Researchers at Wuhan Mental Health Center consecutively recruited adults aged 18 to 60 who had an International Classification of Diseases, 10th Revision diagnosis of schizophrenia and were considered clinically stable by their treating psychiatrists. Recruitment took place from March to May 2024 at the outpatient department of the hospital, which serves Wuhan and surrounding cities in south-central China. Patients were excluded if severe physical illness, marked cognitive or communication difficulties or acute psychotic symptoms prevented them from completing the questionnaire. The single-center sample therefore represents a selected group of non-geriatric outpatients rather than the full spectrum of people with schizophrenia.

Formal religious affiliation was reported by 36.5% of participants, with Buddhism the most common affiliation at 20.1%. Christianity accounted for 6.0% and folk religion for 4.7%; smaller groups identified with Catholicism, Islam, Daoism or other affiliations. Practice use did not closely follow formal membership, however. Among patients with a religious affiliation, 66.1% had used at least one religious, spiritual or folk healing practice, compared with 52.1% of those without such an affiliation, a statistically significant difference. Even among participants reporting no formal affiliation, Zen meditation was used by 38.9% and scripture chanting or religious rituals by 22.1%, illustrating the overlap between formal religion and culturally embedded spiritual practice in China.

The four practices assessed were Zen meditation, scripture chanting and religious rituals, religious prayer, and shamanic dance or exorcism rituals. Their prevalence differed according to affiliation: 65.0% of participants affiliated with Buddhism reported Zen meditation, while religious prayer was reported by 44.4% of those affiliated with Christianity. The authors noted that Chinese spiritual life can combine Buddhist, Daoist, Confucian, ancestral and folk traditions rather than fitting neatly into exclusive institutional identities. The questionnaire therefore measured both declared affiliation and specific beliefs and behaviors, including belief in reincarnation and karma, supernatural interpretations of illness, and whether family members held supernatural beliefs about illness.

Helpfulness ratings varied by practice. Among the 134 participants who used Zen meditation, 77.6% regarded it as helpful. The corresponding proportions were 61.1% for scripture chanting and religious rituals, 59.5% for religious prayer and 57.7% for shamanic dance or exorcism practices. These percentages describe subjective appraisals among each practice’s users, not changes in symptoms or evidence that any practice is clinically effective. The survey did not include standardized clinician-rated symptom measures such as the Positive and Negative Syndrome Scale, and it did not collect detailed antipsychotic use, medication adherence or psychotherapy information. A patient could therefore perceive benefit even if the underlying psychotic symptoms persisted.

Exploratory classification tree analysis identified belief in reincarnation and karma as the first factor separating patients by practice use. Among the 120 participants who endorsed these beliefs, 76.7% reported using a religious, spiritual or folk practice, compared with 44.1% of the 179 who did not, a difference with P<0.001. Further subdivisions involved education and age among those who endorsed reincarnation and karma. Among participants without those beliefs, the analysis instead highlighted non-conventional health beliefs, family members’ supernatural beliefs and occupation. The structure indicates combinations of factors rather than independent causes, and the researchers did not directly measure distress, stigma, motivations for using the practices or pathways into psychiatric care.

Within the subgroup of practice users, religious affiliation was the first split associated with perceived helpfulness. Among 53 patients affiliated with Buddhism, Daoism, Catholicism or Islam, 92.5% rated their practices helpful, compared with 59.3% among the other 118 users, a difference with P<0.001. Within that second group, family members’ supernatural beliefs were again associated with the rating: 70.8% of users whose relatives held such beliefs considered the practices helpful, versus 51.4% of those whose relatives did not. The authors interpreted the family findings cautiously, noting that relatives may reinforce particular ways of understanding illness, but the cross-sectional survey cannot establish that family beliefs cause practice use or perceived benefit.

