Can Mindfulness Meditation Induce Psychotic Episodes?

Can Mindfulness Meditation Induce Psychotic Episodes?

Along with our friend and research colleague Professor Mark Griffiths, we recently published a paper in the Australia and New Zealand Journal of Psychiatry that discussed whether mindfulness meditation has a role to play in the treatment of psychosis.¹ In addition to examining the treatment applications of mindfulness meditation for individuals with psychosis, our paper briefly explored the risk of mindfulness and other forms of meditation actually inducing psychotic episodes. Today’s post explores this subject in more detail and discusses the circumstances in which meditation practice may actually do more harm than good.

As we mentioned in our post on the ‘Top Ten Mistakes Made by Meditation Practitioners’, there is some clinical evidence to suggest that over-intensive meditation practice can actually induce psychotic episodes – including in people who do not have a history of psychiatric illness. A summary of the cases we have come across in the peer-reviewed clinical and scientific literature are as follows:

1. Three individuals with a history of schizophrenia that experienced acute psychotic episodes whilst engaging in meditation retreats.²
2. Two individuals previously diagnosed with schizotypal personality disorder that experienced acute psychosis following meditation.³
3. Three individuals with a psychiatric history that experienced psychotic symptoms following meditation practice.⁴
4. A 25-year old female graduate student in which delusional episodes accompanied by both violent outbursts and inappropriate laughter were induced by meditation.⁵
5. Two individuals without a history of psychiatric illness that experienced psychotic experiences following meditation practice.⁶
6. A male patient that experienced an acute and transient psychotic episode following meditation.⁷

Although the abovementioned studies appear to indicate that meditation can actually induce psychotic episodes, it is important to look at the quality and reliability of this evidence before jumping to any conclusions. In other words, the findings reported in these studies should be considered in light of their many limitations including the fact that all of these studies utilised very low participant numbers, they did not employ a control condition, and most of the participants had a history of psychiatric illness.

It is also important to note that in the majority of the studies outlined above, individuals were invariably engaging in very intensive meditation retreats (in some cases this involved 18 hours of meditation practice per day that was accompanied by lengthy periods of fasting and/or silence). For these individuals, practicing meditation for up to 18 hours per day under conditions of silence and/or fasting most probably reflected a sudden change to their normal daily routine. Within Buddhism, a philosophy of quality and not quantity of meditation is widely advocated, and practicing meditation in an extreme and potentially stressful manner is discouraged.⁸ This is consistent with the view in Western psychology that stress is a key risk factor for psychosis.¹ Therefore, even for those individuals who did not have a history of psychiatric illness, it is perhaps unsurprising that engaging in very intensive meditation retreats lead to psychotic episodes.

A further consideration when evaluating the above evidence is that most of the studies provided insufficient information in terms of the exact modality of meditation that was employed. Therefore, it is very difficult to conclusively isolate mindfulness (i.e., as opposed to other forms of meditation) as the source of the psychotic episodes. This is a particularly important consideration because numerous reports of adverse effects exist for non-mindfulness variants of meditation such as Transcendental Meditation and Qigong. Examples of such adverse effects reported for these types of meditation include panic attacks, musculoskeletal pain, anti-social behaviour, impaired reality testing, dissociation, guilt, uncomfortable kinaesthetic sensations, despair, suicidal feelings, and exhaustion.^1,9 Thus, although techniques such as mindfulness meditation, Transcendental Meditation, and Qigong can be broadly grouped together as modalities of ‘meditation’, it is important to note that these techniques represent fundamentally different approaches. For instance, Transcendental Meditation is a commercial technique introduced in the 1950s by Maharishi Mahesh Yogi – it includes mantra recitation and derives from Hinduism. Conversely, mindfulness meditation is a 2,500 year old Buddhist practice and does not include chanting or mantra recitation – it primarily focusses on breath and present-moment awareness.¹

