Mindfulness Meditation Research: Issues of Participant Scree

What is the mind? What is the mind of a human? What is the mind of the one who investigates the human? Can the human mind understand itself? Can a human mind understand the mind of an other? This is psychology.

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Thu Feb 14, 2019 2:18 am

Depersonalization and Meditation
by Richard J. Castillo
Castillo, Richard J Psychiatry; May 1, 1990; 53, 2; ProQuest pg. 158
Copyright © 2009 ProQuest LLC. All rights reserved.
PSYCHIATRY, Vol. 53, May 1990



FROM a review of the literature on meditation and depersonalization and interviews conducted with six meditators, this study concludes that: 1) meditation can cause depersonalization and derealization; 2) the meanings in the mind of the meditator regarding the experience of depersonalization will determine to a great extent whether anxiety is present as part of the experience; 3) there need not be any significant anxiety or impairment in social or occupational functioning as a result of depersonalization; 4) a depersonalized state can become an apparently permanent mode of functioning; 5) patients with Depersonalization Disorder may be treated through a process of symbolic healing that is, changing the meanings associated with depersonalization in the mind of the patient, thereby reducing anxiety and functional impairment; 6) panic! anxiety may be caused by depersonalization if catastrophic interpretations of depersonalization are present.

Deikman (1963, 1966a), and Kennedy (1976) reported cases in which depersonalization and derealization occurred in individuals practicing meditative techniques designed to alter consciousness. Deikman's cases reported depersonalization and derealization during meditation practice. Kennedy's cases reported these conditions in waking consciousness. In order to determine whether experiences of depersonalization and derealization were occurring in the waking consciousness of meditators, six practitioners of Transcendental Meditation (TM) were interviewed regarding their subjective experiences while engaged in daily activity. All of the persons interviewed reported having at least one experience of what could be classified as depersonalization.


DSM-III-R (APA 1987) defines depersonalization as: "(1) an experience of being as if detached from and an outside observer of one's mental processes or body; or (2) an experience of feeling like an automaton or as if in a dream" (p. 276). Typically, depersonalization is a state in which an individual experiences a "split" in consciousness between a "participating self' and an "observing self." The participating self is composed of body, thoughts, feelings, memories, and emotions. The observing self is experienced as a separate, uninvolved "witness" of the participating self, with the perception that all of the normal aspects of personality are somehow unreal and do not belong to the observing self. There is the experience of being split off from one's participating self and ''watching'' that self behave. The split between the two "selves" is clearly illustrated by descriptions of the experience given by psychiatric patients:

"I had the impression as though I led a double existence. Everything 1 did and said seemed to issue from one ego, yet I also had the definite impression that there was a second ego as well, and that this second ego looked on the activities of the first as though they belonged to a different being .... I could think of this [observed] ego as one thinks of an object and was often surprised by what it did .... What oppressed me most was this incessant observation by my second ego. I moved like a machine in a strange environment." [Taylor 1982, p. 303]

"None of this makes any sense. I laugh but it's like someone else is laughing. It is as though there is a part of me watching and a part of me doing it." [Torch 1981, p. 250]

There are also secondary characteristics of depersonalization, which may include: feelings of dizziness, floating, or giddiness, a feeling of the participating self being "dead," a loss of affective responsiveness, and a feeling of calm detachment (Levy and Wachtel 1978).

Depersonalization, an experience in which the perception of the self is altered, is sometimes accompanied by derealization, an experience in which perception of one's environment is altered. In derealization the environment may take on a two-dimensional or "unreal" quality. Sometimes, normally stable, solid, inanimate objects may be seen to vibrate, or ''breathe:' to be unsolid, fluid, or alive. Shapes and sizes of objects may change, or objects may disappear altogether. Colors may be especially vivid, and some objects may be seen as "shimmering."

Persons experiencing depersonalization frequently report an especially distinct separation between the observing self and mental activities. When these mental activities are cognitive in nature, the affected individuals complain that it seems as if they are not doing their own thinking, imaging, or remembering because they can observe an independent flow of these phenomena in their minds. When the mental activities are affective in nature, the persons will often complain not that their emotions are changed in quality, but rather that there is a loss of emotions (Taylor 1982).

DSM-III-R includes a Depersonalization Disorder (300.60), which has as its diagnostic criteria:

A. Persistent or recurrent experiences of depersonalization as indicated by either (1) or (2) [see above]. B. During the depersonalization experience reality-testing remains intact. C. The depersonalization is sufficiently severe and persistent to cause marked distress. D. The depersonalization experience is the predominant disturbance and not a symptom of another disorder, such as Schizophrenia, Panic Disorder, or Agoraphobia without History of Panic Disorder but with limited symptom attacks of depersonalization, or temporal lobe epilepsy. [pp. 276-77]

Depersonalization may be present as a related symptom in all of these various disorders and is thus a fairly common experience in psychiatric populations.

Depersonalization also occurs in the nonclinical population. DSM-III-R estimates that single brief episodes of depersonalization may occur at some time in as many as 70% of young adults. This estimate is supported by the findings of Dixon (1963), Sedman (1966), and Trueman (1984). Dixon observed that over half of his college student subjects could recognize descriptions of depersonalization as something they had experienced. When one takes into account the high incidence of depersonalization, in both the clinical and the nonclinical populations, it is not surprising that many authors postulate an organic basis or substrate for its occurrence. Mayer-Gross (1935), for example, considered depersonalization a "preformed functional response of the brain": a physiological disturbance that could be triggered by a wide variety of factors.

The etiology of depersonalization is un- known, but in addition to the disorders mentioned in DSM-III-R, depersonalization has been linked with prolonged sleep deprivation (Bliss et al. 1959), ingestion of hallucinogenic drugs (Felsinger et al. 1956; Guttman and Maclay 1936), sensory deprivation (Reed and Sedman 1964), feelings of anxiety (Lehmann 1974; Nuller 1982), and alterations in the person's mode of attention, such as prolonged gazing at a particular object (Deikman 1963, 1966a; Levy and Wachtel 1978; Renik 1978). Psychoanalytic writers on depersonalization have emphasized the defensive function of this experience. Most analytic writers see depersonalization as a means of defending against guilt, painful affects, intense conflict, danger, or conflicting ego identities (Lehmann 1974; Levy and Wachtel 1978; Shraberg 1977; Stolorow 1979).


