MEDITATION AS MEDICINE

A Critique

Wakoh Shannon Hickey

T wenty-seven adults are arrayed at the front of a large, sloping lecture

hall: some lying on their backs, some upright in free-standing chairs,
some in the tiers of seats bolted to the floor. Most appear to range in
age from mid-forties to mid-fifties. The lights are dim, most eyes are
closed, and except for occasional fidgeting, everyone is silent and still.
The instructor, a kindly psychiatrist who bears a striking resemblance to
Santa Claus, has instructed everyone to focus attention on the ebb and
flow of the breath, counting exhalations from one to eight, then return-
ing to one. Each time the mind wanders off, the meditator should begin
counting again at one: the point is not to get to eight, but to continually
refocus attention on the breath.
Toward the end of the evening, participants gather on chairs in a cir-
cle, each speaking in turn about her or his experience. One woman says
she hates meditating, because her mind wanders constantly, and her
thoughts are full of ‘‘mean’’ commentary about herself. A Vietnam vet-
eran remarks that for thirty years he feared that ‘‘if I allowed myself to
have the memories they’d kill me, so I fought them off like I fought the
war.’’ Meditation has helped him to see that his thoughts will not kill
him, and that facing the painful memories relieves the depression and
anxiety caused by his avoidance. Another woman’s voice breaks as she
remarks that part of her resistance to meditation emerges from a belief
that ‘‘I don’t deserve happiness.’’
Scenes like this are being repeated in hundreds, perhaps thousands,
of settings around the United States. They are part of a program called

168 . CROSSCURRENTS
 WA KO H S H A N N O N H I C K EY

Mindfulness-Based Stress Reduction (MBSR), which molecular biologist

Jon Kabat-Zinn, Ph.D., developed at the University of Massachusetts Medi-
cal Center in 1971. During the eight-week MBSR program, participants
attend a two-and-a-half hour class each week. They learn various forms
of sitting and walking meditation, do visualizations to cultivate loving-
kindness, and practice simple yoga postures. They also agree to complete
daily homework assignments: to meditate and do yoga for forty-five min-
utes each day, and to keep a journal recording these practices and the
practitioners’ responses to stressful situations.
Other therapeutic protocols employing mindfulness practice have
been developed specifically for dealing with psychological problems.
Mindfulness-Based Cognitive Therapy (MBCT) has adapted the MBSR pro-
gram for people suffering from depression.1 Dialectical Behavioral Ther-
apy (DBT) is a protocol for treating Borderline Personality Disorder
developed by psychotherapist Marsha Linehan, Ph.D. It includes a form
of mindfulness derived from Zen meditation and seems to be effective
for addressing a disorder that is notoriously difficult to treat.2 For sim-
plicity’s sake, this article will focus on MBSR, the largest of the
programs.

Meditation as medicine: the scope

The precise scope of MBSR is unknown, because the program is not cen-
trally controlled. In 1996, fifteen years after MBSR was launched in Mas-
sachusetts, approximately 120 programs were operating in the U.S., and
‘‘a few’’ in other countries. A year later, the number had more than dou-
bled.3 As of April 2010, a database hosted by the Center for Mindfulness
in Medicine, Healthcare, and Society, which Kabat-Zinn founded, listed
553 MBSR programs around the world. The Center estimates that ‘‘tens
of thousands’’ of people worldwide have completed the program.4 A slew
of medical studies on MBSR have linked it to faster recovery from psoria-
sis outbreaks, improved cardiac health, fewer post-chemotherapy symp-
toms among cancer patients, greater immune responses to flu vaccine,
and increased activity—possibly even neural growth—in areas of the
brain associated with positive mood.5
I have no doubt that mindfulness can be very helpful to people in a
variety of ways. I have practiced it myself for more than twenty-five
years and have taught it to others, and I have both experienced and

JUNE 2010 . 169

MEDITATION AS MEDICINE: A CRITIQUE

observed its beneficial effects. Yet I have a number of concerns about

the way mindfulness practice has become commodified in recent years. I
find some of the recent clinical research on meditation very intriguing.
Yet I have some questions about the research methods and about how to
interpret the resulting data. I will explain those concerns below, but first
I want to do two things: to show the dramatic increase in medical
research on meditation over the past decade, and to consider some of
the rhetorical strategies that underlie this increase. Then, I will offer five
critiques of MBSR and the booming industry in meditation-as-medicine.
Over the past thirty years, literally thousands of books and articles
describing psychological and physiological effects of meditation have
been published.6 Since 1972, the federal government has funded hun-
dreds of research studies dealing with various forms of meditation. In
fiscal years 2008 and 2009 alone, it spent nearly $51 million on this
research. Initially, scientists studied the effects of Transcendental Medita-
tion, as taught by the Indian guru Maharishi Mahesh Yogi. Today, most
studies employ some form of mindfulness meditation—most often
MBSR, MBCT, or DBT. A handful of studies employ other forms of medi-
tation, and some do not specify the type of meditation or mindfulness
practice.7 This is one of the problems with the research: ‘‘meditation’’ is
not well defined.
In the chart at Figure 1, the solid line represents medical research
on all types of meditation funded by the United States government since
1998. It funded seven studies that year, eighty-nine in 2008, and 122 in

Figure 1. Federally funded research on meditation 1998–2009.