Methodological constraints limit how broadly the findings can be applied. The practice checklist was developed for the study from relevant literature and preliminary interviews with 10 patients, while the exploratory four-item non-conventional health-belief scale had acceptable internal consistency in this sample, with Cronbach’s alpha of 0.75, but had not undergone formal factor or validity testing. Classification tree analysis was chosen as an exploratory way to detect potentially nonlinear subgroup patterns, not to build a validated predictive model. Its stability and generalizability remain untested in independent samples. The cross-sectional design also prevents causal conclusions, and recruitment from one tertiary hospital limits representation of inpatients, people with acute psychosis, older adults, untreated patients, rural communities and regions with different religious traditions.

Even with those limitations, the survey documents an important part of how patients in this Wuhan outpatient population experience and manage schizophrenia. The most common practice, meditation, was also the one most often regarded as helpful, while the analysis connected use and perceived benefit with personal beliefs, family context and selected demographic factors. The findings do not justify replacing evidence-based psychiatric treatment or interpreting spiritual rituals as treatments for core psychotic symptoms. They do indicate that clinicians assessing these patients may encounter religious and spiritual practices that are meaningful to them and influential within their families. Recognizing those practices without assuming that they caused symptom improvement could help make psychiatric communication more attentive to the cultural frameworks through which patients interpret illness.

Subject of Research: Prevalence and perceived helpfulness of religious and spiritual practices among clinically stable Chinese outpatients with schizophrenia

Article Title: Use of religious and spiritual complementary practices among Chinese patients with schizophrenia: prevalence, perceived helpfulness, and associated factors

Article References: Tang, M., Liu, H., & Zhong, B.-L. (2026). Use of religious and spiritual complementary practices among Chinese patients with schizophrenia: prevalence, perceived helpfulness, and associated factors. Frontiers in Psychiatry, 17, Article 1948994. https://doi.org/10.3389/fpsyt.2026.1948994

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1948994

Keywords: schizophrenia, religious practices, spiritual care, Chinese psychiatry, patient-reported outcomes, Zen meditation, folk healing, family beliefs, cultural psychiatry, cross-sectional survey, religious, spiritual

The proverb from which the essay takes its name runs: “Before enlightenment, chop wood and carry water. After enlightenment, chop wood and carry water.” Its implication, as Cross explains, is that meaning can be found even in mundane-seeming activities, and that paying attention, moment by moment, to simple daily tasks can be a powerful practice in itself. For a clinician, whose days are filled with repetitive examinations, similar symptoms, and seemingly endless documentation, that message lands with particular force. The essay does not present meditation as a miracle cure or a productivity hack. Instead, it describes a slow, unglamorous transformation in how one doctor relates to his own wandering mind, and how that shift changes what happens in the examination room.

Cross is careful to correct a common misconception about Zen meditation, known as zazen. It is not, he writes, about emptying the mind. Minds do not empty; his certainly does not. Rather, zazen involves bringing the mind to the present moment. When the mind inevitably wanders, the practitioner notices and brings it back, again and again, without drama or self-criticism. The mechanical core of the practice is deceptively simple: sit still, follow the breath, count each inhalation and exhalation cycle up to ten, and restart whenever attention slips. Each act of noticing a distraction and returning to the breath is not a failure of the practice but the practice itself, a repetition that trains attention the way repeated lifts train a muscle.

The essay is candid about the author’s lifelong struggle with attention. As a child sitting in church with his family, he never heard an entire sermon. During college lectures, he drifted off every few minutes. And in clinic, when he runs behind schedule, his mind tends to race ahead, producing what he describes as an uncomfortable, burning feeling in his chest, a physical awareness that families are waiting for him. That sensation will be familiar to nearly any practicing physician. Time pressure in outpatient medicine is chronic and structural, and the cognitive cost of feeling behind is paid not only by the clinician but by the patient in front of them, who receives a distracted half-presence instead of full attention.