Another related factor that limits the generalizability of the findings from the abovementioned studies is that little or no information was provided on the levels of experience or competency of the meditation instructor. As we have identified in several of our own empirical studies, the extent to which a meditation instructor is able to impart an ‘authentic embodied transmission’ of the meditation teachings is a factor that considerably affects outcomes.^10-13 Indeed, poorly-administered meditation training can lead to adverse health effects including: (i) asociality, (ii) nihilistic and/or defeatist outlooks, (iii) dependency on meditative ‘bliss’ (Sanskrit: prīti), (iv) a more generalized addiction to meditation, (v) engaging in compassionate activity beyond one’s spiritual capacity (and at the expense of psychological wellbeing), and (vi) spiritual materialism (a form of self-deception in which rather than potentiating spiritual development and subduing selfish or egotistical tendencies, meditation practice serves only to increase ego-attachment and narcissistic behaviour).^14-16

In summary, there is some small-scale clinical evidence that suggests that meditation can induce psychotic episodes in individuals with or without a psychiatric history. However, the quality of this evidence is highly questionable – especially when viewed in light of the abundance of more methodologically-robust evidence indicating that mindfulness meditation improves somatic, psychological, and spiritual wellbeing. Thus, although poorly-practiced or poorly-taught meditation can actually be harmful to a person’s health, where mindfulness meditation is taught by an experienced and authentic teacher who is aware of all of the risks, then adverse side effects are unlikely.

Ven Edo Shonin & Ven William Van Gordon

 

References

1. Shonin, E., Van Gordon, W. & Griffiths, M.D. (2013). Do mindfulness-based therapies have a role in the treatment of psychosis? Australia and New Zealand Journal of Psychiatry, DOI: 10.1177/0004867413512688.
2. Walsh, R., & Roche, L. (1979), Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. American Psychiatry Association, 136, 1085-1086.
3. Garcia-Trujillo, R., Monterrey, A.L., & Gonzalez de Riviera, J.L. (1992). Meditacion y psicosis. Psiquis Revista de Psiquiatria Psicologia y Psicosomatica, 13, 39-43.
4. Chan-ob, T., & Boonyanaruthee, V. (1999). Meditation in association with psychosis. Journal of Medical Association of Thailand, 82, 925-929.
5. Yorston, G. (2001). Mania precipitated by meditation: A case report and literature review. Mental Health, Religion and Culture, 4, 209-213.
6. Sethi, S., & Subhash, C. (2003). Relationship of meditation and psychosis: Case studies. Australian and New Zealand Journal of Psychiatry, 37, 382.
7. Kuijpers, H.J.H., van der Heijden, F.M.M.A., & Tuinier, S., et al. (2007). Meditation-induced psychosis. Psychopathology, 40, 461-464.
8. Shonin, E., Van Gordon, W., & Griffiths, M.D. (2013a). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4(194): Doi: 10.3389/fpsyg.2013.00194.
9. Perez-De-Albeniz, A., & Holmes, J. (2000). Meditation: concepts, effects and uses in therapy. International Journal of Psychotherapy, 5, 49-59.
10. Shonin, E., Van Gordon W., & Griffiths M. D. (2013). Meditation Awareness Training (MAT) for improved psychological wellbeing: A qualitative examination of participant experiences. Religion and Health, DOI: 10.1007/s10943-013-9679-0.
11. Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M.D. (2013). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness, DOI: 10.1007/s12671-012-0191-5.
12. Shonin, E., Van Gordon, W., & Griffiths, M.D. (2013). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, DOI 10.1007/s11469-013-9460-3.
13. Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). The treatment of workaholism with Meditation Awareness Training: A Case Study. Explore: The Journal of Science and Healing, In Press.
14. Shonin, E., Van Gordon, W., & Griffiths, M.D. (2013b). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.
15. Tsong-kha-pa. (2000). The Great Treatise on the Stages of the Path to Enlightenment, Volume I. (J. Cutler, G. Newland, Eds., & T. L. Committee, Trans.) Canada: Snow Lion.
16. Trungpa, C. (2002). Cutting Through Spiritual Materialism. Boston: Shambala.

