Tami Simon: You’re listening to Insights at the Edge. Today my guest is Saki Santorelli. Saki is director of the internationally acclaimed Stress Reduction Clinic at the University of Massachusetts Memorial Medical Center, executive director of the Center for Mindfulness and Medicine, Health Care, and Society, and associate professor of medicine at the University of Massachusetts Medical School. He has more than 30,000 hours of clinical experience in Mindfulness-based Stress Reduction, known for short as MBSR, and has trained thousands of people, including patients, physicians, nurses, teachers, clergy, business executives, inmates, and correctional staff.

He is the author of the book Heal Thy Self: Lessons on Mindfulness in Medicine, and he has recently worked with Florence Meleo-Meyer of the Center for Mindfulness and Sounds True to create the MBSR online training course, a comprehensive online training in mindfulness based stress reduction, available at SoundsTrue.com.

In this episode of Insights at the Edge, Saki and I spoke about mindfulness as an act of remembering. We also talked about how stress operates in the body and our habitual responses to stress and how the practice of MBSR helps us interrupt or pause and respond differently when we find ourselves in stressful situations. We also talked about the evidence for the benefits of MBSR and is there a correct dosage of mindfulness training that’s required. And finally, we talked about, on a personal level, how MBSR training has impacted Saki Santorelli. Here’s my very honest and warm conversation with Saki.

Saki, I’ve heard you describe mindfulness as an act of hospitality. I wonder, here at the beginning for our listeners, if you could both define mindfulness and then describe how it’s an act of hospitality.

Saki Santorelli: I’d be glad to do that. I’d say I really see mindfulness as an act of love, insofar as if mindfulness is about—well, the operational definition is “paying attention on purpose in the present moment non-judgmentally.” But that’s a very—while it’s valuable, it doesn’t say—it maybe leaves some things out, because it’s not the paying attention in and of itself that cultivates mindfulness. There’s a certain quality of, if you will, heartfulness or a kind of tenderness or openness that really contributes and is a necessary ingredient or element of what we typically call mindfulness, even a kind of goodness.

When I talk about hospitality, I’m speaking about an attitude and a kind of inward posture towards which we meet our moments and events in our lives, whether they are internal or external. We’ve all had—many of us, at least, have had—a kind of education, if you will, in being hospitable to people that come to our house. We offer them food. We take their coats. We invite them in and we meet them at a level that has a certain quality of intimacy often. This goes way back in our Western heritage and roots.

When you typically met somebody in the Middle East—and it is still the case in parts of the Middle East and in Greece—the first thing—you don’t ask them what they do. You don’t even ask them much about who they are. You wash their feet. Take their clothes, their robe off, or their cloak, and offer them food. So, when I talk about mindfulness and hospitality, it is about offering that same quality of attention and attending, if you will, and that same quality of intimacy, or nearness to what arrives in the mind, in the body, and in the world around us.

TS: When I think about mindfulness as a formal practice—and I know that’s part of the way that it’s presented in Mindfulness-Based Stress Reduction work. This is a formal practice that you do for “x” minutes and you sit and you pay attention on purpose in the present moment non-judgmentally. I think it’s probably relatively easy for people to have a sense of what that might be like—the practice of mindfulness in a formal way—but, this idea that I could be mindful in each moment of my life—how do I do that when there are so many different things going on? What do I pay attention to in the moment?

SS: Well, the short answer, and it could sound like a wise guy answer, is whatever is happening. But, if we sort of elaborate on that so that it makes it clearer, certainly in MBSR and in our work in the Stress Reduction Clinic, we have been for all of these 34 years introducing to people to what you just referred to: “formal mindfulness practice,” meaning you set aside a certain amount of time everyday to actually exercise that muscle of attention, of awareness, of a certain kind of intimacy, openness, and curiosity.

There is an operational element of that. It is kind of just—it’s really not so different than playing the scales—learning to play music. You have to begin and you train, if you will. Then, of course, even if, as in our case, people practice for 45 to 60 minutes a day, you still have 23 hours when you’re not practicing formally, and all of those moments are occasions to be awake or to be aware. Informal practice really has to do with being somewhat deliberate and attentive to moments that are as simple as taking a shower and actually feeling the water, for instance, on the body, because often enough you probably have noticed—and all of us have probably noticed—that we’re not even here for the shower. We’re somewhere else. We’re in a meeting and the shower is just kind of something we’re passing through on the way from here to there. Cutting vegetables. Walking in the door at the end of the day and meeting the people that you care about. Noticing what it’s like when you step out of your car on the way to work and feel the snow down the back of your collar, or the feel of the hands on the steering wheel as you drive, or noticing the trees around you at a red light. All of those are moments where we can be deliberate about becoming attentive and as well—we have certainly, over the years—our participants report to us.