170 . CROSSCURRENTS
 WA KO H S H A N N O N H I C K EY

2009.8 The dashed line represents research studies that specifically iden-
tify mindfulness, and the dotted line represents those that explicitly
identify Transcendental Meditation. In 2009, the government funded
four studies of TM and ninety-seven studies of mindfulness (all types).
These are just federally funded research studies. Next, let us look
more broadly at clinical trials: funded publicly, or privately, or both. As
of late January 2010, the National Institutes of Health was tracking 132
clinical trials dealing with meditation of all types, of which sixty-one
were recruiting or preparing to recruit volunteers, thirty were actively
underway, and forty were complete. (One had withdrawn.) Among those,
113 trials studied some form of mindfulness and fifty-seven dealt with
MBSR. Thirty-two trials employed MBCT, and fifteen employed DBT.9
Thus, 79 percent of studies dealing with meditation and 92 percent of
those dealing with mindfulness used one of these three protocols.

‘‘Buddhist meditation (without the Buddhism)’’

Jon Kabat-Zinn has said explicitly that he wants to promote meditation
in a way that does not scare people off by associating it with unfamiliar
religious practices and Buddhist technical terminology. When he began
to develop MBSR in 1971, he anticipated that doctors and scientists, as
well as many patients, would resist a program explicitly grounded in a
particular religious tradition, especially a foreign one. Indeed, over the
past century or more, orthodox physicians have regularly denounced
promoters of alternative medicine as quacks or charlatans. So it is under-
standable that Kabat-Zinn’s rhetoric has carefully distanced MBSR from
Buddhist and Hindu teachings that regard meditation and yoga as reli-
gious disciplines. He calls the mindfulness practice taught in MBSR
‘‘Buddhist meditation (without the Buddhism).’’10
Expressing another pragmatic concern, Kabat-Zinn has said: ‘‘[I]f you
want to be able to integrate into medicine … you’ve got to be able to
charge the insurance companies for this.’’11 To reach his intended audi-
ences effectively, ‘‘[T]he language that we use … is how to take better
care of yourself; how to live more skillfully and more fully; how to move
toward greater levels of health and well-being.’’ He also stresses that
MBSR is ‘‘a complement to medical treatment, not a substitute for it.’’12
When asked at a conference on American Buddhism whether MBSR
might be misappropriating Buddhist traditions, Kabat-Zinn said, ‘‘I really

JUNE 2010 . 171

MEDITATION AS MEDICINE: A CRITIQUE

don’t care about Buddhism. It’s an interesting religion but it’s not what I
most care about. What I value in Buddhism is that it brought me to the
Dharma.’’13 Although he has been involved in explicitly Buddhist medita-
tion practices for several decades, he can make this rather striking
remark because he has defined the key term, ‘‘Dharma,’’ as trans-reli-
gious, trans-cultural, and trans-historic.
He says, ‘‘The word Dharma, to me, is pointing to something that
really is universal.… The cultural and ideological overlays, and the his-
torical elements of [Buddhism], beautiful and honorable and wonderful
as they are, are not necessarily the heart of the Dharma, which tran-
scends them.’’14

Two problematic assumptions

Kabat-Zinn’s remark is based on two assumptions that I want to chal-
lenge. The first is the assumption that the central practice of Buddhism
is, and has always been, meditation. Although this is a common percep-
tion among Americans, any careful study of Buddhist history will reveal
that meditation has almost always been a specialty of a small minority
of monks and nuns.15 Most Buddhist practices have centered on devotion
and generating merit (or good karma) for oneself and one’s ancestors.
The focus on meditation, especially among laypeople, is at most a cen-
tury and a half old, in a tradition that spans more than two and a half
millennia. It has become widespread only in the past fifty years or so.
The second faulty assumption is that Buddhist or Hindu religious ideas
or practices are universal, transcending any particular cultural or histori-
cal context. Scholars of religion, including scholars of Buddhism, have
pointed out that this perennialism itself is a product of modern, Euro-
American colonialism.16
Kabat-Zinn’s assumptions about meditation and the universality of
Dharma place him squarely in a cultural, historical, and religious con-
text that includes Swedenborgianism, Mesmerism, Transcendentalism,
pragmatism, Theosophy, and New Thought. These Western metaphysical
traditions interacted with modernist re-interpretations of Buddhism and
Hinduism in Asia, which were produced in response to particular histori-
cal, political, religious, and economic conditions in Asia. As a result of
these interactions, we tend nowadays to talk about how meditation and
yoga can improve physical and mental health, rather about how they

172 . CROSSCURRENTS
 WA KO H S H A N N O N H I C K EY

can help us to deconstruct the ‘‘self,’’ realize Nirvana, and/or prevent

negative future rebirths. But Kabat-Zinn, like other contemporary pro-
moters of meditation-as-medicine, is silent about (or perhaps unaware
of) this history.17 Robert Sharf, a respected scholar of Buddhism, com-
mented,

[I]t will take a long time—perhaps centuries—for the West to

engage with the Buddhist tradition at a deeper level. Such an
engagement will require that we see past the confines of our own
historical and cultural situation and gain a greater appreciation of
the depth and complexity of the Buddhist heritage. Certainly one
impediment to that is the idea that the only thing that matters is
meditation and that everything else is just excess baggage.18