Deikman has referred to the effects of meditation as the "de-automatization of the psychological structures that organize, limit, select, and interpret perceptual stimuli" (1966b p. 329). In his experiments on meditation, Deikman (1966a) had inexperienced subjects gaze at a blue vase resting on a simple brown end table. The subjects sat for 30 minutes gazing at the vase and were then interviewed regarding their experiences. Most of the Deikman's data came from two subjects, A and G, who completed the longest series of sessions: A, 78 sessions; and G, 106. Some of the reports:

A, 54th session: "It was also as though we were together, you know, instead of being a table and a vase and me, my body and the chair, it all dissolved into a bundle of something which had ... a great deal of energy to it but which doesn't form into anything but only feels like a force:' [1966a, p. 105]

G, 62nd session: " ... things seem to sharpen and there is a different nature to the substance of things. It's as though I'm seeing between the molecules ... the usual mass of solidity loses its density or mass and becomes separate." [1966a, p. 113]

A, 58th session: "The only way I can think of to describe it is being suspended between something and something, because the world all but disappears, you know, the usual world ... so that I'm in a world of converging with that, whatever it is, and that's all there is:' [1966a, p. 113]

G, 74th session: " ... solid material such as myself and the vase and the table ... seems to be attributed then with this extra property of flexibility such as in its natural, fluid state:' [1966a, p. 113]

The obvious depersonalization and derealization experiences reported by Deikman's novice subjects while meditating are strikingly similar to the experiences reported below by my more experienced informants outside of meditation. A key to understanding these phenomena may be in studies involving repetitious and stabilized stimuli. Piggins and Morgan (1977) suggest that the stabilized retinal images and repetitious auditory input that characterize some meditation techniques (including TM) may be considered as evoking mild sensory deprivation conditions. This is consistent with the· hypothesis of deautomatization. Sensory deprivation conditions may be interpreted as the mechanism by which the meditator "short-circuits" the automatic functioning of the perceptual and cognitive systems. The diffusion and partial or complete loss of boundary experienced by Deikman's subjects in gazing at the vase is consistent with experiments on visual fixation in which geometrical shapes were observed to fragment, disappear and reappear, as a whole or in part (Evans and Piggins 1963).


Sheehan (1983) estimates that 50-60% of patients with panic/anxiety disorders have associated symptoms of depersonalization and derealization. The relation between depersonalization and anxiety is still poorly understood. In some cases an experience of depersonalization can precede the onset of anxiety and panic attack (Kennedy 1976; Roth et al. 1965; Sours 1965). However, experiences of depersonalization have been reported in the absence of anxiety (Davison 1964; Deikman 1963, 1966a), and sometimes feelings of anxiety are replaced by depersonalization (Lehmann 1974; Nuller 1982).

Kennedy reported two cases in which patients experienced depersonalization and derealization as a result of meditation practices and suffered sufficient anxiety as a result of their depersonalization to seek psychiatric treatment. In the first of these cases, the patient (a 37-year-old businessman) developed the feeling of being outside his body and looking down on himself after experimenting with a series of meditative exercises described in a book entitled Awareness (Stevens 1971). The patient continued with these experiments over several days until depersonalization and derealization experiences began to occur spontaneously and uncontrollably. The patient sought admission at a local hospital and was treated with tranquilizers and released. However, he sought readmission a few days later in a state of panic because the tranquilizers he had been given (type unstated) seemed to exacerbate his· feelings of unreality. During this second hospitalization ECT was proposed, but the patient refused and was discharged. On the advice of a friend he sought help from a Yoga instructor. The patient stayed with the Yoga instructor for several days, learning about his experiences from the perspective of Yoga psychology. He was then able to return to work, even though the episodes continued to occur, because he felt he had gained enough insight into the occurrences so that he was no longer bothered by them.

The second case involved a 24-year-old man who had been practicing meditative techniques for 2 years and had been experiencing episodes of depersonalization and derealization for at least 18 months prior to being seen by Kennedy. The patient mentioned episodes in which "the sidewalk appeared to disintegrate beneath his feet" (Kennedy 1976, p. 1326). These episodes caused the patient no great concern at first but later the occurrences generated anxiety to the extent that he was unable to maintain employment. After a few sessions of psychotherapy, in which the patient's attitude toward the depersonalization was altered to one of acceptance, the patient was able to resume gainful employment. According to Kennedy:

The intriguing aspect of this is that apparently by using virtually the same mental maneuvers a syndrome may be produced that, depending on the attitude the person adopts toward himself and then toward the resulting phenomenon, may be experienced either as something to be sought and valued or as something to be feared and called a disease. Perhaps what we need to do with patients who exhibit primarily a depersonalization syndrome is to teach them first to accept themselves uncritically and second to accept their depersonalization. [p. 1327]

In these cases, depersonalization occurred first and was followed by panic/anxiety. It is significant that in both cases panic/ anxiety was relieved and occupational functioning restored by the reconstruction of the subjective meaning of the depersonalization in the mind of the patient. This was true even though episodes of depersonalization continued. In medical anthropology this therapeutic process involving the transformation of ideational and emotional factors is known as symbolic healing.


The therapeutic process in the cases noted above, in which the affected individuals were effectively cured of their anxiety and functional impairment, may be analyzed according to a model of symbolic healing formulated by Dow (1986). According to this model the structure of symbolic healing is as follows:

1. The experiences of healers and healed are generalized with culture-specific symbols in cultural myth.

2. A suffering patient comes to a healer, who persuades the patient that the problem can be defined in terms of the myth.

3. The healer attaches the patient's emotions to transactional symbols particularized from the general myth.

4. The healer manipulates the transactional symbols to help the patient transact his or her emotions (p. 56).

According to Dow, every system of symbolic healing (including modern psychotherapy) is based on a model of experiential reality that he calls its mythic world. The word "mythic" is used to imply that there may exist a cultural reality that is inconsistent with other cultural realities but that is experientially true and real to those who belong to the same culture. This implies that both healer and patient share the same presuppositions about the nature of the world. In the therapeutic process the healer actualizes (i.e., makes real in the present situation) the mythic world for the patient through the use of explanation, suggestion, and persuasion. The healer then isolates part of the mythic world relevant to the patient and interprets the patient's problem in terms of this constructed explanatory model. In the actualization process, transactional symbols are formed that become intellectually and emotionally charged for the patient. Transactional symbols can be any ideas, objects, or actions performed by the healer that facilitate the patient's transformation of emotions and subjective experiential reality. If the patient accepts the healer's explanation as a valid model of his or her problem, then by skillful manipulation of the transactional symbols the patient's emotions and lived experience can be therapeutically altered. Dow, following Ehrenwald, refers to this alteration as the existential shift-that is, a change in the patient's experienced reality creating new opportunities for adaptation. In the above cases, a phenomenon that was previously interpreted as a problem and a cause for anxiety in the mind of the patient was transformed into something benign or even valued, with a consequent alleviation of anxiety and occupational impairment.

One of the above cases may be analyzed in order to explicate the concept of symbolic healing. In the case of the patient who sought help from the Yoga instructor, the patient received instruction in how to interpret his experiences in terms of Yoga psychology. This procedure accomplishes steps 1 and 2 in the process of symbolic healing. The patient becomes socialized into the mythic world of Yoga, and the patient's problem is then defined in terms of this cultural myth. In Yoga psychology, a split in consciousness between an observing self and a participating self is imbued with religious significance. Yoga meditation practices are, in fact, designed to produce a permanent split in consciousness of this type. This permanent split in consciousness is considered to be the ultimate goal of yogic practice (Castillo 1985). Thus, the ideation surrounding the experience of depersonalization is modified from that associated with psychopathology to that of religious experience. In this case, the yogic myth identifies the observing self, present in a depersonalized state of consciousness, as the "spiritual self' or "soul:' Once the patient has accepted the definition of the problem in terms taken from the religious model, the patient's emotions will become attached to symbols associated with this mythic world (step 3). The symbols that articulate this myth are such things as religious texts, ritual objects, and the personal teachings of the healer-in this case, the Yoga instructor. By skillful manipulation of these symbols the healer transforms the patient's emotions and overall subjective experience, providing new opportunities for adaptation to life situations (step 4). I suggest this is the process that operated in this case.

