By Dr. Phang Cheng Kar (Consultant Psychiatrist & Mindfulness-Based Therapist).
Recently, I was invited to speak at the Asia Pacific Mindfulness Conference in Singapore. My topic was "A Mindful Relationship With Medicines For Healing The Mind." The following write-up is a summary of the main points presented at the conference on Mindful Medicating.
Mindfulness is a way of life. Naturally, we have mindfulness in daily life training such as mindful eating, walking, driving, listening, speaking, and parenting. But can we medicate mindfully?
I've been practicing and teaching mindfulness for a long time. This is the first time I'm delivering a talk on Mindful Medicating. I'm grateful to the conference organizer for inspiring me to contemplate what it means to consume medication mindfully.
As part of my preparation for the webinar, I've interviewed patients on psychiatric medications and mindfulness practice. My psychologist friends who apply mindfulness in their personal lives and clinical work shared their views. I've also reflected on the brief moments that I was on medication for panic attacks.
I hope you'll never be on medication. I hope your medical or mental health conditions can be treated by mindfulness-based therapies and other non-medication methods. However, if medication is unavoidable, especially for chronic diseases, here are ways to medicate mindfully.
I suggest we can take medications mindfully, based on the MINDFULGym's definition of mindfulness:
Mindfulness means [1] remembering to [2] pay attention to the present moment with an attitude of [3] kindness, a [4] a beginner's mind, and [5] wisdom.
[1] Remembering
[2] Pay Attention
[3] Kindness
[4] Beginner's Mind
[5] Wisdom
In our context of Mindful Medicating, it's remembering to pay attention and relate to our medication with an attitude of kindness, a beginner's mind, and wisdom.
"Sounds intriguing, but how do we do that?" Good, you're paying curious attention, which is a feature of mindfulness. Right here, I propose five practical and valuable ways to medicate mindfully:
1. Remembering:
A less known component of mindfulness (Sati, in Pali) is its cognitive function - remembering. In Mindful Medicating, it basically means remembering to take our medication according to the doctor's instructions.
Take notes in the clinic on your doctor's instruction on using the medications; dose, frequency, duration, etc. If you're not sure of the instruction, feel free to ask the doctor or pharmacist for clarification.
If you're anxious or have a poor concentration (common in mental health conditions), get a friend or family to accompany you to remember the instruction.
A pillbox and a mind bell reminder can help minimize forgetfulness. They're also beneficial for a positive experience by associating medication with meditation through the mind bell (often used by meditators).
2. Pay Attention:
Mindfulness is attention training; it's paying present-moment attention. Is it focusing on the breath as in meditation? No. In Mindful Medicating, we pay attention to the moment-to-moment experience of taking medication.
Just as we eat mindfully in Mindful Eating, we learn to take medication mindfully in Mindful Medicating.
You likely have had the mindless experience of not fully remembering your medicating experience. You doubt, "Did I take the medication just now? Should I take one more time?" Now, it's the time to medicate mindfully to prevent this from happening.
Minimize distraction when taking any medication. You might forget whether you've taken your medication if you're distracted by conversation, TV, or gaming.
Feel the medication resting on your hand; look at its color and shades; feel the swallowing sensation of the pill with water.
Mentally label, "Taking med, I know I'm taking med. Right here, right now, I'm taking my med."
Before or after swallowing the medication, take a mindful breath, put on a gentle smile on your face and heart.
It's essential to pay attention to our mindset when we take medication. In the medical world, we often notice the power of the placebo effect. If you, your doctor, family, and meditation teacher believe a medication works, it has a higher probability of being effective. On the other hand, there's the nocebo effect. If you believe the drug is harmful, it's more likely to be less potent and has more side effects.
3. Kindness:
Mindfulness is not just paying attention. It's paying kind attention, relating to the experience of medicating with kindness, respect, and gratitude. The combined therapeutic effect of mindfulness and kindness (aka kindfulness) has great potential in advancing the application of mindfulness.
Radiate grateful thoughts to everyone who has contributed to creating the medication: scientists who invented it, the pharmaceutical company that manufactured it, the doctor who prescribed it, the pharmacist who dispensed it. Mentally, appreciate all the conditions that make the medication available to you.
Be gentle and kindful to the mind and body. Set a kind intention. Try saying in your heart, "Dear Brain, Body & Medicine. Please meet one another. I hope you can be friends for mutual benefit. May you be safe (from side effects), healthy (body), and happy (mind)."