 

Simply Being With Nothing to Be: A Commentary

Simply Being With Nothing to Be: A Commentary

Over the course of the last six months or so, we have been gradually populating the ‘Spiritual Songs and Poems’ section of this blog. Included in the ‘Spiritual Songs and Poems’ section are what in Buddhist language are known as ‘vajragitis’. Vajragiti is a Sanskrit term that comprises the word vajra which means ‘indestructible’ or ‘diamond’ and the word ‘giti’ which means song. So the vajragiti is a form of ‘diamond song’ that can be used to transmit what are often very profound and essence tantric teachings. Within certain Buddhist traditions, and as is the case with the vajragitis composed by ourselves, these songs often reflect the spontaneous expression of a person’s understanding or realization in relation to an aspect of the spiritual path. Given that such transmissions are generally intended to be digested at the intuitive rather than the ‘academic’ level, their intended meaning may not always be apparent. Accordingly, and in response to a number of requests we have received for further elucidation in relation to several of our own vajragitis, today’s post takes the form of a commentary upon the four-verse vajragiti called ‘Simply Being with Nothing to Be’. The full 16-line vajragiti is presented first followed by a commentary on a verse by verse basis.

 

Simply Being with Nothing to Be

 

Nowhere to go, nothing to do
No reputation to build, none to defend
No possessions to amass, none to protect
This is fearlessness born of Apranihita.

Simply here, simply now
Simply birth, simply death
Simply content, simply aware
Simply abiding, simply being.

 

No space, no time,
So no here, no now.
No self, no other,
So no attachment, no aversion.

 

Letting go with nothing to let go of
Practice with no path to walk
Simply being with nothing to be
This is the all-pervading wisdom of Dharmadhatu.

 

Commentary

 

Nowhere to go, nothing to do
No reputation to build, none to defend
No possessions to amass, none to protect
This is fearlessness born of Apranihita.

The first verse of this vajragiti is concerned with renunciation. In order to enter the spiritual path we need to renounce unskilful paths. Renunciation of unskilful attitudes and behaviours is therefore a prerequisite for entry onto the spiritual path. Many people believe that spiritual renunciation means forgetting about the world and everything we know. However, this represents a mistaken understanding because rather than forgetting about or turning one’s back on the world, true spiritual renunciation means completely surrendering oneself to, and becoming fully immersed in, the world. In order to surrender ourselves to the world we have to let go of all our attachments and all our aversions. We have to let go of hope and fear. If we harbour hopes then we leave ourselves exposed to suffering. Hope means that we are not content with the present moment and that we wish to try and change it. However, the only way to really change the present moment is to immerse ourselves fully in it – hope stops us from doing this. If we have hope, then we automatically have fear. We are fearful that our hopes will not be realized. Many people think that in order to be happy they need hope. But this kind of happiness is very conditional and is reliant upon the presence of external factors.

When we completely surrender ourselves to the world, and when we completely surrender ourselves to ourselves, then life becomes much less of a struggle and grind. When we renounce the path of always wanting to be somewhere else, be someone else, or have something else, then deep spiritual peace can take root in our mind. It is at this point that we can make the present moment our home. There is nowhere else we need to be and there is nothing else we need to do. If we have a good reputation, that’s just great but if we don’t then that’s great too. It really doesn’t matter. The same applies to material possessions and wealth – if we have them then it’s really marvellous and we can enjoy them – but if we don’t have them it’s just the same. Because we are not attached to things like wealth, career, or reputation, then we don’t have to spend all our energy being stressed and worried about these things. A lot of people are so caught up with these things that they never get to know who they really are, and before they know it they are old, at death’s door, and full of regret at having allowed their life to fly by meaninglessly.

It is letting go of our attachments that allows us to truly experience spiritual freedom and taste what it means to abide in fearlessness. This newfound fearlessness is completely unconditional and even extends to concerns such as death. We experience the spiritual fruit of fearlessness because we have absolute contentedness and are totally without desires. The Sanskrit word for ‘desirelessness’ is ‘apranihita’ – it means we have renounced worldly ways to such an extent that if need be, we are actually free to wholeheartedly engage in so-called worldly activities.

 

Simply here, simply now
Simply birth, simply death
Simply content, simply aware
Simply abiding, simply being.