The mythic world of Transcendental Meditation is completely consistent with that of traditional Yoga. The presence of an observing self in consciousness is thought to be an experience of the spiritual self or soul, which the TM meditators call "the Witness:' or "the Higher Self:' Having this experience is called 'Witnessing:' Witnessing is described as the experience of being a witness to one's self that is, being split into an observing self and a participating self. TM meditators interpret these experiences as "higher states of consciousness" or "enlightenment:' In the mythic world of the meditators, Witnessing is considered to be highly desirable. The meditators interviewed in this study were asked if they had ever had any experiences of "Witnessing:' and to describe those experiences. The reports fit the criteria for experiences of depersonalization.


Mr. A is a 33-year-old research associate in marine geology at a major university. He holds a BA in geology and a PhD in oceanography. He has never been married. He has been practicing TM for 12 years. He reports being in a state that could be described as a mild state of depersonalization almost constantly, accompanied by frequent mild episodes of derealization. He reports no impairment in either social or occupational functioning. His first depersonalization experience occurred 10 years ago, while he was on a 3-month TM residence course.

I was sitting in a lecture listening to someone speak. The first thing I noticed was a slight change in· my vision. The change was like a camera lens zooming out, a pulling back. There was a sort of tunnel vision associated with it so that I had the sensation that instead of looking from the front of my head I was looking from behind, through my eyes. A certain calmness pervaded everything. It was very much a feeling of "watching:' This sensation lasted for about 15 minutes or so, and then faded out. I didn't feel particularly wonderful. I recognized about half way through it what was happening.

Mr. A reports that he has had a similar experience almost all the time for the past 3 or 4 years. His derealization experiences are characterized by the perception of bands of color around objects and by vibration.

I also tend to see bands of color around people and objects. Objects have a slight vibratory quality to them. They don't lose their distinctness of outline though. The boundaries between objects are vibrating but sharp. In other words, the boundaries are not flowing together, but they're not rigid, almost as if objects were alive and breathing. They don't change shape, it's just sort of a liveliness to them.

When asked about his emotions he reported a general lack of emotions combined with an almost constant feeling of mild happiness or contentment.

There are certainly no negative emotions. The emotions are not strong, maybe a mild sense of happiness. It's not a strong feeling-in fact, it's almost an absence of emotion. There's a slight positive emotion, but it's not a "bursting with joy" kind of emotion. It's a more passive state than that. It has the quality more of observing it than experiencing it. I'm used to it now. It's not remarkable anymore. It's just sort of normal. But I don't want to leave the thing sounding better than it is, because it's not bad, but it's not wonderful.

Ms. B is a 34-year-old graduate student in English as a Second Language. She holds a BA in Philosophy and Religion, and an MEd in Educational Administration. She has never been married. She has been practicing TM for 14 years. She had one experience of depersonalization about 11 years ago, which she considers to be a particularly clear experience of "Witnessing."

I was talking to someone and all of a sudden it felt like I wasn't doing the talking. And it was a very disconcerting experience because you always like to feel like you're in charge. And all of a sudden I had the feeling, "Who's doing this talking? It's not me." So I was listening to my voice and the words came out without my doing it. I was continuing to speak but I wasn't part of the experience. It feels like a dichotomy. You're so used to being a part of the experience you're undergoing that to all of a sudden not be part of that is very strange. Gradually the experience just faded. I couldn't make it stop, it just went by itself. It lasted about 45 minutes. It's very difficult to explain. The activity was going on but I wasn't doing the activity.

Ms. B reports that she has not had any similar experiences since that time; however, when questioned about her present-day general emotional tone she reported a general lack of strong emotions and a mild pervasive feeling of contentment. This might suggest an extremely mild condition of depersonalization that has become so well established as to be unnoticeable. She has not had any experiences of derealization and reports no social or occupational impairment.

Ms. C is a 32-year-old horticulturist in a large urban area. She is the director of an organization that maintains 13 community gardens, and she coordinates the activities of approximately 2,600 volunteer workers. She holds a BA in Ethnobotany and has been practicing TM for one year. She has never been married. She reports no current impairment in her daily activities as a result of her depersonalization experience. She had her first experience of depersonalization, accompanied by acute derealization, about 3 years ago, while practicing a different form of meditation that she used to practice before she began TM. In this meditation she would sit cross-legged on the floor face to face with her boyfriend (about 2 feet apart), and they would gaze at each other for hours at a time. During this experience she felt as if she were lifted out of her body. She became very frightened but was unable to do anything about it. She continued with the meditation, and gradually the fear subsided. She then felt a "total clarity" of mind. "It was like being totally open to everything. I looked around at the trees and it was like I was in Nature, like I was Nature. It was breathing, and I could feel it breathing. Everything was kind of pulsating:' The experience of derealization lasted for several hours, disappearing gradually. The depersonalization continued for 6 weeks after the initial onset. A second depersonalization experience occurred a year later, again induced by the same form of meditation practice and accompanied by acute derealization.

We were sitting face to face, and his whole face turned to plastic, and then it melted, and then there were just his eyes. Then he disappeared, and all I could see was golden light, and then green light, and then white light. For three days we just sat there. We got up to get water and to go to the bathroom, and we slept at night, but the rest of the time we just sat there because we were so amazed.

Again, in this experience the derealization gradually disappeared upon the resumption of normal activity, but the depersonalization continued for several weeks. Since beginning the practice of TM about a year ago, Ms. C has had the experience of depersonalization almost constantly. During a recent TM residence course in which she was doing extra meditations, she experienced pronounced vividness in colors and a ''breathing'' quality in the surroundings. When asked about her emotional tone during her present-day activities she replied:

I don't feel elated or anything, it just feels normal. I feel very comfortable. My monthly period is not affecting me like it used to. I'm hardly getting any reaction from that, and that's usually the only problem I have with my emotions now; a certain time of the month and a certain change in the hormones, and that's about it. Although I do feel sort of half in the world and half out.

Mr. D is a 42-year-old professor of Business Administration at a major urban university. He holds a BS and MS in Electrical Engineering, an MBA, and a PhD in Management. He is married, with no children. He has been practicing TM for 15 years. He reports no current impairment in social or occupational functioning, although there was significant social impairment when his depersonalization experience began. He had his first experience. of depersonalization 13 years ago during a 3-month TM residence course. This experience continued for 6 months after the completion of the course.


It was like being a pure impersonal observer watching a movie. There was a real distance between the inner being and the outer being. There was a real pureness and coolness, and noninvolvement, and no emotions. Everything I would say and every emotion that I had from the viewpoint of that "inner thing:' which is what I was, was just phony. It was like living in a movie where you knew it was a movie. Emotions had no relationship to that "inner being"; they were as phony as a bad movie. This made me uncomfortable. It was very different living than the kind of living you ordinarily have. People that I had known for years - they meant nothing to me. There was no real connection. It was like I would just sit there and watch it all go by.

