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September 17, 2014

Mindfulness could undermine whole consultation process

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Dear Editor,

Mindfulness is a new relaxation technique currently being endorsed by the ICGP and promoted as a stress reduction method to avoid burnout in general practice. Whilst the altruism and intention is certainly admirable, it should be noted that mindfulness is ‘an Eastern meditative technique adopted directly from Buddhism’.

Mindfulness is more than a meditative practice; it is an outlook on life and reality that is designed to cultivate detachment. Detachment is necessary in Buddhism because Buddhism teaches that attachment to this world, to your thinking, your desires and indeed to your identity as an individual or self keeps you in the cycle of rebirth.

Mindfulness is the method of detachment through which one ultimately becomes liberated, achieving a state of complete detachment or Nirvana. This process of detachment or mindfulness is often defined as a “moment-by-moment non-judgmental awareness of the present”.

Given that we cannot in reality detach ourselves from rational informed reasoning whilst maintaining effectiveness in consultations, this form of relaxation therapy is disturbing as it undermines the activity of active listening, cognitive reasoning and expressed empathy in the consultation.

In Buddhism, the mind is perceived as being a barrier to grasping ultimate reality and truth; therefore the mind must be bypassed. Mindfulness is designed to do just this — bypass the faculty of the mind. But is it common sense to detach the rational mind from the reality it encounters on a momentary basis?

The concept of mindfulness is becoming more widely accepted in the Irish healthcare community and therefore deserves some critical appraisal. We must be careful to assess what becomes generally accepted in everyday medical practice. If one practises mindfulness meditation on a regular basis, one endorses and eventually may adopt the world view behind it, accepting that the process of detachment is helpful to us and useful for our patients. However, if we accept that the self is actually real, there can be no true detachment from it; the conscious and active pursuit of liberation from self must be seriously questioned.

Whilst mindfulness focuses on the processes of detachment from self, it actually involves doing the exact opposite. Being mindful means basically concentrating on yourself. The techniques of mindfulness meditation may lead one to enter an altered psychological state similar to that of self-hypnosis. In this state, the practitioner’s critical thinking and judgment are suspended, leaving the mind open to virtually anything.

The consultation is an active engagement in a very meaningful, relational interaction between two very existent and important people. The consultation is the process that needs to be strongly supported and protected by our profession for the good of our patients. Mindfulness, in my view, has the potential to undermine the unique dialogue and relationship which we engage in daily as GPs.

Dr Richard Gavin,
Cornerstone Medical Practice, Drogheda.