So, that you might call deliberate formal practice. You are kind of priming the pump. What people often report is that out of that kind of deliberateness, they also notice what they really—or what we call spontaneous moments of mindfulness in everyday life. They just say, “I never saw the tree like that before in my backyard,” or “I can’t believe how green the grass is,” or “The smells around me that I never noticed before.” Those are not either contrived or attempted to be attended to. They just happen. So, in that sense, people are really simply saying they’re beginning to get in touch with the richness of the moment, the richness of everyday life, and the richness that surrounds us that we don’t often see, feel, touch, or taste directly.

There is something about all of that that I think is really important, and that is to really begin to explore the possibility that attention is actually an offering, that we are offering our attention to the breath, to sensations in the body, to the cutting of vegetables, the preparing of the meal, the lighting of the candle, the bathing of our child. When we offer attention, we always get something back. It becomes a very reciprocal and relational process—this something that we call mindfulness—and in that way, often enough, the kind of subject-object views that we often hold about how life is and what we are attending to, begin to, in fact, fall away. People start to wonder, “Well, is the rain inside of me or is it outside of me? I’m ‘hearing it,’ but it’s a little fuzzier if there is a boundary.” I think, in part, that comes out of that sense of you offer and there’s a return. There’s an offering and a returning. I almost think of it as kind of a blessing.

TS: That’s beautiful. I love that. I want to dig a little deeper though, because sometimes I think I hear people talking about being mindful as something that is possible to do 24/7. And as you were talking [about], there’s the category of formal practice 45 to 60 minutes a day. There’s deliberate mindfulness in the shower or when I’m eating. I can imagine periods like that where I’m by myself, I tune into the sensations, and I’m really present—when I’m washing dishes or eating a meal. That makes sense to me. The third category you talked about, spontaneous moments—maybe I’m walking outside and I see something beautiful. I get that. But then there’s the rest of my life that doesn’t fit into those categories. My question is how do I bring more mindfulness, if you will, into that fourth category, which is all the rest of my hours?

SS: Well, it’s a really good question, Tami, and I’m no expert, because I certainly can’t say that I’m awake and aware 24 hours of the day, 365, and I’m not sure that that’s the goal, or if there is a goal in that sense at all. I think you’re asking a really intriguing and important question. Here’s at least some part of my sense of that. In part, I think that mindfulness is about remembering. I don’t really mean remembering like where I put my keys or where I left my hat. I mean remembering in a more fundamental way. I mean remembering in the sense of remembering some sense of who I actually am.

In those other moments that you are talking about, that becomes really helpful. It happens to all of us, but I’m thinking about a moment that just happened yesterday or two days ago. I came home and I was hanging out with my wife. We were talking about something or other—the content is not important in the context of what we’re talking about—and I noticed that there was a little edge to my response and she noticed it too. In that moment, I said to her, because I noticed it, that I was sorry and that I realized I had been working really hard the last three days and I was tired, and that it had nothing to do with anything that she said or didn’t say.

It’s a moment of me taking stock in where it all started [which] was in my body. I felt something in my chest or solar plexus area that helped me. It alerted me in some way to that sharpness I just described, or that little abruptness, and I heard it in my voice. The body is an amazingly powerful reference point. My sense is that we often get so disconnected from the body that we’re no longer able to use it as an instrument of understanding—not just of information, but of a certain kind of knowledge that has implications in our lives.

I think one of those gateways that you are talking about is for us to be far more attentive to the body, not in the sense of reifying the body as better than the mind in any way, if you will, but of beginning to become much more attentive to its existence and what it offers us in terms of our capacity to see, feel, adjust, and make choices. I know, certainly in our work with the people we serve in the Stress Reduction Clinic and in our professional training world, that is one of the areas [in which] we are really intent on people becoming much more attentive and available, because it has everything to do with our ability to be embodied. That sense of embodiment I have a real experience of helping to ground me and allow me to be more alert to the little moments and the big moments when I might need to be attentive or I might need to refrain on purpose from a usual conditioned reaction.