Mr. D has been in an almost constant state of depersonalization for the past several years. However, he no longer finds it an uncomfortable experience. He has grown completely accustomed to this mode of functioning and apparently suffers no impairment from it. The only time he experiences any discomfort is on the rare occasions when the depersonalization ceases. This occurs usually only when he is very tired or ill. At these times he becomes temporarily disoriented and has the feeling of "What am I doing here?" When this occurs he is forced to reorient himself to his new perspective. In describing his present state of mind he reported:

Now it's like a movie, but it's a good movie. I am content, but I'm not moved by it, or thrilled by it. I'm content with it. I'm part of it but separate from it at the same time .... There is really a sense of non attachment to life. I'm definitely there, and my life is definitely going on around me-and I'm part of it, but I'm not part of it .... I have a problem when I get kicked out of this thing. Because it takes real time to change over and function in another state. I can't go between them just like that [snapping his fingers].

When asked about his present emotional state of contentedness he replied, "Contentedness is one of the last things I would have expected out of meditation when I was starting it all off. I mean contentedness is such a strange kind of existence in life. It's very different from what I would have anticipated. I thought that things would be different. The evenness of it all is remarkable:' Mr. D also has frequent mild episodes of derealization. "Things take on a slightly warmer and slightly glossier appearance-like dew."

Mr. E is a 38-year-old chiropractor in a major urban area. He is married, with one child. He has been practicing TM for 14 years. He reports no social or occupational impairment. He also had his first depersonalization experience during an extended TM residence course, which occurred about 12 years ago. "I left my room after a lot of meditation, and I went down for a meal, and part of me was eating the meal and part of me was sitting inside laughing:' This initial episode was short-lived (only a few minutes), but in recent years he estimates that he has a similar experience in a mild form a large part of the time.

My experience in general though is that it's not a clear something that I remember, but it could be happening more often than I notice. Sometimes when you first start having these experiences they seem flashy, but after a while you're not even sure if you've had them. The first few times it's really flashy, but then you probably have them a lot more and you don't really notice. Although sometimes there's a perceptual shift-like you're looking through a tube or a telescope-like you're looking at something from somewhere else. But I think that you would become comfortable with that if it was happening all the time.

Mr. E also has infrequent experiences of mild derealization. "There is a definite aliveness in the environment, almost as if you're aware that there is consciousness in everything:' When asked about his present emotional experience he replied, "A normal day for me is when everything just goes right. When things don't go right, then I think it's strange. But my emotions are not as ecstatic as you might imagine, it's more even. I would say sort of warm; and it's very fulfilling in a knowing sort of sense rather than in a feeling sense."

Mr. F is a 43-year-old probation officer in a suburban area. He holds a BS in Behavioral Science and an MS in Counseling Psychology. He has been divorced for 10 years. He has three children, one grown and two in the custody of his ex-wife. He has been practicing TM for 12 years. His first depersonalization experience was a brief episode during a TM residence course 8 years ago. He now has a similar experience "more than 50 % of the time."

I don't know how to describe it. It's like I'm not totally there while I'm doing the activity. But it's not like I'm not paying attention. It's like I'm not totally caught up in the activity. It's like my body and the activity are doing it themselves and I'm just sort of watching it. ... Thoughts are going on by themselves more in relationship with the activity, and it's like I'm something other than that watching it.

Mr. F has episodes of depersonalization most frequently while he is working, usually writing up case reports, and he experiences no impairment in his functioning. He reports that the efficiency of his work seems to be enhanced during these episodes and the work seems more effortless. "It would feel just like the writing was flowing out as I was doing it. And yet part of me was just sitting back watching the whole thing taking place." His emotional tone is similar to the other informants. "Usually very contented but not aroused-in other words, not ecstatically joyful, but just a sort of low level of happiness or contentment." He has also had frequent episodes of mild derealization.

It's like spots or something. I don't know what you'd call it. In other words, it's like there's all kinds of little moving things [laughter]. Objects are not as solid. They're more like - millions of little spots would be the nearest. And boundaries between objects are more fluid. They're less defined because the whole object itself seems to be moving-not literally moving, but sort of on some level moving, almost like you looked through heat - how it shimmers. Sort of like that, but not exactly like that, but along that line.

None of the informants reported a personal history of psychiatric disorder; however, family medical histories were not obtained. In addition, the informants were not given a physical examination; thus the possibility of organic pathology cannot be ruled out. Nevertheless, the well-documented ease of inducing a depersonalized state through the use of repetitive stimuli and/or stabilized sensory input (as in TM, which utilizes the repetition of a mantra) lends weight to the conclusion that the depersonalization was induced by meditation (Deikman 1966a, b; Lex 1979; Ornstein 1977; Piggins and Morgan 1977; Renik 1978). Moreover, this conclusion is supported by the fact that this type of split in consciousness is the stated intention of yogic meditation practice (Castillo 1985).


The salient features of the experience of depersonalization in the meditators interviewed are: 1) the experience can become a continuous, apparently permanent mode of functioning in the individual; 2) there need not be any significant impairment in social or occupational functioning; 3) there may be the subjective experience of improvement of performance in occupational functioning; 4) there is the apparent long-term loss of the ability to feel strong emotions, either negative or positive; 5) a subjective experience of constant mild pleasantness or contentment may be present; 6) the affective nature of the experience appears to be strongly connected to the symbolic content attached to depersonalization; 7) generally mild episodes of derealization are common.

All of the meditators interviewed are successful in their careers, are apparently satisfied with their lives and optimistic about the future, and are very friendly, personable people. Their lives seem to run smoothly, with the absence of any significant anxiety or stress. I maintain that they feel comfortable with their depersonalization because they view the experience positively. I suggest that the relative lack of reported anxiety in response to the depersonalization is a result of the ideational construction of the experiences in terms consistent with the mythic model of TM. In other words, instead of "pathologizing" the experiences - that is, interpreting them as psychopathology according to a medical model of reality - they are "sacralizing" the experiences - that is, interpreting them according to a sacred model of reality. Therefore, I suggest that the presence or absence of panic/anxiety in association with depersonalization can be a function of the nature of the ideational construction of the experience in the mind of the individual.

For example, in a depersonalized condition, if the individual holds catastrophic interpretations of this state, such as, "I am going crazy" (one of the diagnostic criteria of a panic attack), then a panic/anxiety response may result. However, if in the same situation the individual interprets the episode with the thought, "I am having a sacred experience:' then an entirely different bodily response may develop, characterized by lack of arousal and parasympathetic dominance (Lex 1979).