So my first objection to Kabat-Zinn’s rhetoric is that it is, at best,

myopic. At worst, it may be intellectually dishonest. I understand why
he uses the rhetorical strategies he does, and I can see how they might
seem necessary to accomplish the larger goal of making a helpful prac-
tice more accessible to people who might never try it otherwise—a goal
that I applaud. But this rhetoric also erases two or three millennia of
Hindu and Buddhist history—and the monks, nuns, monarchs, nobles,
and ordinary laypeople who preserved and developed it. Kabat-Zinn him-
self learned mindfulness from Buddhist teachers, in Buddhist communi-
ties. I do not actually think there is anything inherently wrong with
practicing meditation or yoga or lovingkindness for better wellbeing. It
is recognized as a legitimate goal within these traditions, albeit a lesser
one than enlightenment or union with Brahman. What I am critiquing
here is a rhetorical erasure of the past, and the assumption that one’s
own social, cultural, and historical perspective applies universally.
My second concern is that MBSR separates meditation and yoga not
just from their doctrinal contexts, but from their moral frameworks. In
both religious traditions, moral conduct is the foundation of meditation
practice, because one cannot have peace of mind if one’s behavior is
unethical. In Buddhism, lay practitioners are expected to observe five
basic moral precepts: not killing, lying, stealing, engaging in sexual mis-
conduct, or intoxicating oneself or others. Buddhist monks and nuns
adopt additional precepts, numbering from ten to more than 300,

JUNE 2010 . 173

MEDITATION AS MEDICINE: A CRITIQUE

depending upon the tradition and, in some cases, the gender of the prac-
titioner. (In some orders, nuns take more vows than monks.) Exemplary
conduct is what makes monks and nuns worthy of the honorific title
‘‘Venerable,’’ and that is why it is considered meritorious for laypeople
to make donations to the monastic Sangha. Doing so generates positive
karma. The purpose of moral conduct is to overcome greed, hatred, and
ignorance, and move along the Path toward enlightenment. Moral con-
duct (yama and niyama) is also the foundational practice of yoga, accord-
ing to the Eight Limbs of Yoga developed by Patanjali. The ultimate
purpose of yoga is to realize union with the Divine. In MBSR, partici-
pants in the day-long meditation retreats that are part of the training
may be asked to observe the five Buddhist precepts for laypeople on that
particular day. But moral conduct is not typically part of MBSR training;
these stipulations are not universal; and they were not part of the
courses I will discuss in the following paragraphs. Furthermore, although
the Center for Mindfulness offers training and certification programs for
MBSR teachers, and recommends both ongoing meditation practice and
graduate-level education in a relevant discipline, it does not regulate
teachers or require any certification to teach the program.19
Nor is community central to MBSR training, which is my third con-
cern. The program, like the American Vipassana movement that under-
lies it, is highly individualistic. In Buddhist practice, as in many other
religious disciplines, community is central. Even hermits depend upon a
community for food. Community, or sangha, is one of the Three Trea-
sures of Buddhism. MBSR, on the other hand, consists of classes, work-
shops, retreats, books, and audio materials that individuals buy. In class
sessions, students spend very little time interacting with one another, so
relationships have little opportunity to form. Students’ formal relation-
ship with the teacher ends when the course ends. One consequence of
this individualistic structure is that people may stop practicing once the
course ends, which obviously limits its effectiveness.
In two MBSR classes that were part of a research study at Duke Uni-
versity, participants reported a significant drop in the amount of medita-
tion they did after they completed the course. Many stopped meditating
altogether without the support of weekly class meetings. Of the fifty-six
people who originally enrolled in the study, only twenty-four completed
the program and showed up for the follow-up assessment eight weeks

1 74 . CROSSCURRENTS
 WA KO H S H A N N O N H I C K EY

later. On average, they reported meditating about half as much as they

had during the class. Meditation is very difficult to maintain on one’s
own, especially when difficult emotions or memories arise.
A fourth problem is that MBSR stresses individual practice as the key
to wellbeing, so it tends to avoid any analysis of the systemic or institu-
tional causes of suffering. These include racism, sexism, and poverty, all
of which can affect access to medical care, at least in the United States.
Kabat-Zinn is clearly aware of and concerned about these issues,20 but
the program itself is individualistic. This inattention to systemic suffer-
ing is a feature MBSR shares with metaphysical religions that promote
positive thinking or the so-called ‘‘prosperity gospel.’’ If you are suffer-
ing, it is your individual psychological problem.
One reason for this in MBSR may be the socio-economic status of
people who take the courses. In most cases, the program is only fully
accessible to people who can spare several hundred dollars and devote
about eight hours a week to it for two months. In the Duke study just
mentioned, MBSR classes were offered free of charge, in part to attract
people who otherwise could not afford the normal fee of $370 to $395.21
Nevertheless, 35 percent of the participants recruited reported annual
incomes over $65,000. Only 4 percent had incomes below $20,000. And
yet, according to the most recent available data from Durham County,
approximately 22 percent of local adults had incomes below the federal
poverty level of $9,750. Among women, 32.5 percent of those without
children and 38 percent of those with children had incomes below the
poverty line.22
Of those who took a Duke MBSR course in the spring of 2007, 85
percent had college or graduate-level education. Twenty-three percent
had college degrees; 11 percent reported some graduate-level education;
and 51 percent had graduate degrees. And although the population of
Durham County was 48 percent white and 38.5 percent black, 91 percent
of the MBSR participants were white. While these results cannot be gen-
eralized to all participants of MBSR courses, they do suggest sharp dis-
parities between the general population of Durham and the people
taking MBSR courses there.23
If this demographic profile does hold true more generally, however,
then perhaps one reason the program does not include systemic analyses
of illness and other forms of suffering is that the people involved are