TS: Your example is really helpful and, I think, something that people can probably relate to. At the Center for Mindfulness, you’ve put a lot of attention into understanding stress and how stress affects us. You mentioned you had three busy days at work and I think people can relate to that. I’d love to know what it is that you have discovered about how stress is operating in our bodies and what the practice of mindfulness does to change our habitual responses to stress.

SS: I think you’ve really nailed it by using the term “our habitual.” In our parlance, we would say “our habitual reactions.” In that way, we would delineate between reactions, which are not necessarily bad. Our capacity to react to a car that’s moving into our lane on a fast-moving highway is nothing less than spectacular, highly orchestrated, and largely speaking outside of our deliberate cognitive functions. It’s a darn good thing it is, because it usually gets us out of the way and it helps us survive. So, that sense of being reactive, in some cases, or reacting, is a life-saver, literally and figuratively, just so we’re all clear about that.

But, often enough, our reactions are habitual, which means really they are conditioned. They’re based on history. They’re based on memory. They’re based on the past. Often enough, those reactions may very well have been productive. I like to think that they might have even been evolutionary, like this is the best that I could do when I was six or five or ten. Or this is even what the situation called for when I was at some point in my life, and “it” worked. It helped me survive. It helped me ameliorate the threat. It helped me to, in some ways, thrive. But like merely any habit over time, it becomes a pattern that may or may not work. In some ways you could say that the menu gets restricted in terms of here I am in situation A. Do I usually pull solution B out of my pocket, or solution C? Out of habit, that’s usually what happens.

Another possibility is to learn to respond more to what we typically call stress, or stressful or demanding situations, in ways that are less mechanical, less the product of a kind of automatic pilot conditioning, and more context-specific. Like in this situation, A or B might still be the best thing or the best response, but what about Z? Z might be the best response, but if my menu is narrowed, I never get to Z. Typically the body plays a large role in us getting to Z or not getting to Z. It doesn’t play the only role. The mind clearly plays a role in us maybe getting to Z if Z is the right response.

In that way, the sense of being able to stop, which is its own practice in and of itself, because essentially momentum—at least my experience of it [and] thousands of medical patients I’ve worked with experiences [of it]—motion is intoxicating. Momentum is kind of intoxicating. We will easily do something or say something or act in a way that one second later we say, “Why did I do that again? How did that come out of my mouth again? I can’t believe that I’ve made the same choice that I’ve made before that never really works.” It’s in hindsight and it’s often not in very distant hindsight, but almost immediately we realize I just fell back into the same old pattern.

The capacity to sort of stop or to pause enough to see a situation is part of the, if you will, training in MBSR. The capacity to when we stop, merely automatically, we see things more clearly or more broadly. An example is—well, it’s a sports metaphor or a sports example. I apologize. I do remember reading Michael Jordan one time saying that when he gets into the heated intensity of the game, sometimes his vision gets too narrow, or got too narrow, since he’s not playing any longer. He was trying to push the game and he said in those moments, “I have to stop.” It doesn’t mean he has to stop dribbling the basketball or running or whatever. He’s talking about inwardly. “I have to let the game come to me.”

“When that happens,” he said, “I see passing lanes I never saw before. I see teammates on the court I didn’t see moving in a particular way before that I might be able to make a connection with around scoring another basket.”

I think that that’s true for all of us, as in somehow or other, the stopping allows us to see the game, if you will, a little bit more closely. In the case of stress, we begin to feel the sensations in the body with more clarity or more acuity—those sensations that often trigger particular kinds of thoughts and particular kinds of emotions that lead to particular kinds of responses or usually particular kinds of reactions. That stopping—that seeing—allows us to understand things a little bit more clearly so that we could choose. Do I want to do this again? Do I want to act like this again? Is there something else possible here?

I think that that’s a gradual kind of process where we just keep continually building that muscle of bringing attention to the body—bringing attention to the thoughts and emotions that are arising in situations. It’s not like it takes minutes. We can sense those things very quickly. Largely, they are acting unconsciously and driving us anyway. The process of becoming more mindful—those largely just below the surface of awareness habits and patterns begin to become seen. I know in our work, in the early parts of our eight-week course, people report a period of time when they’re seeing more clearly, but they can’t make any changes. It’s painful. Or when they’re seeing their reactivity more clearly and the outcome of those actions and the ways that they feel disappointed or frustrated. They even grieve about it. I just think that that’s all part of the learning process.