There are implications of this study for research on Depersonalization Disorder. It is possible that Depersonalization Disorder is a culture-bound syndrome. The apparent ease by which depersonalization can be induced and its high incidence in the normal as well as psychiatric populations indicate that it is indeed some sort of natural response of the brain to the environment. However, the response of the individual to depersonalization and derealization seems to be quite variable and subject to shaping by social and cultural factors. The "mythic world" of some individuals, lacking any other alternative for depersonalization/derealization, may be pathologizing what could be viewed as a normal experience, transforming it into an episode of mental illness.

Because it is estimated that 50-60 % of all patients with panic/anxiety disorders suffer from depersonalization (Sheehan 1983), there are also implications for research in this area. Depersonalization is generally seen as a symptom of Panic Disorder, and a diagnosis of Depersonalization Disorder will not be made if panic is present as a symptom. In that case, DSMIII- R recommends Panic Disorder as the proper diagnosis. However, it may be that if the assigned meaning of depersonalization in the mind of the patient includes catastrophic interpretations, then panic may be the result of depersonalization, rather than the reverse, which seems to be the prevailing assumption in present diagnostic opinion. Further, the effectiveness of symbolic healing in alleviating panic/ anxiety in depersonalized individuals, and thereby diminishing functional impairment, suggests psychotherapy as a preferred treatment instead of the use of tranquilizers, which can heighten feelings of dissociation and unreality.



AMERICAN PSYCHIATRIC ASSOCIATION (APA). Diagnostic and Statistical Manual of Mental Disorders. 3rd ed., rev. American Psychiatric Association, 1987.

BLISS, E. L., CLARK, L. D., and WEST, C. D. Studies in sleep deprivation-relationship to schizophrenia. Archives of Neurological Psychiatry (1959) 81:348-59.

CASTILLO, R. J. The transpersonal psychology of Pataiijali's Yoga-Slltra (Book I: Samddhi): A translation and interpretation. Journal of Mind and Behavior (1985) 6:391-417.

DAVISON, K. Episodic depersonalization. British Journal of Psychiatry (1964) 110:505-13.

DEIKMAN, A. J. Experimental meditation. Journal of Nervous and Mental Disease (1963) 136:329-43.

DEIKMAN, A. J. Implications of experimentally induced contemplative meditation. Journal of Nervous and Mental Disease (1966a) 142:101-16.

DEIKMAN, A. J. De-automatization and the mystic experience. Psychiatry (1966b) 29:324-38.

DIXON, J. C. Depersonalization phenomena in a sample population of college students. British Journal of Psychiatry (1963) 109:371-75.

Dow, J. Universal aspects of symbolic healing: A theoretical synthesis. American Anthropologist (1968) 88:56-69.

EVANS, C. R., and PIG GINS, D. J. A comparison of the behaviour of geometrical shapes when viewed under conditions of steady fixation and with apparatus for producing a stabilised retinal image. British Journal of Physiological Optics (1963) 20: 1-13.

FELSINGER, J. M., LASAGNA, L., and BEECHER, H. K. The response of normal men to lysergic acid derivatives. Correlation of personality and drug reactions. Journal of Clinical and Experimental Psychopathology (1956) 17:414-28.

GUTTMAN, E., and MACLAY, W. S. Mescaline and depersonalization: Therapeutic experiments. Journal of Neurology and Psychopathology (1936) 16:193- 212.

KENNEDY, R. B. Self-induced depersonalization syndrome. American Journal of Psychiatry (1976) 133:1326-28.

LEHMANN, L. S. Depersonalization. American Journal of Psychiatry (1974) 131:1221-24.

LEVY, J. S., and WACHTEL, P. L. Depersonalization: An effort at clarification. American Journal of Psychoanalysis (1978) 38:291-300.

LEX, B. The neurobiology of ritual trance. In E. Aquili, C. Laughlin and J. McManus, eds., The Spectrum of Ritual: A Biogenetic Structural Analysis. Columbia University Press, 1979.

MAYER-GROSS, W. On depersonalization. British Journal of Medical Psychology (1935) 15:103-26.

NULLER, Y. L. Depersonalization: Symptoms, meaning, therapy. Acta Psychiatrica Scandinavica (1982) 66:451-58.

ORNSTEIN, R. E. The Psychology of Consciousness. 2d ed. Harcourt Brace Jovanovich, 1977.

PIGGINS, D., and MORGAN, D. Note upon steady visual fixation and repeated auditory stimulation in meditation and in the laboratory. Perceptual and Motor Skills (1977) 44:357-58.

REED, G. F., and SEDMAN, G. Personality and depersonalization under sensory deprivation conditions. Perceptual and Motor Skills (1964) 18:659- 60.

RENIK, O. The role of attention in depersonalization. Psychoanalytic Quarterly (1978) 47:588-605.

ROTH, M., GARSIDE, R. F., and GURNEY, C. Clinical and statistical enquiries into the classification of anxiety states and depressive disorders. In Proceedings of Leeds Symposium on Behavioural Disorders. London: May and Baker, 1965.

SEDMAN, G. Depersonalization in a group of normal subjects. British Journal of Psychiatry (1966) 112: 907-12.

SHEEHAN, D. V. The Anxiety Disease. Scribner's, 1983.

SHRABERG, D. The phobic anxiety-depersonalization syndrome. Psychiatric Opinion (1977) 14:35-40.

SOURS, J. L. The "break-off' phenomenon. Archives of General Psychiatry (1965) 13:447-56.

STEVENS, J. O. Awareness. Moab, Utah: Real People Press, 1971.

STOLOROW, R. S. Defensive and arrested development aspects of death anxiety, hypochondriasis and depersonalization. International Journal of Psycho-Analysis (1979) 60:201-13.

TAYLOR, F. K. Depersonalization in the light of Brentano's phenomenology. British Journal of Medical Psychology (1982) 55:297-306.

TORCH, E. M. Depersonalization syndrome: An overview. Psychiatric Quarterly (1981) 50:249-58.

TRUEMAN, D. Depersonalization in a nonclinical population. Journal of Psychology (1984) 116:107-12. PSYCHIATRY, Vol. 53, May 1990

Richard J. Castillo, MA, is a PhD Candidate, Department of Anthropology, Harvard University, and Lecturer in Anthropology, University of Hawaii at West Oahu, Pearl City, HI 96782 (mailing address).

The research for this paper was supported by a National Science Foundation Predoctoral Fellowship.

The author is indebted to Professors Arthur Kleinman, Byron Good and Charles Lindholm of the Anthropology Department, Harvard University, for their many valuable insights and criticisms on earlier drafts of this paper.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Fri Feb 22, 2019 2:47 am

Meditation in Association with Psychosis
by Tinnakorn Chan-Ob, M.D.* and Vudhichai Boonyanaruthee, M.D.*
Journal of the Medical Association of Thailand
October 1999  




This study analysed the correlation between contemplation and psychosis from three cases of patients presenting psychotic symptoms subsequent to practising meditation. Sleep loss following a wrong doing in meditation was found to be the main cause in the first two cases, and drug withdrawal was found to be the principal factor in causing a psychotic eruption in the third case. In this last case, sleep deprivation subsequent to meditation was only a minor influence.

