to the heart of how much trouble parents have in setting appropriate limits because they are afraid of momentarily making their child sad or mad. However, if a parent doesn't teach his or her child how to handle being being disappointed or told "no," then who is? Why not "let your kid go and be a better example to the other [bleeping] kids," as Louis C.K. says?

He then talks about how face-to-face interactions can help build empathy, but when a child engages in cyber-bullying, he or she does not get the feedback of seeing the other child's expression turn to sadness, and instead "when they write 'you're fat', then they just go mmm..that was fun, I like that."

Next, C.K. gets to the heart of what mindfulness is about to me. "You need to build an ability to just be yourself and not be doing something. That’s what the phones are taking away. The ability to just sit there, like this. That’s being a person." I would add that of course, the ability to just sit and tolerate being yourself was already difficult before smartphones became ubiquitous, with a 2006 Kaiser Family Foundation report showing that American youth spent almost 4 hours a day watching TV/videos, over 1.5 hours listening to music, about 1 hour on a computer, and almost another hour playing video games, with many of these activities happening simultaneously. Let's not forget all the other mindless ways of distraction other than smartphones.

C.K. even ventured into existentialism, how "underneath everything in your life, there's that thing, that forever empty…that knowledge that it's all for nothing, and that you're alone." He dares to utter the truth, long known to Buddhists, that "life is tremendously sad, just by being in it." He adds, "That's why we text and drive, pretty much 100% of people who are driving are texting…people are willing to risk taking a life and ruining their own cause they don't want to be alone for a second."

Lastly, Louis shared a story about how he was driving one day, and a Bruce Springsteen song came on that made him feel really sad. Instead of avoiding his sad feelings by texting people, "I pulled over, and I just cried…so much, and it was beautiful…sadness is poetic, you're lucky to live sad moments…I was grateful to feel sad, and then I met it with true, profound happiness." His overall message is one that I try to tell patients all the time. They often tell me that they don't let themselves feel sadness or grief, because they're afraid of feeling overwhelmed. However, attempts to suppress those sad feelings just get in the way of a person truly being content with life. As C.K. said, "Because we don't want the first bit of sad, we push it away...and you never feel completely sad or completely happy, you just feel kinda satisfied with your products, and then you die."

Despite the jokiness of the delivery, Louis C.K.'s message is quite serious and well thought-out. I hope everyone listens.