 

Being without fear and desire means that the mind is left with no alternative other than to dwell in the here and now. There is nowhere else it can go and nowhere else it would rather be. There is nothing left for the mind to do other than be present with itself and with the unfolding present moment. From the state of authentic renunciation, we can sit with total contentedness at the centre of all universes and observe the birth and death, the becoming and dissolving of all phenomena. We can observe the beings who are born and who pass away – one moment they are present but the next moment they are gone. One moment they are happy but the next moment sad. One moment they are in the company of friends and family but the next moment they are all alone. We see that beings come and go, planets come and go, and even the universes come and go. We observe the passing of time and the passing of space. Ah la la, what joy to abide in the present moment!

 

No space, no time,
So no here, no now.
No self, no other,
So no attachment, no aversion.

 

Although being able to maintain an unbroken flow of present moment awareness means that we can truly taste great spiritual peace, there are still subtle levels of ignorance and attachment associated with the state. So the third verse of this vajragiti is where we completely leave behind and transcend relative concepts such as the present moment. This is where we fully realise that time and space are nothing other than man-made concepts, and that consequently, there can’t exist a here and now. It is also where we fully understand that ‘self’ and ‘other’ are also concepts born of ignorance, and that accordingly, even notions such as attachment and aversion must be rejected. The mind that transcends notions such as attachment and aversion dwells in total equanimity and sees the all as one. At this point, all things are equalised in the expanse of unconditioned truth. There is no good and there is no bad. There is no self and there is no other. There is also no non-self.

 

Letting go with nothing to let go of
Practice with no path to walk
Simply being with nothing to be
This is the all-pervading wisdom of Dharmadhatu.

 

Having transcended all concepts including that of a spiritual path, we can enter the path of no-path. This is where we realise that there never was a path to walk, nor was there a fruit to obtain. It dawns on us that, all along, we were the Buddha, that every sensory object we have ever experienced was the Dharma, and that every being we have ever met was the Sangha. We understand that the only thing that kept us from experiencing this was our own mind, and that we only need undergo the slightest shift in perception in order to become a fully-enlightened Buddha.

When we try to let go, we see that there is nothing to let go of, and nobody to let go of it. This is because an inseparable part of the whole can’t let go of the whole – however much it tries the wave can never separate itself from the ocean. When we try to practice we see that there is no path to walk – we already are the path. And even if we let go and just try to ‘simply be’, we see that ‘simply being’ also constitutes an implausible concept. We find ourselves with no alternative other than to relax into the all-pervading wisdom of ‘Dharmadhatu’. The Sanskrit word ‘Dharmadhatu’ means the realm of truth or the realm of unconditioned truth. By simply being with nothing to be, not only do we enter the realm of unconditioned truth, but we actually become it. Our awareness pervades the entirety of existence and becomes the very fabric of reality. There is no more action and nothing left to do. Compassionate activity manifests effortlessly wherever there are suffering beings. Finally, we have returned home.

 

 

Further Reading

Dalai Lama. (2001). Stages of Meditation: Training the Mind for Wisdom. London: Rider.

Gampopa. (1998). The Jewel Ornament of Liberation: The wish-fulfilling gem of the noble teachings. (A. K. Trinlay Chodron, Ed., & K. Konchong Gyaltsen, Trans.) New York: Snow Lion Publications.

Khyentse, D. (2007). The Heart of Compassion: The Thirty-seven Verses on the Practice of a Bodhisattva. Boston: Shambhala Publications.

Sogyal Rinpoche. (1998). The Tibetan Book of Living and Dying. London: Rider.

Trungpa, C. (2002). Cutting Through Spiritual Materialism. Boston: Shambala.

Tsong-Kha-pa. (2004). The Great Treatise on the Stages of the Path to Enlightenment (Vol. 1). (J. W. Cutler, G. Newland, Eds., & The Lamrim Chenmo Translation committee, Trans.) New York: Snow Lion Publications.

Urgyen Rinpoche. (1995). Rainbow painting. Hong Kong: Rangjung Yeshe Publications.