Discussion regarding the correlation between meditation and psychosis is presented in this study

Key word Meditation, Psychosis, Sleep Deprivation

Buddhism has been the national religion in Thailand for a long time. From children to the elderly, meditation, a kind of Buddhist practice has been very popular among Thai people for hundreds of years. It is divided into two types: mindfulness (Vipassana) and concentration.

Meditation, a fundamental and imperative practice for attaining its goal: nirvana, has different procedures. Although they are explicitly diverse in method, they cannot be separated naturally in practice. In this context, Vipassana meditation does not affect the alteration of consciousness, but concentration meditation does(1).

Many experiences that occur while meditating such as feelings of mystical encounters, unity, a deeply felt positive mood, and a oneness with individual things(2,3). The most common psychiatric features are depersonalization and derealization, while the others are panic and anxiety(4). In general, these psychiatric consequences cause few problems to meditators, and up to now, there has been no report on meditation-induced psychosis. However, this study presents 3 cases from the Maharaj Nakorn Chiang Mai Hospital who showed psychotic symptoms while practising meditation. This research studies the possible causes of psychosis in the three meditators.


Case 1

A 25-year-old female student suffering hallucinations was presented to the hospital with hallucination after practising meditation at a renowned temple in Chiang Mai. She had a past history of stress, depression and family problems. It was suggested that she solve her problems by using a psychological approach because the problem arose from psychological cause. Therefore, she went to the temple and took a meditation course. The method used in this temple differed from others. It was called "Intensive course", and consisted of 7 days of very tough practice. The meditators were suggested to stick to meditation all the time, eat once a day, sleep as little as possible, 4-5 hours a night. All meditators received the same approach regardless of their previous state of mind. The main point of the practice was the awareness of every moment of movement. They were asked to forget other things that came to mind and to focus their full attention on body movement. During the course, the subject in this case felt more tense and worried about what she should do in the meditative practice along with what to do next in her real life. She ate and slept less, and sometimes could not sleep at all. Nevertheless, she continued to practice meditation in the morning. One week later, she began to feel a fear of being persecuted by an unknown origin, and she was then brought to hospital. A mental status examination revealed hallucinations, disorientation to time and place, labile affect, mild loosening of association and very poor insight and judgment. There was no neurological deficit on physical examination, and findings were negative on Electroencephalogram (EEG) and Cranial Computerized Tomography (CCT). The patient's initial diagnosis was "Acute psychosis".

Therapy and follow-up.

The patient was administered a sedative drug that made her fully rested. Haloperidol was prescribed for controlling the psychotic symptom. The patient gradually recovered and was cleared in one week. The final diagnosis was "Brief psychotic disorder".

Case 2

A 35-year-old businessman was distressed about his economic problems. He, therefore, went to a meditation center (the same temple as in case 1) in an effort to calm himself and find an answer to his situation. He found that it was very hard to detach himself from such a big problem. He ruminated about it over and over again, and tried to focus on only one thing, as the teacher had assigned but it, made him feel more distressed. Then he lost his appetite and was unable to sleep. He replaced his insomnia by walking meditation (the meditation practice where the meditator focuses all his attention on his step of walking), which he did all night for 3 consecutive nights. After that, he experienced hallucinations and delusions of grandiose. He believed that he was able to contact God, read peoples' minds and know everything. He developed bizarre behavior, pressure of speech, flight of ideas and absolutely no insight. Finally he was brought to the hospital. The patient was admitted to hospital and investigated for organic causes for his condition. The results of an EEG and a CCT revealed no relevant pathological findings. The patient was diagnosed "Acute psychosis".

Therapy and follow-up.

The patient was given Haloperidol at 15 mg/day. His psychotic symptom subsided two days later and had almost disappeared after one week. The patient was discharged on day 22 fully recovered. The final diagnosis was Bipolar disorder Type I (Manic Psychosis).

Case 3

A 28-year-old woman had a psychic breakdown 2 weeks after practising meditation. The psychiatrist's assessment of her condition stated that she had persecutory hallucinations, and delusions and loosening of association. She was known to have schizophreniform disorder for the last 2 years and was therefore given Haloperidol as an antipsychotic. She took the medicine for 1 month. After being discharged, she discontinued it because of her unwillingness to take any further role as a patient. Then she was lost to follow-up. Later she became involved in a family conflict, which was concurrent with a financial problem. These problems forced her to become troubled. When she discovered that no one could help her, she thought of meditation as a solution and went to the same temple as the first two cases. She practised meditation for 10 days, and when she began to have severe psychotic symptoms, she was admitted to hospital. The patient was diagnosed with Schizophrenia.

Therapy and follow-up.

The patient received Trifluoperazine at 15 mg/day, an antipsychotic drug previously administered to her. Her psychotic symptoms subsided after seven days. The patient was discharged 1 month later when she had clinically improved.


All three cases presented with the same symptom (psychosis), which precipitated their psychological problems. It raises the issue of whether meditation can induce psychosis. This study revealed that psychosis was the first diagnosis for the first two cases. In acutely psychotic cases, psychosocial stressors and sleep deprivation are common features, and their response to the antipsychotic drug (Haloperidol) was very good. In the last case, the patient had a history of schizophreniform disorder and sleep deprivation. Therefore, the effect of practising meditation was only a precipitating factor for relapse of the disorder.

Psychosis might not be a sequelae of meditation practice. However, Freud interpreted the "oceanic" meditative experience from meditation as a reaction formation of omnipotence to infantile helplessness(5). Kris viewed meditation as a transitory regressive state that is conducive to the expression of hidden memories, fear, love and anger(6). In addition, meditation is seen as a "libidinal, narcissistic turning of the urge for knowing inwardly. A sort of artificial schizophrenia with a complete withdrawal of libidinal interest of the outside world(7)". However, that was their opinion with no evidence to support it, especially the regression to psychosis. This view is also in contrast to the Lord Buddha's teaching about meditation. Allison described that the adaptive regressive states have been differentiated from pathological regressive states by virtue of their transitory and quickly reversible nature, and their ability to increase self esteem(8). However, there is no evidence of a long meditative state that produces a regressive thought or behavior whether during meditation or post meditation. The history of the three patients as described, showed that practising meditation caused them to suffer sleep deprivation, and a tendency to sleep disruption. In the first case, the practice was too strict, and extreme, and might be regarded as a malpractice: not in a middle way, and it caused evident sleep loss before psychosis erupted. This study might cite several papers published on the relationship between sleep deprivation and psychosis, which explain that sleep deprivation can precipitate transient psychosis or manic symptoms as described by Wright(9). Also Tyler described psychotic symptoms after total sleep deprivation as being more like paranoid or schizophrenic-like illnesses and others have supported this(10-14). In this sense, given psychosis may be like the state of delirium concerning its course and clinical picture (case 1), and Bipolar disorder (case 2), which has a causal relationship to sleep loss as explained by Wehr et al. (15-18). In the last case, psychosis developed after a relapse caused by the lack of drugs. Sleep loss facilitated by practising meditation was only a minor precipitating factor. This finding was similar to the reports of others(19,20).

