Blue Sheep

Prescribing Mindfulness Allows Doctors to Ignore Legitimate Female Pain

Eat right, exercise, don’t smoke, and meditate?

slate.com|Sarah Yahm

A few years ago, after a series of cascading injuries and illnesses that rendered me unable to type, drive, or sleep, I briefly became a professional patient. Like all of my professions, I took it seriously. I went to appointments armed with lists of well-researched questions written down neatly on my yellow legal pad, brought in the occasional medical journal article, and compiled detailed descriptions of my array of increasingly bizarre symptoms. My goal was to get my doctors to take me seriously so they would dive into the complexities of my case. I wanted to walk out of every appointment one step closer to determining the underlying cause of my mysterious condition and with concrete strategies to ameliorate my suffering so I could work, sleep, and live my life again. Inevitably, though, I instead was handed the same thing over and over—a prescription for mindfulness.

My primary care physician told me to download guided meditation MP3s from the clunky hospital website; my therapist insisted that I do deep breathing exercises even though they triggered my mysterious abdominal spasms; and the pain clinic declined to do “any interventions” at all, instead vaguely suggesting mindfulness. The pain clinic’s message was clear—after two appointments and a clean MRI, I was being dismissed. From now on, managing my pain was my responsibility, not theirs.

Before these medical problems, I’d had only benign feelings toward meditation. My parents, products of the 1960s, were always dashing off to the Omega Institute and Kripalu when I was a kid, and I meditated briefly in college to impress a boy who’d just returned from a gap year in India. I’d mostly thought of mindfulness as promising evidence that mainstream medicine was becoming more progressive, more open to alternative, adjunctive treatments, and more interested in the patient experience.

The reality, I now know thanks to years of being denied medical care and instead being prescribed mindfulness as self-management, is quite different. For me, the current obsession with mindfulness has become synonymous with my overall feelings of disempowerment within the medical system. In my experience, in clinical settings, mindfulness is frequently disempowerment framed as empowerment, a way of placing responsibility for suffering squarely on the patient herself and a way for doctors to wash their hands of problem patients.

And I say herself deliberately, because data indicates both that women underreport pain and that their pain is taken less seriously when they do report it.

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Grace Alexander also had an objectively verified medical condition—spinal disc degeneration and cauda equina syndrome, nerve compression in the lumbosacral spine. She was bedridden with her left leg half-paralyzed, partially incontinent, “and in so much pain I couldn’t breathe. The solution was … be positive / meditate,” wrote Alexander. She does use mindfulness breathing techniques to help manage her pain, but those tools weren’t going to reverse her partial paralysis or her incontinence. She needed more aggressive interventions like surgery, medications, and injections to gain back her mobility. The mindfulness rhetoric felt familiar to Alexander, though, who grew up in an evangelical sect and as a child with intense migraines was taught that if she prayed hard enough and had enough faith her pain would go away, “and if you’re not better it’s your fault for not having enough faith.”

This circular logic permeates the way mindfulness is currently being prescribed in medical settings: If it doesn’t work for you, it’s because you’re too anxious and too invested in your pain, which is in fact more evidence that you need to practice mindfulness. And we’re back to the trope of the hysterical female pain patient.