A Skeptic Neurologist's MBSR Journey
By Gus Castellanos
I practiced Neurology and Sleep Medicine for 25 years before retiring. I came to MBSR in 1998 while still practicing medicine. So, when a colleague brought MBSR to the Medical Center we were working at, he asked me to refer patients, “We have this new program called Mindfulness-Based Stress Reduction - MBSR. Please send your chronic pain patients, insomniacs, caregivers that are burning out - anyone who is stressed,” he said to me.
I balked, not knowing what MBSR was or how they could help my patients. Sensing my hesitation, my doctor friend said, “Look, Gus. This is an 8-week program established in 1979 at the University of Massachusetts Medical School. There is good research on how it helps pain, sleep, and anxiety.” And there was, even in 1998, plenty of research showing that it could be helpful. Because the treatment we had for chronic pain, insomnia, and other Neurologic disorders was limited, I decided this would be an option to offer my patients.
“OK. How do I refer patients?” I asked a week later.
He explained what to do, who to call, when the course started. As he finished, he paused and said,
“You know Gus. You should take this class; you seem pretty messed up these days.”
I froze. What me? “I am not having any problems,” I thought to myself and said, “Thanks, but I’m OK.”
Suddenly, I noticed a tightening of my chest and a vague sense of nausea. And some anxiety and fear.
Sensing my hesitation, he replied, “I will be taking the class because I am really stressed out. Join me. It will be good for us.”
I pondered the offer for a moment and said nervously, “OK, I will join the class.” I felt myself suppressing my feelings, then added, “But to be clear, I’m doing so to see what is that I will be referring my patients to.”
At the time, I was experiencing considerable job stress and burnout. But I was in denial, which led me to handle things poorly. I was convinced that I didn’t need help and that I knew how to take care of myself. So, I rationalized that I really was doing the MBSR class for my patients. Unexpectedly and fortunately, by class four, I became acutely aware of how much I was suffering. As the course progressed, it became clear how poorly I was coping with my stress. Then it hit me - this was about me and my self-care, not about my patients.
One surprise was the realization that workaholism was one of my coping strategies. That the worse I felt about work and at work, the more I buried myself in my work. By attending to the needs of others, I would feel better, I thought.
While this did get me out of my head and out of ruminating about how bad things were, this contributed to my burnout and kept me from addressing the causes of my stress and feelings.
Finishing the MBSR course, I felt renewed and refreshed. I started a daily mindfulness practice, which increased my awareness of how I felt and my harmful coping strategies. This self-awareness led to self-regulation and self-care as I adopted healthier coping habits. And my professional and personal life improved. I’d like to say the improvement continued, but I “fell off the practice bandwagon” after eight months. Things worsened again, so I attended another MBSR course three years later.
Because of my personal experience with MBSR, I began referring patients to the program. Most, but not all, came back saying their condition was improved or improving significantly. And all were pleased with the course and thankful I had suggested it for them. Most curious was that I referred several chronic insomniacs, those that despite everything modern sleep medicine had to offer, were still not sleeping satisfactorily. All of them came back saying they were much better. However, a few of them said their sleep had not changed. And though their sleep was not better, they did not mind!
Turns out they had unexpected positive outcomes that were more important to them. This was something I never heard before in my practice – that if the treatment I prescribed for a condition didn’t help that condition, the patient would still be pleased with the treatment. I remember a thirty-five-year-old manager at a medium-size corporation who came to me for insomnia and headaches due to job stress. I had been treating him with partial success for a few years. I referred him to MBSR. After the course, he came back to see me and said, “Thanks for sending me to the MBSR class. I enjoyed it. I am continuing to practice mindfulness. It was a great experience. But guess what, my sleeping is the same. Still not good.” Startled and disappointed, I was about to say something when he stated, “Don’t worry. I am OK with this because I am paying more attention to my five-year-old son. I feel really present when I am with him thanks to mindfulness. And my son really enjoys our time together now.” He went on to say this was so important and rewarding that he didn’t mind not sleeping well.