As Lord Buddha's teaching is pertinent to meditation: meditation, regardless of kinds or schools, has never produced psychotic symptoms provided it is practised in the right way. It can induce a euphoric state, calm, and wise thoughts. The deeper, the better. The deeper, the wiser. As the Buddha said, "The mind attaching to higher stages of concentration is ready for all kinds of work(1)." Hence, two possible factors that may be considered when talking of meditation and psychosis are:

1. sleep deprivation that is facilitated by meditative malpractice: one strict rule of meditation is "Do not torture your body while practising meditation. Be concerned about your mind, not things about your body (including your brain)." Meditators who can often make good this rule and are likely to satisfy the euphoric state (Piti: in Upacara samadhi) or calmness and unity (Jhana: Attainment concentration) they are encountering. However, meditators may not take enough time for rest or sleep through ignorance or misunderstanding. Some keep practising all day and night. Such a practice probably induces sleep loss followed shortly by psychosis or delirium.

Three levels of concentration: I. Momentary concentration (Khanika-samadhi) usually happens in daily life without training. 2. Access concentration (Upacara-samadhi) -- A more sustained concentration, usually induced by practising meditation, but sometimes occurs accidentally. In this stage, the feeling of euphoria and strange experiences can occur such as seeing various kinds of pictures and an alteration of bodily sensation. However, all this disappears when meditation is discontinued. 3. Attainment concentration (Appana - samadhi, Jhana) -- A deep, higher level- concentration, divided into 4 sublevels (Jhana 1-4). The final sublevel gives meditators no response to their environment, including their body sensation, but they are in a happy mood(21).

Fig. 1. Hypothesis of the development of psychosis by meditation.

2. Meditator's fear "Nimitta" -- a natural phenomenon in Access or higher level concentration(1). Nimitta in Access concentration is "visualized image [controllable, conceptualized image which appears in Attainment concentration (Jhana)]" presented by various kinds of uncontrollable pictures such as the full moon, animals, a beast, ugly or beautiful things and even God, which comes mostly in concentration meditation. Some meditators see terrible pictures that make them so scared they possibly lose their mind. Should this event actually occur, then meditators can confide in their practitioners. Meditation can be controlled by the meditators and they can abolish Nimitta whenever they want to in order to prevent frightening or unwanted consequences.

The above diagram shows the study's hypothesis of psychosis following the practice of meditation in three cases. The more dense lines mean the stronger causal relationship. Psychotropic drug discontinuation caused a flare up of the existent anxiety and frustration (case 3). The patient turned to meditation to mitigate these symptoms. Drug discontinuation also altered sleep. Sleep loss concurrent with drug discontinuation (bold line) was the major cause of developing psychosis in this patient. This model is generally accepted. In the first two cases stress led them to practice meditation (dotted line), but the way they did it was not correct and it caused sleep deprivation. Wrongly practiced meditation causes more stress. The more stress, the more sleep loss. Sleep deprivation itself can bring about psychosis.


This study shows three patients presenting psychosis to the hospital after meditation. Their condition was not caused by meditation itself, but sleep deprivation and other factors. The first two cases showed delirium and Bipolar type caused directly by sleep deprivation. The other was exacerbated by sleep deprivation concurrent with lack of drugs. Those who develop psychosis subsequent to meditation are likely to have had a predisposing factor, and then become frustrated by inability to achieve the desired level of meditation. Whereas, meditators who can attain the desired level of meditation will not suffer from any psychological distress. However, it is very difficult to attain this level of meditation, even for a healthy person.

Meditation rarely produces psychosis providing it is carried out properly under an experienced supervisor and no harm should come to the meditators. A very long history of practising meditation in Thailand has ensured everyone about meditation and whether or not it can produce psychotic symptoms. On the other hand, there have been some reports from Western countries, although they are doubtful, as Epstein and Lieff concluded, "Most reported cases of pathological responses to meditation are by Western practitioners, but no attempts to locate this phenomenon in traditional settings have been reported. Thus, there are many gaps in our understanding ... "(22).

The authors warn that psychosis relating to meditation possesses other factors besides meditation itself. In addition, meditation should not be forbidden for a patient who needs to do it, but good guidance and supervision is necessary. Meditation, can be of very great benefit for all kinds of meditators, from all walks of life.


(Received for publication on November 11, 1998)

* Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.


1. Abhidhamma Pitaka. Tripitaka (Thai Buddhist canon). 4th ed. Department of religious, Ministry of Education, Kamsassana printing. Bangkok 1982.

2. Stace W. Mysticism and philosophy. London, JB Lippincott, 1960.

3. Davidson JM. The physiological of meditation and mystical state of consciousness. Perspect Bioi Med 1976; 19:345-80.

4. Castillo-RJ. Depersonalization and meditation. Psychiatry 1990;53: 158-68.

5. Freud S. Civilization and its discontents (1930), in Complete Psychological Works, Standard ed, vol 21. London, Hogarth Press 1961.

6. Kris E. The psychology of caricature. Int J Psychoanal 1963; 17:285-303.

7. Alexander F. Buddhist training as an artificial catatonia. Psychoanal Rev 1931;18:129-45.

8. Allison J. Adaptive regression and their intense religious experiences. J Nerv Ment Dis 1967; 145: 452-63.

9. Wright JB. Mania following sleep deprivation. Br J Psychiatry 1993;163:679-80.

10. Tyler DB. Psychological changes during experimental sleep deprivation. Disease of the Nervous System 1955;16:295-9.

11. Bliss EL. Review of disorders of sleep in schizophrenia and depression. In: W. Dement, ed. Sleep and Altered Stated of Consciousness. Baltimore: William & Wilkins, 1967: 456-69.

12. West JL, Jenzen HH, Lester BK. Psychosis of sleep deprivation. Annals of the New York Academic of science 1962;96:66-70.

13. Tucker RP. A review of the effects of sleep deprivation. University of Michigan Medical Center Journal 1968;34:161-4.

14. Karanyi EK, Lehman HE. Experimental sleep deprivation in schizophrenic patients. Arch Gen Psychiatry 1960;2:534-8.

15. Wehr TA. Sleep loss as a mediator of diverse causes of mania. Br J Psychiatry 1991 ;159:576-8.

16. Wehr TA. Sleep loss: A preventive cause of mania and other excited states. J Clin Psychiatry 1989: 50 (12,Suppl):8-16.

17. Wehr TA, Sack DA, Rosenthal NE. Sleep reduction as a final common pathway in the genesis. Am J Psychiatry 1987;144:201-3.

18. Wehr TA, Goodwin FK, Wirz-Justice A, et al. 48-hour sleep wake cycles in manic-depressive illness: Natural observations and sleep deprivation experiments. Arch Gen Psychiatry 1982;39:559- 65.

19. Garcia Trujillo R, Monterrey AL, Gonzalez de Rivera JL. Meditacion y psicosis. (Meditation and psychosis.) Psiquis Revista de Psiquiatria 1992; 13: 39-43.