Of course, it’s also a part of mindfulness practice itself. How do we hold ourselves in those moments of feeling grieved, disappointed, inept, or incompetent? Isn’t that part of the hospitality process? How do we make it work for those strangers that arrive at our door—for those unwanted guests—and see if it is possible to learn from them? Gradually, my experience is—it’s more than my experience—people report the first glimmers of “You know, I’m in this situation I’m typically in and I didn’t do the same thing.” It’s not as if once you change it once, it’s done for good. People get a taste of “Oh, this is what it means to stop. This is what it means to see things a little bit more clearly,” and then be more deliberate about “I think I’ll meet that situation differently.” That is moving from reacting to responding.

Quite honestly, Tami, at least in my experience, it’s a very uneven process. It isn’t like looking at a resume or a CV that looks like you’ve just mounted one mountain peak after the next. It’s filled with ups and downs and peaks and valleys where there is some level of integration and everything breaks down and you think, “God, I’m not learning anything. I’ve been at this for three weeks or three years or three decades.” Then, there’s a kind of new level of integration and it’s not a linear process, but it’s an adventurous process nonetheless.

TS: Well, that’s helpful to hear you say that as someone who has been practicing mindfulness for a long time—to report its unevenness probably really normalizes that for a lot of people.

SS: At least that’s my experience and I’ve talked to lots of people about this and I’d say that unevenness is fairly much across the board.

TS: Now, Saki, this is just a dot I’d like you to connect and just to make something explicit that you’ve been pointing to here, which is this ability to stop or interrupt a pattern. How do we develop that ability through the formal practice of mindfulness? What’s the connection there?

SS: That’s a wonderful connection, because people need to understand that in some way, both in a direct way and I think as well in a more conceptual way. I think it goes something like this: every time that we—I’m going to be somewhat colloquial—every time we plunk our butts on the cushion, whether that cushion is a chair or the floor, every time we decide to stretch out—I’m talking about in this case MBSR or mindfulness practice in general—and lift our leg or practice yoga or some other body discipline, if we’re talking about formally, those moments or those decisions are actually—we are actually stepping into the training ring, if you will, at those moments, or what I like to call even more so, the laboratory. And the laboratory is our own lives, our own experience.

In those moments in the formal practice, we are actually training the mind, training the body, and for this matter, training the heart, because everything that happens inside the formal practice is none other than a slice of our lives. Inside the specialized condition of formal practice, we can see a little bit more clearly. For example, we may be sitting and having moments of calmness, tranquility, or pleasantness, and then the right hip begins to ache or the itch on our nose seems to become unbearable. Those sensations in the body at this moment are nothing other than—or they’re certainly similar to—our everyday lives. Everything is just going along hunky-dory until something changes, some unpleasantness arises. It could be even minor, but it really throws us.

Similarly, when we’re practicing formally, we are far more attentive to what’s been passing through the mind largely in the form of thoughts and emotions. All of a sudden, we see that there are thoughts, emotions, and bodily sensations that are all unanticipated. They are all a surprise. They are all here. What begins to occur in formal mindfulness practice is we learn something about relationality and—particularly in the cases I’m describing—how to be in relationship to those sensations, how to be in relationship to those thoughts, and how to be in relationship to those feelings or those emotions.

Over time, maybe we could even say how to be in wise relationship to those sensations, thoughts, and emotions, because we all know that we’ll get a particular sensation in the hip, and then we’ll have the thought “This is killing me.” Then we’ll have an emotion. Maybe it’s fear or it’s grief or it’s anger, because it’s interrupting my meditation practice. Now that’s no different than what’s happening to us outside the laboratory of formal practice when somebody cuts us off on the highway or when our boss says, “You need to do this and not that,” or when we have a fight with our teenager.

The unexpected is arising. The formal practice is a kind of training camp, if you will, for what happens that we get to look at more closely so that we can maybe be more attentive to it when it happens outside the laboratory of formal practice. The meditation is nothing other than a slice of our lives that we get to see with hopefully a little bit more clarity, because we are offering our attention to it and in our offering, it is revealing something back to us that might have enormous potential in our everyday lives.