JUNE 2010 . 175

MEDITATION AS MEDICINE: A CRITIQUE

less afflicted by racism and poverty, which are systemic problems affect-
ing health and access to medical care.24
My fifth and final critique has to do with methodological problems
associated with medical research on meditation. Some of the studies are
quite intriguing. Yet peer-reviewed journals have noted a variety of
methodological concerns. These include inadequate controls, small sam-
ple sizes, demographic homogeneity among participants, and inattention
to gender as a variable. In response to such critiques, researchers have
attempted to improve their study designs. Some more recent review arti-
cles have reiterated the need for methodological rigor but are more posi-
tive about the results.25 Although meditation may not be sufficient or
appropriate for some people (e.g., those suffering from severe post-trau-
matic stress, major depression, or psychosis), mindfulness, in conjunction
with medication, does seem to be helpful to those who have difficulty reg-
ulating their emotions.
Brain research on meditators is more problematic. Again, some find-
ings are very intriguing. Certainly, the images produced by PET scans
and functional MRIs of meditators appear to be very clear and compel-
ling. Yet we must bear in mind that at every stage of production, these
images are generated in a ‘‘black box’’ of assumptions, technical proce-
dures, and human factors that we cannot see.26 For example, extraordi-
nary results depend upon comparison to a theoretical ‘‘normal’’ result,
but ‘‘normal’’ is very difficult to define. In studies of brain activity using
PET scans (positron-emission tomography, which creates three-dimen-
sional images of the brain by tracing movements of radioactive isotopes),
‘‘normal’’ typically means a right-handed white male. This means that
variations in race, gender, left-handedness (and possibly age) could pro-
duce different results. In addition, scans of research subjects’ brains are
compared to a hypothetical ‘‘average’’ brain—a mathematical model that
can vary from laboratory to laboratory. Brain activity also varies accord-
ing to factors such as time of day, and whether the subject has recently
ingested substances such as caffeine or nicotine. Because the imaging
technology is expensive, sample sizes are typically small, which affects
the degree to which particular results can be generalized.
Data from scans are translated into colored images, an interpretive
process that is not necessarily consistent from study to study, and that
inevitably highlights some differences and downplays others. A focus on

1 76 . CROSSCURRENTS
 WA KO H S H A N N O N H I C K EY

activity in a particular area of the brain also tends to obscure the ways
that brain functions may be distributed across several areas simulta-
neously. The ‘‘resting’’ state between activities under study may be
defined inconsistently from study to study as well, which affects how
results are compared. (And, as has been noted, ‘‘meditation’’ is not
defined consistently or well in clinical research.) The interpretation of
images requires cooperation across multiple scientific disciplines, among
researchers who have different types and degrees of expertise, and possi-
bly competing agendas when it comes to issues like publication credit,
research funding, and career advancement. Although the images may be
very effective rhetorically, the more carefully one peers into the black
box, the more problematic the images become. It is important to be hon-
est about these limitations—even if it makes research funding a bit more
difficult to obtain.
At the 2005 Mind and Life Institute conference on the clinical appli-
cations of meditation, the Dalai Lama was regaled with information
about the latest clinical research on mindfulness. After the final presen-
tation, he remarked: ‘‘For me, analytical meditation is more useful.’’ He
explained, through his translator, that it is important to analyze the
source of one’s pain. Often it is rooted in an effort to grasp at imperma-
nence, or in self-centeredness, or in an unrealistic view of one’s situa-
tion. Each of these problems requires a different kind of approach, he
said, without elaborating. His final remark produced peals of laughter
but was also telling: ‘‘In order to use your intelligence more effectively,
I prefer sound sleep better than meditation.’’27
Advocates of mindfulness training argue that its transformative
power lies in its ability to help people notice their subconscious internal
narratives more clearly, and free themselves from destructive habits of
mind. It helps them to be more fully present and more compassionate
with themselves and with others, which promotes healing. I agree com-
pletely. Again, I practice mindfulness and I teach it to others—usually in
a non-religious way, and always free of charge.28 I also agree that it is
appropriate to ‘‘meet people where they are’’ when offering a practice
that can foster liberation from mental habits that create suffering. Bud-
dhist tradition acknowledges that people have different motives for prac-
tice and are at different stages of development. I have no objection to
meditation teachers doing outreach into new settings, and offering a

JUNE 2010 . 177

MEDITATION AS MEDICINE: A CRITIQUE

beneficial practice to people who might otherwise never set foot in a

meditation hall. I think mindfulness can be helpful to people of any reli-
gion, and to those who are non-religious.
What I find objectionable is the tendency to turn this discipline into
a commodity for sale. To do so risks fostering the very attitudes—greed
and individualism—that both Buddhist and yogic traditions assert are
inimical to liberation.
I also believe long-term formation in religious community can be
very valuable, to the extent that it encourages us to grapple with prob-
lems we might otherwise avoid facing, such as our own self-centeredness
or unwillingness to forgive, and the challenges of welcoming and work-
ing with people we might not like or understand. (Granted, not all reli-
gious communities do this.) Communities can also offer support and
help us to find meaning during periods of difficulty—which, as some
clinical research suggests, can be good for people’s overall health and
happiness.
While I applaud the desire to foster healing that drives many pro-
moters of meditation-as-medicine, I also have the concerns I have enu-
merated here: myopic rhetoric, the removal of meditation practice from
its moral and communal frameworks, a tendency toward individualism
and commodification, and questions about research methodologies.
Above all, while a therapeutic approach to meditation is well suited to
modern consumer capitalism, it does not necessarily contribute to
addressing broader social problems that affect psychological and physical
health, or access to medical care. For that we need to think systemically
about the dynamics of race, gender, and class—and their effects in our
political system, as recent debates over medical insurance reform amply
demonstrate. We must grapple with those issues collectively, and work
collectively for systemic change. In doing so, we need historical and cul-
tural perspective. In short: we need people who are embedded in their
communities and actively engaged in trying to make them healthier.