Since I started teaching MBSR in 2010, I regularly witness participants experience benefits, insights, and changes in themselves and their lives that were not expected. Many of these were not even on their radars. The manager came to MBSR to get better sleep and found himself more present with his family, improving his relationships.
Personally, I attended MBSR to see what it might offer my patients. While I did see what MBSR could offer my patients, more importantly, I developed the self-awareness to clearly see my feelings. And I became honest about my self-destructive patterns, allowing me to make real changes in my life.
Changes that benefited those around me a well as me.
This is why I always suggest to the students in my classes that though it is reasonable to expect improvement in whatever brought them to the class, to also keep an open mind and stay open to other possibilities. In MBSR class one, I introduce the late cultural anthropologist, Angeles Arrien’s “The Four Fold Way:” 1) Show up 2) Pay attention to what has heart & meaning 3) Tell the truth without blame or judgment 4) Be open to any outcome and result. With the emphasis on #4.
Over the years, people have recounted stories of their unexpected outcomes. Some were simple, like a reduction in road rage. Some profound, like quitting their jobs to pursue their true calling or leaving an unhealthy relationship. A quite common discovery that many find is that they not only need, but deserve, care. I teach MBSR to schoolteachers. Many come to MBSR wanting to learn how to teach mindfulness to their students. “They are the ones who need it,” they say. By class three or four, these teachers find that the course is about attending to their own care first and foremost. They come to know and honor their own needs and learn to practice self-care. They also realize that if they don’t take care of themselves, they will be less effective in taking care of others, not just their students, but their families as well. Germanely, they appreciate they cannot teach or pass on mindfulness if they are not mindful themselves.
To have an open mind and stay open to outcomes, it helps to cultivate a beginner’s mind. Beginner’s mind is one of the core MBSR attitudes. A beginner’s mind is one that is open to the novelty and aliveness of the present moment. It is not constricted by opinions, beliefs, or past conditioning. Among the benefits, it opens us to a wider range of responses to our challenges.
As a well-known Zen saying goes,
“In the beginner’s mind, there are many possibilities, but in the expert’s mind, there are few.”
We learn too that our choices and responses come from within. As MBSR teachers, we do not tell participants what they should or should not do. We are grounded in the actuality that each participant is the expert in their own experience. Deep within them is the strength and courage to meet whatever is happening with awareness and compassion. They possess the capacity to see clearly their own needs. Crucially, we believe they have the wisdom, know-how, and intuition to respond skillfully in every moment, particularly in moments of suffering. Our role is to bring forth that capacity, however doubted, forgotten, or neglected. By guiding the participants in recognizing their own power to hold their messes, blessings, and wounds in awareness, we empower, not enable. We support, not fix.
A decade of teaching MBSR has taught me so much about courage, wisdom, and compassion, both in myself as well as in those in my classes. It has been an honor and a privilege to teach MBSR and share my experience, insights, and mistakes with so many as they meet their challenges with grace and grit.
If you are thinking about or are planning to join an MBSR course, consider doing so with a beginner’s mind. Keep it simple. Show up to class. Show up to the present moment. Pay attention. Do the practices and exercises to the best of your ability. Allow the unfolding and unfurling. Stay open to outcome.
Practices to cultivate a beginner’s mind:
1) Choose an object, a plant, a flower, a piece of art, a paperweight, a pen. Look at it, noting its color, shape, edges. Feel it, is it rough, smooth, or both, its weight, its texture. What do you hear, smell? Stay curious. Open your senses to what you’re experiencing as if you’d never experienced it before.
2) Brush your teeth or eat a meal with your opposite hand.
3) Seek novelty by looking for something new in a co-worker each day - clothes, hairstyle, mannerism.
"The real voyage of discovery consists, not in seeking new landscapes, but in having new eyes." - Marcel Proust
Gus Castellanos, M.D. is a graduate of the U of Miami Miller School of Medicine, 1980. He practiced Neurology and Sleep Medicine for 25 years. He began practicing mindfulness in 1998 and teaching mindfulness programs in 2009. He is now a full-time mindfulness-based program teacher that is certified to teach MBSR by the University of Massachusetts Center For Mindfulness.