What is Mindfulness?


by John Carbone, M.D.

One clear definition of mindfulness comes from Jon Kabat-Zinn, Ph.D., founder of Mindfulness-Based Stress Reduction: “Mindfulness is paying attention in a particular way — on purpose, in the present moment, and non-judgmentally.”

Personally, my favorite definition is by my primary mindfulness teacher, Shinzen Young: “Mindfulness is a set of attentional skills which can be cultivated with systematic practice. These skills are concentration, sensory clarity, and equanimity.”


Fundamentally, concentration is the ability to focus on what is deemed relevant and to let go of what is deemed irrelevant. Without the ability to direct and maintain attention, learning would be impossible, regardless of the subject.

Why do we find it hard to concentrate, then? Suffice it to say that in our rapid-fire, sound-byte, multi-tasking, hyper-connected, over-stimulated, and under-exercised society, concentration can be extremely challenging for anyone. On top of that, it’s not generally taught that concentration is a skill that can be developed with practice.

So let me repeat the good news: Concentration is a skill that can be developed with practice — and it’s not rocket science.

Let’s take as an example a basic breath meditation. The instructions are simple. For 20 minutes, keep the attention on the breath, and if the attention wanders off the breath, as soon as you notice that, let go of that distraction, and bring the attention back to the breath.

The instructions are simple but the practice is not easy. What most people find is that the mind wanders off countless times to countless distractions: plans, fantasies, memories, body sensations, and emotions. But with time and practice, it’s possible to maintain the attention on the breath for longer and longer periods of time with less and less time spent in distraction. Just like working out at the gym helps a person develop strength, formal meditation practice helps a person focus on whatever he/she deems important, whether it’s the professor’s lecture, the coach’s instructions, the book, the basketball hoop or any other goal, making it that much more likely that he/she will learn the topic, or succeed in whatever the endeavor.

Sensory Clarity

Sensory clarity is the ability to experience precisely what is occurring in one’s own sensory experience. To develop sensory clarity, we focus our concentration on our senses: seeing, hearing, smelling, tasting, and feeling.

Let’s take the example of eating a meal. With our eyes we observe the presentation of the dish, the colors and visual textures; with our nose we smell the aromas; with our tongues and mouths, we taste the flavors and feel the textures of the food. Paying attention to experience can increase our delight and satisfaction. Even a simple meal attended to in this way can be incredibly interesting and fulfilling.

One of the first mindfulness exercises we do in the Mindfulness-Based Stress Reduction (MBSR) course is to eat a raisin mindfully, and it’s common to hear people report things like, “I never realized how much flavor one raisin could have.” This may not be our habit and may take effort in daily life, but the experience is fulfilling – much more so than zoning out in front of the TV while mindlessly polishing off a bag of chips.

A high degree of sensory clarity is important for many professions. Chefs, wine sommeliers, coffee roasters, perfume designers — any worth their salt have diligently worked to enhance their sensory clarity. So do artists, musicians, architects, and many others in specialized fields. While some degree of natural talent plays a role, systematic training is essential.

Thought is also considered to be a sense phenomena. Just as the eye receives and transmits external sights, and the ear registers external sounds, the mind perceives thoughts consisting of mental images and mental talk. Sometimes people are astonished to discover that thoughts can be both auditory and visual.

Emotion also figures in to our experience. It can be broken down into the component parts of thoughts and certain flavors of body sensation. Let’s take, for example, the emotion of anger. How do you know when you’re angry? If you’re mindful, you might notice an increased heart rate, shallow breath, clenched jaw, tension around the eyes, and a heated sensation that is most pronounced in the upper chest and neck. Certain angry thoughts accompany the bodily sensations. On the other hand, if you feel amusement, a smile may take over your face and and a subtle humor/amusement flavor will rise in the face.

Basically, our human experience consists of the five classical senses (seeing, hearing, smelling, tasting, and feeling) plus thought. When we recognize that emotion is a combination of thinking and feeling, it turns out that no matter how complicated our lives might seem, every single experience we will ever have will consist of some combination of only six total component parts! There is enormous freedom, power, and creativity when we can become consciously aware of that fact.


Equanimity is the ability to allow sensory experience to come and go without pushing it away or pulling it in. In my opinion, this is the most important skill a person can learn to reduce stress and suffering. The best explanation for why this is the case is this equation from Shinzen Young:

Suffering = Pain x Resistance

Note: In Shinzen Young’s definition, pain includes discomforts that we wouldn’t necessarily identify as pain per se, such as itches, mild aches, agitation, irritation, too hot, too cold, as well as any uncomfortable emotions such as sadness, embarrassment, etc.  

For any given pain, the lower the resistance, the lower the suffering. And, if resistance is zero (that is, the person experiences pain with perfect equanimity), the pain will not cause suffering. So, if pain is 5 and resistance is 2, 5x2=10 degrees of suffering. If pain is 5 and resistance is 0, 5x0=no suffering.

You may have heard the phrase, “pain is mandatory; suffering is optional.” This personal example will help demonstrate that.

I was three days into a demanding retreat, sitting still in formal meditation for many hours each day. After a couple of days, I was really hurting. My knee, my hip, my buttocks and my back would all take turns grabbing my attention with various aches and pains. Then I remembered Shinzen’s equation, S=PxR. If the equation is accurate, I realized that I must be resisting something somewhere. But where?

With real curiosity, I scanned my body, starting with the most obvious place at the time: my right knee, which was throbbing and burning. I was surprised to find no resistance there, though. I continued scanning down the right leg into the shin and foot, up into my upper leg and hip. No resistance there either. Then I brought my attention into the abdomen and to right upper quadrant of my abdomen, and there it was, just below my ribs: Resistance!

Instantaneously, the resistance disappeared, and the suffering did, too, along with the pain. This was my first tangible, personal experience of the equation at work, and the rest of the retreat, and my life, has never been the same. I still enjoy my creature comforts and am not against using more conventional methods of relieving discomfort, but now I know that the suffering that often comes with pain and discomfort can be reduced or eliminated simply by letting go of resistance.

To summarize, mindfulness can be defined as a threefold attentional skill set consisting of concentration, sensory clarity, and equanimity. These skills can be increased with systematic practice. And, it's worth the effort, because over time, these skills can markedly decrease stress and suffering while increasing joy and fulfillment.

John Carbone, M.D. is a board certified family physician with extensive experience in mindfulness meditation. In his primary care practice, Dr. Carbone has witnessed the suffering caused by stress and stress-related illnesses and the benefits of mindfulness meditation, both in his own life and the lives of others.

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