I don’t know if that’s too elaborate.

TS: Not at all.

SS: That’s my experience. What happens in the laboratory becomes so valuable for life outside the laboratory. Of course, I’m making a dualism between inside and outside, but just for the sake of the concept. When people get that, there’s a real figure ground switch and that figure ground switch is that people realize all of a sudden the meditation doesn’t end at the 45 minutes—that the whole life is an opportunity to be in that kind of relationship with our experience. That’s a real turner.

I can tell you that in the process of the eight-week MBSR course when people all of a sudden touch that figure ground switch, then practicing becomes really interesting for people, because it’s no longer just doing this exercise. People all of a sudden say things like, “Wait a second. This isn’t about stress reduction. This is about my life.” And you know what? They’re right.

TS: Saki, have you seen [that] a certain number of hours of formal practice are really required for people to start seeing the kind of benefits you’re describing? Is there some sort of minimum dosage required?

SS: I wish I could answer that. The studies have attempted to look at doses—what’s called “dose response.” There are some inklings of dose response, but we don’t really know yet. Or, at least I can say, I don’t know yet. I think that is as well an uneven kind of process. Some people come back after week one and say that they notice positive differences and some people come back after week four and say I don’t think I’m getting this at all. Often enough, the people that say they’re not getting it at all are maybe getting more than they imagine. Or maybe they’re not. It’s hard to know. I can’t honestly say to you that I know what that actually is around a dose response. We don’t know. I don’t think it’s standard for anybody, or for everybody.

TS: I’m curious what we do know in terms of the “evidence base” for MBSR, because this is one of the big claims, of course, about how the MBSR training differs from other approaches to meditation, is that there’s all this scientific proof that this is an evidence-based form of practicing. What do we know for sure?

SS: First of all, I guess I’d like to frame it a little bit. I never think about it as it’s different than and we have proof. My own view is that we are in the infancy of the science. It may be that what we think we know today—it’s fairly inevitable, actually—won’t be true in 10 years. Of course, that’s the way science is all the time, when you think about it. Fifteen years ago or 20 years ago, no one believed that there was such a thing as neuroplasticity—that the brain was a continually changing organ and that it was producing new neurons.

Nobody believed 10 years ago that stress was actually a critical factor in morbidity and mortality in peoples’ lives. Thirty years ago, stress wasn’t even considered a major risk factor in most diseases. That has changed. Ten or five years ago, people didn’t realize that stress had powerful impacts or how [it] showed up differently in the lives of infants, adolescents, and adults. We now know way more about that.

I can’t say that MBSR has proven anything. I think what I can say safely is that there is a body of scientific literature suggesting that there is efficacy for a wide range of medical and psychological conditions for people who practice mindfulness. We now know even from the basics and for the longest time, and still the answer was even if there is an effect and even it’s an efficacious or positive effect, we don’t know why or how. We don’t know the mechanisms. You could say in the last four or five years that neuroscience has been attempting to suggest how this works. Now the field of epigenetics is beginning to suggest [that] if we study the way that genes up and down regulate in real time with meditators, we see that there’s an up and down regulation of genes that have very powerful control over parts of the body in terms of tumor suppression or inflammatory processes.

So, nothing’s been proven yet, but what I think is happening in science is we’re beginning to get a feeling for, if you will—and I think that that’s how science works—places to look to begin to understand the mechanisms of efficacy. We are certainly developing a body of literature suggesting that relatively intensive training in mindfulness meditation is efficacious for people who have a range of medical and psychological conditions. Those studies just keep continuing to unfold.

In the last five years, there have been more than 1,200 or 1,500 papers written about mindfulness and MBSR in the scientific literature. There’s a kind of exponential rise in that literature. I am sure that that will change, because nothing continues to go exponential forever. Then we’ll refute some things that we thought we knew or we’ll understand them in new ways. But at the moment, it looks like our capacity to train the mind to become more deliberately attentive to, in fact, re-educate and self-educate, this common human capability of paying attention can have a range of positive effects for people at various points along the lifestyle, from preschool to adulthood.