Breathe & send positive wishes
to the medication...
When I take my medication, I'll often be kind to my body by humming the 'Rasa Sayang' song (see above for the music box version). As I hum the song, I soothe my tummy or heart with my hand while projecting a positive wish to the medication.
You can also wish others who are on a similar medication be well and happy. "Everyone in the world who is taking such medication, I wish you a speedy recovery. May we be healthy and happy."
* Rasa Sayang is a Malay folk song. It means 'feeling loved.'
4. Beginner's Mind:
Being mindful is not just paying kind attention to the medication and medicating experience. It's befriending the medicating process with a beginner's mind. Observe with curiosity the thoughts, feelings, bodily sensations, and behavior changes associated with the medication. Record the observation non-judgmentally and discuss it with your doctor.
There are many possibilities in the beginner's mind, but in the expert's, there are few - Shunryu Suzuki.
Be open to possibilities instead of jumping to conclusions on what we notice (e.g., heart palpitation) as a side effect of the medication. I often educate my clients to consider three possibilities whenever they experience any 'effect' after a medication.
Is the effect (e.g., heart palpitation) a side effect of the medication?
Is the effect a symptom of the emotional illness you're being treated (e.g., panic attack)?
Is the effect due to other medical conditions (e.g., thyroid hormone disorder)?
A mind is like a parachute.
It doesn’t work if it's not open
- Frank Zappa
I find this beginner's mind model of relating to medication effect very pratical and useful. Noting medication effects in this way helps to reduce anxiety. We're less prone to jumping to a negative conclusion, more so if we had a negative experience with medication. It helps to troubleshoot side effects mindfully and realistically. After discussing with the doctor, we're more able to see things as they really are and make wise decisions on medication adjustment.
5. Wisdom:
It's beneficial to reflect on and respond to medication wisely. Mindful attention to medication needs to be guided by wisdom; it's called wise attention. I'm not referring to high-end philosophical wisdom. I mean down-to-earth wisdom. Practical wisdom says that acceptance of illness and medication is crucial for effective treatment.
We need to accept the illness we're experiencing (e.g., bipolar depression).
We need to accept that an illness may need medication (e.g., mood stabilizer).
We need to accept that a medication may have side effects (e.g., weight gain).
We need to accept that lifestyle changes (e.g., exercise, stop alcohol, sleep earlier) may be necessary when we're on medication.
We need to accept that an effective treatment plan is more than just taking medication. Family support, counseling therapy, a healthy lifestyle, regular mindfulness practice are the other vital ingredients for recovery.
Hello Pills.
How long more do I need you?
Acceptance is, of course, never easy. Try these 5 Mindful Vitamins (mindfulness-based coping statements) to encourage acceptance.
i). I'm not alone: You're not alone in taking any medication. Connect to others on similar medication to share experience and resources to maximize the positive effect of the medication.
ii). What can I do?: Focus on what you can do to recover and let go of what's not within our control. Try your possible best. We don't always have the best, but we can always try to make the best from whatever is available to care for ourselves.
iii). What have I learned?: Our illness and experience with medication can be a blessing in disguise. My personal experience of coping with panic attacks using medication and mindfulness helps me be a better psychiatrist. I can empathize with my patients more authentically and provide practical advice. Try to give meaning or purpose to your illness and medication. It's a teacher if we know how to pay attention wisely.
iv). It could have been worse: Be grateful that you get to consume the medication. Many people have a worse experience. There's no medication for some illnesses. The medication may not be available, or there's no expertise to use it, financial difficulty, etc. We don't deny the unpleasant experience of medicating but try to adopt a more balanced perspective to make peace with medication.
v). This will also pass: Hopefully, you only need medication for the short term. If not, be thankful that at least you have the mindfulness practice to help you cope. The illness may not always get better, but you can always learn to manage it better. It's possible to need less medication with proper treatment and the mindfulness tools that are freely available.
You may want to read the inspiring story of how a psychology professor and mindfulness practitioner accepts his bipolar depression and mood-stabilizing medication (coming soon).
In the book "I'm Still Human: Understanding Depression With Kindness," you can read Jasmine's journey of depression and recovery with the combined usage of antidepressant medications and mindfulness.
I would like to dedicate this talk/write-up to all my patients (past, present, and future) who need medication. May you be healthy, happy, and be at peace with your medication.
Happy Medicating...