What makes the essay compelling is the contrast it draws between that old pattern and the present one. After years of zazen, Cross writes, he has learned to notice when his mind is wandering and to bring it back. The burning feeling still arrives when he is running late, but he recognizes it now, stops thinking about what comes next, looks the parents in front of him in their eyes, and listens. In the essay’s central scene, those parents are young, exhausted first-time parents with a newborn wrapped in a fluffy tan blanket, armed with a list of questions: What about these hiccups? Is it possible to overfeed a baby? How often should a temperature be checked? None of the questions has a dramatic answer, and the physician does not have all of the answers, but he works through them one by one, and the parents smile with relief when told they have a healthy newborn. He reports, simply, that he enjoys being with them.

The winter clinic that Cross describes is a study in repetition. An eighteen-month-old sits turning the pages of a book with clear nasal drainage pouring out, coughing and pulling at an ear. The next two patients, close in age, have exactly the same symptoms. The clinical findings accumulate in small, precise observations: a faint macular rash on the chest and back of one child, a thin rim of fluid behind the left tympanic membrane of another, very mild subcostal retractions in a two-year-old, a cry in a three-year-old that is more hoarse than at the last visit. Most of what he notices will not change his management. Some of it will. In either case, he writes, he finds a sense of pleasure in the repetition and enjoyment in the attention paid to small details. Chop wood, carry water.

That framing speaks to a tension at the heart of modern clinical medicine. Repetition is often treated as the enemy, something to be optimized away through templates, protocols, and automation. Yet diagnostic skill in primary care depends on exactly the kind of fine-grained, repeated observation that boredom erodes. A hoarse cry that has changed since the last visit, a subtle retraction beneath the ribs, a faint rash that could be dismissed as irritation: these are the details that separate careful practice from careless practice, and they are available only to a clinician who is actually present. The essay suggests that contemplative training offers a way to sustain that presence not through willpower or guilt, but through a genuine, cultivated interest in what each moment contains.

The day ends with a teenager being treated for depression, sitting on the examination table and leaning forward with her elbows on her knees, smiling. Fluoxetine has been effective, though she thinks an increased dose might help. She is not seeing a therapist, but she is open to the idea. Cross sits on his stool, turned toward her, while she tells him about her school year. It feels good, he writes, to hear her talk and open up. Even here, at the end of a long day, with sore feet, unfinished charts, patients to call, and a long drive home ahead, he reports that he is not thinking about any of those things. His patient is talking, and he is in the room with her. His closing line is a single sentence: “And I am happy.”

Woven through the narrative is a reflection on ambition and its limits. Cross writes that he has been striving toward something for most of his life, that he has always had goals, and that he would not be sitting on that stool in that examination room without years of work in school and medical training. But Zen has brought a different perspective. He sees that no achievement is ever truly satisfying, and that happiness is not down the road with the next achievement, promotion, or publication. Happiness, he writes, is available here and now, in this moment, with this patient. For a profession in which burnout is widespread and in which clinicians are often caught in a cycle of deferred satisfaction, always working toward the next milestone, that reframing carries real weight.

Published open access, the essay is a work of narrative medicine rather than a research study; no datasets were generated or analyzed, and the author reports no funding. Its contribution is not statistical but observational and personal, a first-person account of how a contemplative practice translates into clinical presence. It joins a growing body of writing on mindfulness and well-being in medical training and practice, fields concerned with self-regulation, metacognition, and the cultivation of attention as a professional skill. What distinguishes it is its refusal to romanticize. The meditation described is uncomfortable, the legs ache, the mind wanders constantly, and the author still considers himself a beginner. The clinic is still behind schedule, the winter still brings the same coughs and ear infections in an endless loop. Nothing external changes. What changes is the quality of attention brought to each ordinary moment, and with it, the experience of the work itself. Before enlightenment, chop wood and carry water. After enlightenment, chop wood and carry water. The wood and the water are the same; the person carrying them is not.

Subject of Research: Zen meditation and mindful attention in clinical medical practice

Article Title: Chop Wood, Carry Water

Article References: Cross, S. (2026). Chop Wood, Carry Water. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10863-z

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10863-z

Keywords: Zen meditation, zazen, mindfulness, primary care, physician well-being, narrative medicine, attention, burnout, pediatrics, self-regulation, metacognition, clinical practice