In some ways, I think that [the] attention that is being given through the science is—we live in a very psychologically- and scientifically-minded culture on one hand, so I think on some level, that’s giving a certain kind of credence to all of this. Of course, as you and I both know, and your listeners as well, meditation wasn’t developed to light up an fMRI machine or to up or down regulate our genes. There are qualitative shifts that people report as well and those wind up being, I think, absolutely as important as people suggesting, for instance, that they are more capable of being fluid, flexible, of feeling more at ease, of feeling more comfortable in their own skin, and at learning new ways to be in relationship to their own internal experience or to the people around them or to the world more generally. Science is just one way to study that, one way to attempt to validate it. It’s not the only way.

TS: Saki, in your experience—here you’ve been practicing MBSR for how long?

SS: Well, I’ve been at the Stress Reduction Clinic as a full-time employee here for 30 years, and I came 32 years ago. I was the first intern in the Stress Reduction Clinic in 1981. I had been practicing mindfulness for—well, I had been practicing meditation for 10 years before I got here. It’s 41 years, I think, now into that adventure.

TS: You mentioned to us that your own process has been one of uneven discovery of the benefits. They come; it’s not just a linear, straight line.

SS: Right.

TS: I’m curious if there is anything that you could say—you know, I thought that meditation and MBSR training would deliver this thing to me and it just hasn’t, actually.

SS: [laughs] Yes. That’s an interesting question, Tami, because my expectations about what it should or ought to deliver has changed as well over the years. I don’t think I am actually looking for it to deliver something to me these days. And that’s a relief. I’m much more curious about simply being engaged than I am about it delivering some specific skill. Of course, you could ask— and you would be absolutely right to ask—well then, why do you keep it up? I think it’s because, for me at this point in my life, it’s more a way of being.

It’s more a way of being in, how shall I say—it’s a way that I experience in being enormously helpful—“helpful” is even too weak a word—to inhabit my life. I want to be in relationship to all of it—the pleasant, the unpleasant, the joyful, the sorrowful. Mindfulness practice—and I don’t mean just in the formal sense—offers—I can’t say offers me that—I would say, that my experience of it is that it allows me to live more fully into what it’s like to live a full life. It keeps showing me new things all of the time. It keeps revealing something new. It’s not like repeating the experience.

TS: I’m sure you must encounter many, many people who come to an MBSR training, and their objective is not to be in relationship to everything that’s happening in their life. They don’t necessarily want to be in relationship to the painful things.

SS: That’s right. That’s exactly right.

TS: They want to get out of pain and that’s why they’re coming to the MBSR training.

SS: Yes, that’s why it was developed. So what about that?

TS: How do you address that person who says, “I’m here to get at the pain?”

SS: My feeling is that meditation is kind of like a developmental catalyst. It will touch you wherever you are in your life. I’m just as happy when somebody comes to the Stress Reduction Clinic to take an MBSR course and they say, “I have one goal. I want to be more relaxed. I want to be more at ease.” If that’s what they leave with, to me, that’s wonderful. That’s enough.

There are other people that might come with that goal, and all of a sudden, they actually confront some element of what we would typically call the more existential moments or wonderings in a life. Like they ask a question some weeks later, “Who’s observing?” I don’t ask that question. They ask that question. Or they say at the end of eight weeks, “This is the most spiritual experience I ever had.” Since I haven’t talked to them about spirituality, then all I have to do is say, “Is that so? Can you say something about what you mean by that?” Then they are not trumpeting my brand or aligning with what they think I want to hear.

Whether it’s that they have come to be more relaxed, to reduce their pain, or to, in some ways, hopefully ameliorate some of their high blood pressure. They all have a place in the room. It’s a perfectly fine place to begin and to begin this journey, this exploration. I don’t have a kind of a—I’m not giving them some kind of cognitive explanation of what meditation and mindfulness is all about and what the benefits of it are as a kind of promise. There’s no selling it.

If they come for pain, then great, let’s see what happens. There are no guarantees here that your pain will change in any way, but if you’re willing to practice for the next eight weeks, if you’re willing to show up for class, and if you’re willing to be in relationship to yourself, then I’m willing to be in relationship with you. I’ll support you all the way along the way—certainly, often enough, after it’s all over. Then, you be the judge if this was helpful or not and in what ways it might or might not have been helpful.

TS: That’s beautiful. I like it. It’s a completely open system for people to step into.