Works cited
Allen, Nicholas B., Richard Chambers, Wendy Knight, and Melbourne Academic Mind-
fulness Interest Group, 2006, ‘‘Mindfulness-Based Psychotherapies: A Review of Conceptual
Foundations, Empirical Evidence and Practical Considerations.’’ Australian & New Zealand
Journal of Psychiatry 40(4), pp. 285–94.

178 . CROSSCURRENTS
 WA KO H S H A N N O N H I C K EY

Baer, Ruth A., 2003, ‘‘Mindfulness Training as a Clinical Intervention: A Conceptual

and Empirical Review.’’ Clinical Psychology: Science and Practice 10(2), pp. 125–43.
Bishop, S. R., 2002, ‘‘What Do We Really Know About Mindfulness-Based Stress Reduc-
tion?’’ Psychosomatic Medicine 64, pp. 71–83.
Brown, Kirk Warren, and Richard M. Ryan, 2003, ‘‘The Benefits of Being Present:
Mindfulness and Its Role in Psychological Well-Being.’’ Journal of Personality & Social Psychology
84(4), pp. 822–48.
Davidson, R. J., J. Kabat-Zinn, J. Schumacher, M. Rosenkranz, D. Muller, S. Santorelli,
F. Urbanowski, A. Harrington, K. Bonus, and J. Sheridan, 2003, ‘‘Alterations in Brain and
Immune Function Produced by Mindfulness Meditation.’’ Psychosomatic Medicine 65, pp. 564–
70.
Dumit, Joseph, 2004, ‘‘Producing Brain Images of Mind,’’ in Picturing Personhood: Brain
Scans and Biomedical Identity, Princeton, NJ: Princeton University Press, pp. 53–105.
Hickey, Wakoh Shannon, 2008, ‘‘Mind Cure, Meditation, and Medicine: Hidden Histo-
ries of Mental Healing in the United States.’’ Ph.D. diss., Duke University.
Hoppes, Kimberly, 2006, ‘‘The Application of Mindfulness-Based Cognitive Interven-
tions in the Treatment of Co-Occurring Addictive and Mood Disorders.’’ CNS Spectrums
11(11), pp. 829–51.
Jarrell, Howard R., 1985, International Meditation Bibliography 1950–1982. Vol. 12, ATLA
Bibliography Series, Metuchen, NJ and London: The American Theological Library Associa-
tion and The Scarecrow Press, Inc.
Kabat-Zinn, Jon, 1994. Wherever You Go There You Are. New York: Hyperion.
Kabat-Zinn, Jon, 1998, ‘‘Toward the Mainstreaming of American Dharma Practice,’’ in
Al Rapaport, and Brian D. Hotchkiss ed., Buddhism in America: The Official Record of the Land-
mark Conference on the Future of Buddhist Meditative Practices in the West, Boston, January 17-19,
1997, Rutland, VT: Charles E. Tuttle, Co., pp. 478–528.
Kabat-Zinn, Jon, 2000, ‘‘Indra’s Net at Work: The Mainstreaming of Dharma Practice
in Society,’’ in Gay Watson and Stephen Batchelor, eds., The Psychology of Awakening: Bud-
dhism, Science, and Our Day to Day Lives, York Beach, ME: S. Weiser, pp. 225–49.
Kabat-Zinn, Jon, 2005, Coming to Our Senses: Healing Ourselves and the World through Mind-
fulness. 1st ed. New York: Hyperion.
Kabat-Zinn, Jon, and University of Massachusetts Medical Center/Worcester, Stress
Reduction Clinic, 1991. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face
Stress, Pain, and Illness. New York: Delta.
Leuchter, A. F. et al., 2002, ‘‘Changes in Brain Function of Depressed Subjects During
Treatment with Placebo.’’ American Journal of Psychiatry 160(2), pp. 387–8.

JUNE 2010 . 179

MEDITATION AS MEDICINE: A CRITIQUE

Linehan, Marsha, 1993, Cognitive-Behavioral Treatment of Borderline Personality Disorder.

New York: Guilford Press.
Lopez, Donald S., Jr., 2008, Buddhism & Science: A Guide for the Perplexed. Chicago: Univer-
sity of Chicago Press.
Lutz, A., L. L Greischar, N. B. Rawlings, M. Ricard, and R. J. Davidson, 2004, ‘‘Long-
Term Meditators Self-Induce High-Amplitude Gamma Synchrony During Mental Practice.’’
Proceedings of the National Academy of Sciences 101, pp. 16369–73.
McMahan, David L., 2008, The Making of Buddhist Modernism. New York: Oxford Univer-
sity Press.
Monro, Robin, A. K. Ghosh, and Daniel Kalish, 1989. Yoga Research Bibliography: Scientific
Studies on Yoga and Meditation. Cambridge, UK: Yoga Biomedical Trust.
Murphy, Michael, and Steven Donovan, 1999, The Physical and Psychological Effects of Med-
itation: A Review of Contemporary Research with a Comprehensive Bibliography 1931-1996, in
Eugene Taylor, ed. 2nd ed. Sausalito, CA: Institute of Noetic Sciences.
Ott, Mary Jane, Rebecca L. Norris, and Susan M. Bauer-Wu, 2006, ‘‘Mindfulness Medita-
tion for Oncology Patients: A Discussion and Critical Review.’’ Integrative Cancer Therapies
5(2), pp. 98–108.
Payne, Richard K., 2007, ‘‘Traditionalist Representations of Buddhism,’’ in American
Academy of Religion Annual Meeting, Buddhism in the West Consultation. San Diego, CA, forthcom-
ing in Pacific World.
Roepstorff, Andreas, 2004, ‘‘Mapping Brain Mappers, an Ethnographic Coda’’ in R.
Frackowiak et al. eds., Human Brain Function. London: Elsevier, pp. 1105–17.
Schmidt, Stefan, 2004, ‘‘Mindfulness and Healing Intention: Concepts, Practice, and
Research Evaluation.’’ Journal of Alternative & Complementary Medicine 10(Suppl. 1), pp. S7–
14.
Sharf, Robert H., 1995a, ‘‘Buddhist Modernism and the Rhetoric of Meditative Experi-
ence.’’ Numen 42, pp. 228–83.
Sharf, Robert H., 1995b, ‘‘Sanbokyodan: Zen and the Way of the New Religions.’’ Japa-
nese Journal of Religious Studies 22(3–4), pp. 417–57.
Sharf, Robert H., and Andrew Cooper, 2007, ‘‘Losing Our Religion.’’ Tricycle: The Bud-
dhist Review 64(Summer 2007), pp. 44–9.