SS: It is and it also means we don’t have to sell it. We never sell it. In fact, we’re much more often doing the opposite—of saying to people, “Are you prepared for this? It’s stressful to take the stress reduction program.” And it is, because it means you have to make a change in lifestyle virtually immediately. What does that mean? Well, all of a sudden you have to come to the medical center for 10 sessions, 10 weeks. You have to give up one Saturday in your life. You have to figure out how to carve out 45 or 60 minutes a day to practice all the various home practices and that means you’re going to have to negotiate with your family for that 60 minutes.

You’re going to probably have to alter your life in some way, because nobody in 2013 in the United States has a spare hour in the day—or most people don’t—so they have to make it. You won’t find it. You actually have to make it. In that sense, there’s a real give-and-take here. You really begin to discover that this is a participatory process. I’m going to get out of this what I put into it. It is going to involve me taking a measure of responsibility that I may not have taken before in the context of my medical care, because by and large we’ve all been inculcated into a system that said you get sick and we’ll take care of you. But that’s a myth.

In America, at least, we know that health care as we have known it—as a delivery system—is dead. It’s not health care, it’s disease care. And there’s certainly a lot of room for disease care, but it isn’t health care at this point in time. For it to move from where it is into the health care, it’s going to take people becoming engaged—for people to become much more participants in their own health and well-being [and] to become much more literate about their health.

MBSR is simply one vehicle for this kind of what we call “participatory medicine.” That’s exciting to me, because I think that ultimately we all have to, in some ways, shoulder the responsibility for our lives. Certainly, that doesn’t mean abandoning medicine. I think the way we’ve seen it work here is that physicians refer a lot of their patients here. In 34 years of being here, we’ve just passed the 20,000 mark of people who have completed the MBSR Stress Reduction Program here at UMass. More than 5,000 physicians have referred those people, then on top of that, a whole other cadre of health care professionals.

I think it’s because people trust that we’re doing our work. We’re researching it. We’re publishing our results. We’re not making claims that are larger than they need to be. And probably most importantly, we don’t see this as alternative medicine. We see that good medicine has to do with physicians and medicine doing what they can for us. When I get a broken leg, medicine is going to do something for me. They are going to do something to me. And you know what? I want them to do it. But I think as we come to see that—I mean, breaking my leg is an acute situation. Having rheumatoid arthritis, heart disease, some kind of gastrointestinal problem, headaches, or a sleeping disorder—they’re more chronic.

We have to learn something about how do I live well with what I’ve got. I think that that takes the physician doing what they can to and for us, and us doing and learning about what we can do for ourselves. If you take those two approaches and put them together, I think you get a very interesting synergy—a very powerful synergy—that may be more powerful than either approach by itself. I think that that’s where medicine and health care are heading.

I think that health care reform in America is about people becoming more engaged. Mindfulness and mindfulness training is one of those ways that people can become more engaged in learning about themselves and having at least the capacity to ask themselves the question, “How do I want to live my life? How do I want to inhabit my life?” and perhaps having some approach, some means, or some methods or tools for actually living into that question.

TS: At the beginning of our conversation, Saki, you talked about mindfulness as an act of love. As you are speaking right now, I’m imagining someone who says, “I know that my life would be better if I had a practice like MBSR, but I don’t know if I quite have enough self-regard or self-love—whatever the word would be—to do it. I’m not quite there yet.” How do you help that person cross the bridge?

SS: It’s a great question. They don’t have to have it. I think the hardest—in the Stress Reduction Program, this a very interesting kind of process. People call, maybe their physician refers them, we call them, we send them out information about it, and we enroll them in a free orientation session that’s required before the course begins. (This isn’t a marketing conversation; it’s to try to respond to your question.) Then, of course, they decide to either enroll or not enroll. They have had all this front-end information. They have had contact with our staff one way or another. They have met the staff at the orientation session. They have gotten a taste of what the course would be like and some context about our life here at UMass, the research behind it, and all of that.

Still, Tami, I think the hardest thing for people to do in the entire eight weeks of the MBSR course is to cross the threshold into that classroom the first day. I think, in those moments, they are saying “yes.” They may not know exactly what they are saying “yes” to, but I believe that they are saying “yes” to themselves. They may not have a lot of self-regard. They may not have a sense of self-love. That’s OK. They are still saying “yes” in one sense of saying, “I’m worth it enough to give this a try.” That’s as much as I care about. That’s all that’s required. You crossed a threshold. Then I’m going to be here in relationship with you and I’ll do whatever I can to be of assistance to you as you explore this process over the next eight weeks. And that’s enough.

You don’t have to have a prerequisite, but you have to be able to say “yes,” because when you say “yes” and cross that threshold, you are also saying “no.” You are saying “no” to a certain kind of complacency, “no” to perhaps a whole set of beliefs or a belief system about yourself and about what you are and you are not capable of, and quite frankly, that’s all going to be challenged in the context of an MBSR course anyway. It happens all the time to people. That threshold crossing is the big “yes.” It’s the big “yes.” It might be a really quiet “yes.” It might just be, “OK, I’ll give this a try. I’ll give this a try.” Really what they are saying is, “I’m going to give myself a try.”

TS: And one final question, Saki. You mentioned that over 20,000 people now have taken the initial—

SS: They’ve completed it.

TS: —have completed the MBSR training.

SS: Yes, more than 20,000 started.

TS: So, more than 20,000 have completed it, and now here the MSBR training program is being offered as an online course. And this creates the opportunity for tens of thousands, if not hundreds of thousands, of more people to complete this training now available online. I’m wondering if you have a vision for how this will ripple out into the world—you could say, a vision for a mindful society—people engaged in mindfulness. What do you think might come from MBSR training being widely available?

SS: That’s a really—how shall I say? That question comes with a lot of—it’s fraught with danger and it’s fraught with possibility. Let’s just say it’s an opportunity and there are all sorts of possibilities in that. Of course, one of the most critical variables in what you’re asking, Tami, is about teachers. Are there enough competent teachers? They don’t have to be perfect. They just have to be good enough. Well, what does that mean?

One of my concerns is, yes there are more people that want to take MBSR courses and there are more people saying they are MBSR teachers. I certainly am concerned about it. I can’t police it, but I’m concerned about the quality of those teachers. That’s why the center has a pretty intensive and global training program—to see if we can be very attentive to the quality of MBSR teachers that are out there in the world so that people who encounter them across the world have a good teacher, have a competent teacher, who understands the methodology more than just from a book or from taking a class.

The online course [from] Sounds True and the Center for Mindfulness that you have supported so beautifully—the official MBSR online course that we are going to launch in a month or so, in September— is incredibly exciting to me for just the reason that you’re describing. It won’t be perfect, but I trust it and I hope that—I’ve done it, I’ve engaged in it, and continue to engage in it with you and your team and our team here, because I am excited about the potential for it to create access [for] people to a training process that I feel I can speak well for.

[I] can say, well, it doesn’t completely represent an MBSR course, because you’re not doing it in a group and you’re not getting the benefit of a group interaction. The basic instructions, the basic home assignments, the ways that we will explore the various dimensions of stress and stress hardiness, and resilience and reactivity, are true to the work that we’ve been engaged in at UMass for 34 years. That’s an incredible opportunity. I’m very grateful that you have made this opportunity available and that we could partner in it.

In that sense, I hope and envision that this course will be another stone, if you will, one more beautiful stone in a kind of universal temple that perhaps is being built by people all over the world. It’s not a temple of bricks and mortar, what you’re describing as this more mindful society—a society where people are far more attentive to each other, where we recognize that your health and my health are completely and inextricably linked, and the ways that we treat this planet in one part of the world is inextricably linked to how it is being experienced by people in another part of the world. So, yes, I’m excited about it.

When we created the Creating a Mindful Society conference in New York two years ago, it came out of my own vision of feeling like it’s the time. It’s time. We need a kind of peoples’ meeting of where this becomes more commonplace. This becomes more available to people. This becomes much more readily a part of the national or international or basically the human fabric—this capacity to study, to practice, to relate to our lives, to the world around us, to the people around us, in ways that are more kind, caring, compassionate, awake, and wise, if you will. This online course is, I hope, a vehicle that many people will avail themselves of and find valuable. I’m excited about it.

TS: I’ve been speaking with Saki Santorelli—a very humble, honest, and warm conversation. Thank you so much, Saki.

SS: Oh, it’s my pleasure, Tami. It’s a pleasure to have the opportunity to speak with you today.

TS: Along with Florence Meleo-Meyer of the Center for Mindfulness, Saki has created a new, comprehensive online training course on Mindfulness-Based Stress Reduction with Sounds True.

SoundsTrue.com. Many voices, one journey. Thanks for listening.