Notes
1. See http://www.mbct.com, accessed January 29, 2010.
2. Marsha Linehan, Cognitive-Behavioral Treatment of Borderline Personality Disorder, Diagnosis
and Treatment of Mental Disorders (New York: Guilford Press, 1993). See also http://
behavioraltech.org. Linehan is a student of Willigis Jäger, OSB, a Benedictine monk who

180 . CROSSCURRENTS
 WA KO H S H A N N O N H I C K EY

also received authorization as a Zen teacher in the Sanbo-Kyodan school of Zen, a modern
movement that has been active in Buddhist-Christian dialogue. Although marginal in
Japan, Sanbo-Kyodan has been extremely influential in American Zen. Jäger left Sanbo-
Kyodan in 2009 to found his own organization. http://www.willigis-jaeger.de/en/?Zen:
New_Line_of_Zen and http://www.ciolek.com/WWWVLPages/ZenPages/HaradaYasutani.html,
both accessed January 29, 2010. See also Robert H. Sharf, ‘‘Sanbokyodan: Zen and the Way
of the New Religions,’’ Japanese Journal of Religious Studies 22, no. 3–4 (1995).
3. Jon Kabat-Zinn, ‘‘Indra’s Net at Work: The Mainstreaming of Dharma Practice in Soci-
ety,’’ in The Psychology of Awakening: Buddhism, Science, and Our Day to Day Lives, ed. Gay Watson
and Stephen Batchelor (York Beach, ME: S. Weiser, 2000), 239–40.
4. The directory of programs may be found at http://www.umassmed.edu/cfm/mbsr/
index.cfm, accessed April 9, 2010.
5. Links to much of this research can be found at http://psyphz.psych.wisc.edu/web/pubs/
pubs_articles.html#2009. Some representative examples include: S. R. Bishop, ‘‘What Do
We Really Know About Mindfulness-Based Stress Reduction?’’ Psychosomatic Medicine
64(2002); R. J. Davidson and J. Kabat-Zinn et al., ‘‘Alterations in Brain and Immune Function
Produced by Mindfulness Meditation,’’ Psychosomatic Medicine, no. 65 (2003); A. F. Leuchter
et al., ‘‘Changes in Brain Function of Depressed Subjects During Treatment with Placebo,’’
American Journal of Psychiatry 160, no. 2 (2002); A. Lutz et al., ‘‘Long-Term Meditators Self-
Induce High-Amplitude Gamma Synchrony During Mental Practice,’’ Proceedings of the
National Academy of Sciences 101 (2004); Michael Murphy and Steven Donovan, The Physical
and Psychological Effects of Meditation: A Review of Contemporary Research with a Comprehensive Bib-
liography 1931–1996, ed. Eugene Taylor, 2nd ed. (Sausalito, CA: Institute of Noetic Sciences,
1999). See also Jon Kabat-Zinn, Wherever You Go There You Are (New York: Hyperion, 1994);
Michael Murphy and Steven Donovan, ‘‘Toward the Mainstreaming of American Dharma
Practice,’’ in Buddhism in America: The Official Record of the Landmark Conference on the Future of
Buddhist Meditative Practices in the West, Boston, January 17–19, 1997, ed. Al Rapaport and Brian
D. Hotchkiss (Rutland, VT: Charles E. Tuttle, Co., 1998); Michael Murphy and Steven Dono-
van, Coming to Our Senses: Healing Ourselves and the World through Mindfulness, 1st ed. (New
York: Hyperion, 2005); Jon Kabat-Zinn and University of Massachusetts Medical Center/
Worcester Stress Reduction Clinic, Full Catastrophe Living: Using the Wisdom of Your Body and
Mind to Face Stress, Pain, and Illness (New York: Delta, 1991).
6. Murphy and Donovan, The Physical and Psychological Effects of Meditation: A Review of Contem-
porary Research with a Comprehensive Bibliography 1931–1996, 153–277. Most of the references
are articles in peer-reviewed academic and scientific journals; a few are books oriented
toward more general audiences. Of the studies published before 1970, most were authored
in the 1960s by Indian researchers studying physiological effects of yoga and by Japanese
researchers studying effects of Zen meditation. A bibliography published more than a dec-
ade earlier by the American Theological Library Association included more than 2,200
entries, including 937 articles in journals and magazines; more than 1,000 books in Eng-
lish, German, French, Spanish, and Portuguese; 200 dissertations and theses; 32 motion
pictures; 93 sound recordings; and 32 societies and associations, Howard R. Jarrell, Inter-
national Meditation Bibliography 1950–1982, vol. 12, ATLA Bibliography Series (Metuchen, NJ
and London: The American Theological Library Association and The Scarecrow Press, Inc.,

JUNE 2010 . 181

MEDITATION AS MEDICINE: A CRITIQUE

1985). A 1989 bibliography on studies of yoga and meditation lists 1275 articles; 31 books,
dissertations, and reports; and 292 conferences, symposia, and seminars. Robin Monro,
A.K. Ghosh, and Daniel Kalish, Yoga Research Bibliography: Scientific Studies on Yoga and Medita-
tion (Cambridge, UK: Yoga Biomedical Trust, 1989).
7. The National Institutes of Health maintains a database of federally funded research from
1985 to the present, called Research Portfolio Online Reporting Tool (RePORT). It is available
at http://projectreporter.nih.gov/reporter.cfm. This database replaced the CRISP database
(Computer Retrieval of Information on Scientific Projects) on September 1, 2009. CRISP was
available at http://crisp.cit.nih.gov/ until October 31, 2009, at which time it was discontin-
ued. CRISP data went back to 1972. Both databases include(d) projects funded by multiple
agencies. Searches of both RePORT and CRISP on October 18 and 23, 2009, for studies with
the keywords ‘‘meditation’’ or ‘‘mindfulness,’’ revealed a total of 434 projects from 1972 to
date, many of which were or are multi-year projects. The RePORT database is updated
weekly, and now includes additional data. Searches on January 29, 2010, of the period from
1985 to date revealed 685 studies involving either meditation or mindfulness. The multi-
year projects were each counted as individual projects for purposes of these tallies.
8. http://projectreporter.nih.gov/reporter.cfm. Accessed January 29, 2010.
9. http://clinicaltrials.gov/ct2/search, accessed January 29, 2010. Among the MBSR studies,
33 were recruiting, 16 were actively underway, and 13 were complete. Among the MBCT
studies, 21 were recruiting, 7 were active, and 4 were complete. Among the DBT studies,
8 were recruiting, 4 were active, 2 were complete, and one had suspended operations.
10. Kabat-Zinn, ‘‘Toward the Mainstreaming of American Dharma Practice,’’ 481.
11. Ibid., 505.
12. Ibid., 487.
13. Ibid., 515.
14. Ibid., 495.
15. A number of respected scholars of Buddhism have pointed this out. One recent exam-
ple is Donald S. Lopez Jr., Buddhism & Science: A Guide for the Perplexed (Chicago: University of
Chicago Press, 2008), 207–10. See also the references in note 16, below.
16. Richard K. Payne, ‘‘Traditionalist Representations of Buddhism,’’ presented at American
Academy of Religion Annual Meeting, Buddhism in the West Consultation (San Diego, CA
2007, forthcoming in Pacific World), 5–6. See also Robert H. Sharf, ‘‘Buddhist Modernism
and the Rhetoric of Meditative Experience,’’ Numen 42 (1995). For an excellent, extended
discussion of ‘‘Meditation and Modernity,’’ and of modern deployments of mindfulness
meditation, see David L. McMahan, The Making of Buddhist Modernism (New York: Oxford Uni-
versity Press, 2008), 183–240.
17. Wakoh Shannon Hickey, ‘‘Mind Cure, Meditation, and Medicine: Hidden Histories of
Mental Healing in the United States’’ (Ph.D. diss., Duke University, 2008).
18. Robert H. Sharf and Andrew Cooper, ‘‘Losing Our Religion,’’ Tricycle: The Buddhist Review
64, (Summer 2007).
19. http://www.umassmed.edu/cfm/oasis/index.aspx, accessed January 30, 2010.
20. Kabat-Zinn, Coming to Our Senses: Healing Ourselves and the World through Mindfulness.
21. In its regular, fee-based MBSR courses, the Duke Center for Integrative Medicine offers
some scholarships, but does not accept medical insurance to cover course tuition.

182 . CROSSCURRENTS
 WA KO H S H A N N O N H I C K EY

22. The remaining 58 percent of MBSR participants fell within the broad range of incomes
between $20,000 and $65,000. E-mail from Duke MBSR researcher Andrew Ekblad to Shan-
non Hickey March 3, 2008. Telephone conversation between Andrew Ekblad and Shannon
Hickey March 5, 2008. These data were collected in late 2006 and early 2007, but not ana-
lyzed until 2008. Durham poverty figures from 2005 can be found at http://www.durhamnc.
gov/departments/eed/income_char.cfm. Accessed October 25, 2009. Federal poverty guide-
lines for 2005 can be found at http://aspe.hhs.gov/poverty/05poverty.shtml. Accessed Octo-
ber 25, 2009. According to 2007 estimates by http://www.city-data.com, poverty rates in the
City of Durham were 18.3 percent for all white residents, and 21.4 percent for all black res-
idents. http://www.city-data.com/city/Durham-North-Carolina.html. Accessed October 25,
2009. For racial data, see http://www.city-data.com/county/Durham_County-NC.html.
Accessed October 25, 2009. For 2000 census data on Durham, see http://www.durhamnc.
gov/departments/planning/pdf/demographics.pdf. Accessed March 5, 2008.
23. 2007 MBSR Outcomes Study, Duke Center for Integrative Medicine, Principal Investiga-
tor Clive Robins, Ph.D. Results are as yet unpublished. These figures were provided in an
electronic mail message from researcher Andrew Ekblad to Shannon Hickey, March 3,
2008; and in a telephone conversation between Ekblad and Hickey on March 5, 2008.
24. Another disparity within the world of meditation as meditation is the gender of its
most visible spokespersons versus that of MBSR teachers and students. Most of the visible
promoters in this field are white men with formal academic credentials, typically from
elite institutions. This is not surprising, but it does obscure the role of women in spreading
and popularizing the actual practice. At a 2005 conference on ‘‘The Science and Clinical
Applications of Meditation,’’ sponsored by the Mind and Life Institute in Washington, D.C.,
all but one of the fourteen individual presenters was male. http://www.investigatingthemind.
org/speakers.html Accessed October 28, 2009. At an October 2007 conference at Emory
University, called ‘‘Mindfulness, Compassion, and the Treatment of Depression,’’ the
featured speakers included eleven men and one woman. http://www.mindandlife.org/
mlxv.brochure.pdf pp. 9–13. Accessed October 28, 2009. In April 2008, another confer-
ence on clinical applications of meditation was held at the Mayo Clinic in Rochester,
Minnesota. Other than the Dalai Lama, his translator, and one other Buddhist monk who
spoke at Emory, all of the panelists were white. http://www.mindandlife.org/mayo08.
brochure.pdf pp. 9–11. Accessed October 28, 2009. But among MBSR teachers in the
United States, women outnumber men by more than two to one. (Determined by review-
ing the names of teachers listed in the database at http://www.umassmed.edu/cfm/mbsr/,
identifying those whose names are typically feminine or masculine, and checking bio-
graphical data where available.) See Hickey, ‘‘Mind Cure, Meditation, and Medicine,’’
ibid., 182. Although general demographic data about MBSR students is not available, in
the Duke courses discussed in this essay, 84 percent of the participants were women.
ibid.
25. Bishop, ‘‘What Do We Really Know About Mindfulness-Based Stress Reduction?’’ ibid.
Allen, N. B.; R. Chambers; W. Knight, and Melbourne Academic Mindfulness Interest Group,
‘‘Mindfulness-Based Psychotherapies: A Review of Conceptual Foundations, Empirical Evi-
dence and Practical Considerations.’’ Australian & New Zealand Journal of Psychiatry 40, no. 4
(2006); Ruth A. Baer, ‘‘Mindfulness Training as a Clinical Intervention: A Conceptual and

JUNE 2010 . 183

MEDITATION AS MEDICINE: A CRITIQUE

Empirical Review,’’ Clinical Psychology: Science and Practice 10, no. 2 (2003); Kirk Warren Brown
and Richard M. Ryan, ‘‘The Benefits of Being Present: Mindfulness and Its Role in Psycho-
logical Well-Being,’’ Journal of Personality & Social Psychology 84, no. 4 (2003); Kimberly Hop-
pes, ‘‘The Application of Mindfulness-Based Cognitive Interventions in the Treatment of
Co-Occurring Addictive and Mood Disorders,’’ CNS Spectrums 11, no. 11 (2006); Mary Jane
Ott, Rebecca L. Norris, and Susan M. Bauer-Wu, ‘‘Mindfulness Meditation for Oncology
Patients: A Discussion and Critical Review,’’ Integrative Cancer Therapies 5, no. 2 (2006); Stefan
Schmidt, ‘‘Mindfulness and Healing Intention: Concepts, Practice, and Research Evalua-
tion,’’ Journal of Alternative & Complementary Medicine 10 Suppl. 1(2004).
26. Joseph Dumit, ‘‘Producing Brain Images of Mind,’’ in Picturing Personhood: Brain Scans and
Biomedical Identity (Princeton, NJ: Princeton University Press, 2004). My thanks to Barry Saun-
ders, M.D., Ph.D., of the University of North Carolina-Chapel Hill School of Medicine, for
bringing these issues to my attention. Mellon-Sawyer Seminar: Human Being, Human
Diversity, and Human Welfare, A Cross-Disciplinary and Cross-Cultural Study in Culture,
Science, and Medicine, at the Franklin Humanities Institute, Duke University, March 19,
2007. See also Andreas Roepstorff, ‘‘Mapping Brain Mappers, an Ethnographic Coda,’’ in
Human Brain Function, ed. R. Frackowiak et al. (London: Elsevier, 2004). Thanks to Richard
Jaffe, Ph.D., of Duke University, for bringing the latter to my attention.
27. Highlights from the Science and Clinical Applications of Meditation Conference: An Overview of the
Investigating the Mind 2005 Meeting with the Dalai Lama (Washington, DC: Mind and Life Insti-
tute, Mind and Life XIII, 2007), CD-ROM. These remarks occur at the end of the concluding
presentation by Ralph Snyderman, M.D., of Duke University Medical Center.
28. Although I am ordained as a Zen priest, full ordination and authorization as a Zen
teacher occurs in multiple stages. I am not yet authorized as a Zen teacher. I am authorized
as an academic teacher, and regard that as my vocation. In the academic courses I offer,
I teach the larger doctrinal and moral frameworks of Buddhist and Hindu meditation in a
critical, historical, and comparative manner. Outside of class, I offer meditation instruction
in various religious and non-religious settings—without charge. As a priest, I am bound by
a set of vows; my practice is supervised by a Zen teacher (Rev. Gengo Akiba, the Soto-shu
bishop emeritus for North America); and I belong to a Zen community.

184 . CROSSCURRENTS
Copyright of Cross Currents is the property of Wiley-Blackwell and its content may not be copied or emailed to
multiple sites or posted to a listserv without the copyright holder's express written permission. However, users
may print, download, or email articles for individual use.