20. Walsh R, Roche L. Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. Am J Psychiatry 1980; 137:663-73.

21. Phra Devathi. Dictionary of Buddhism. 8th ed, Mahachulalongkom Royal College. Thaphrachan, Bangkok, 1995.
22. Epstein MD, Lieff JD. Psychiatric complications of meditation practice. J Transpersonal Psychol 1981;13:137-47.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Fri Feb 22, 2019 3:44 am

Single Case Study: Transcendental Meditation, Altered Reality Testing, and Behavioral Change: A Case Report
by Alfred P. French, M.D.1, Albert C. Schmid, Ph.D.2, and Elizabeth Ingalls, MLS3
The Journal of Nervous and Mental Disease, Vol. 161. No.1
Copyright © 1975 by The Williams & Wilkins Co.



This paper presents the case of a 39-year-old woman who, several weeks following initiation into transcendental meditation (TM), experienced altered reality testing and behavior. We discuss the course of this episode, present evidence for a causal relationship between her practice of TM and altered behavior, and discuss the appropriate treatment of such phenomena.

The past decade has seen an increasing awareness of the value of each individual's subjective experiences, including an interest in "altered states of consciousness," induced by various means. Of these, the most prominent meditation form to be represented in this movement is transcendental meditation (TM) in which 200,000 people have been trained in this country (6). TM consists of the correct utilization of a mantra, or "sacred sound," to facilitate a state of consciousness characterized by physiological and psychological quiescence (4, 5).

The objectives of this paper are to present a case of psychosis-like behavior, which occurred in direct conjunction with the use of TM,
and to discuss the theoretical and therapeutic implications of this case.


Mrs. M., a 38-year-old woman who had never previously experienced any behavioral or thought disorder of any kind, experienced a radical "expansion" of her state of consciousness within days after beginning TM according to approved methodology. This state was initially characterized by sustained optimism, moderate euphoria, and a strong sense of the inherent goodness and value of her experience. In a letter to her teacher, written after 1 month of TM, she described "mental and creative energy at a peak .... Soaking up creative energy like earth drinking rain. Beautiful people everywhere. Life is so rich I have to keep expanding to hold my portion." She later explained, "I was in a state of openness and readiness for new growth; I felt that there were unreached areas in my mind and that there must be more to life. When, through meditation, I began reaching new areas of myself, I was delighted."

Two weeks after beginning meditation, but not during meditation itself, she began to experience compelling fantasies, which were euphoric in quality. These led to unusual behavior which would have been described clinically as psychotic. Soon she actively sought these experiences. Later, she described them as "waking dreams in which I created and experienced fantastic cosmic and inner adventures. I was able through them to fulfill my meta-need to help relieve the world's tensions by astrologically correcting a planetary gravitational imbalance that was deeply troubling the human race."
(It should be noted that, although there was continuity between the initial euphoric response to TM and the quality of the first of the compelling "waking dreams," this sustained exploration of an affective state. and its associated content. are not part of TM.)

We interviewed Mrs. M. at the end of the 3-month period during which she had experienced euphoria. She was an attractive, neatly dressed and young looking woman who was immediately congenial upon our arrival. She displayed substantial use of intellectual processes, particularly abstractions and analogies, and seemed clearly above average in intellectual functioning. She was oriented in all spheres, and her discourse was coherent but at times circumstantial. She spoke freely about herself and her unusual experiences. She seemed to be experiencing a fixed level of moderate euphoria reflected in frequent laughter, a virtually constant smile, and an attitude of cheerful optimism toward all events, including her recent experiences. The unusual finding was the lack of variation in her affect and general manner over the 3 hours we interviewed her. She later explained, "I was not totally there. I was operating also on other levels and couldn't completely return to the here and now that you were experiencing."

Fig. 1. lMMPI profiles 4 months after beginning TM [x] and 10 months later [x].

Psychological test results at this point indicate a moderate thought disorder. The Minnesota Multiphasic Personality Inventory (MMPI) profile (Figure 1) indicates excessive pressure from unconscious material, resulting in anxiety, social and emotional alienation and withdrawal, and ruminative and obsessive qualities. The Rorschach performance was characterized by tension, depressive content, concern about death, and obsessive attempts to integrate percepts of the blots. With respect to the latter, Mrs. M. was only partially successful at perceptual integration and at times displayed moderately loosened associations. Her performance also reflected rather primitive sexual content. The initial Adjective Check List (ACL) profile (Figure 2) (1) is that of a somewhat inhibited individual who was both anxious and actively seeking help from others, while at the same time seeking independence and new experience.

During the 2 months following our interview, there was a dramatic shift in the nature of Mrs. M.'s experience. The affect became dysphoric, and the intensity increased until it was "unbearable." Simultaneously, there was a loss of control. "The process took me over. I was on such a precarious balance, that it would have been dangerous to change direction or stop." She experimented occasionally with shorter meditation times, and with eliminating meditation altogether, with no perceptible decrease in the rush or intensity of the experience. "I was afraid to stop altogether lest I lose the link that kept my feet on the ground." During this interval, only inexperienced TM teachers were available. Although clearly aware that Mrs. M. was in severe distress, they could offer no advice except the standard "meditate your allotted time and come in for checking." She sought a psychiatric evaluation to ascertain "whether I was in my right mind." The young Szaszian psychiatrist described her experiences as "unusual," but not indicative of mental illness. He suggested further counseling, which was a financial impossibility, and recommended medication.

"I turned to psychological and religious literature when new experiences began to occur to ascertain that I was going through a positive and natural process and to answer my questions about what was happening. Rossi's theories of psychosynthesis and growth, Maslow's metamotivation, metaneed, peak experience, and self-actualization concepts, Jung's symbols and archetypes, Lilly's rules for observing inner experiences, Ellenberger's "creative illness," and Maharishi's discussions of evolution and levels of consciousness became incorporated into my experience." The entire episode finally ended when, "in a state of complete physical and emotional exhaustion, I knew I had reached my limit." The rush gradually subsided, and "I began to sleep again. I had to sleep or die."

Fig. 2. Adjective Check List (2) profiles 4 months [x] after beginning TM and 10 months later [x]

The MMPI and ACL were repeated 10 months after the initial testing and our interview. The second MMPI profile (Figure 1) indicates no evidence of thought disorder, in contrast to the initial profile. The validity scales indicate a defensive posture, and reflect a response set of "faking good" (F-K = 14). The shift in the ACL profile (Figure 2) over the 10-month period is toward less self-confidence, increased impulsiveness, and a marked decrease in the subjective sense of discomfort and need for outside assistance, while autonomy and active interest in new experience remain high. This might be summarized as a shift toward being both more "loose" and more comfortable.


The challenge of any process designed to catalyze adaptive change may be to facilitate access to repressed material without excessive hazard, while simultaneously facilitating the integration of emerging material into the personality structure. Derepression, by itself, is readily obtained by a wide variety of methods but cannot by itself lead to adaptive change. Some meditation forms appear to decrease repression, while providing various means for reintegration of material. TM involves experiencing "a thought at 'subtler' or more abstract levels of thinking, in an easy and natural manner" (4, p. 8). This occurs because "the nature of the mind is such that allowing the mind to remain lively, in a non-directed manner, spontaneously minimizes mental and physiological activity."4 We hypothesize that this shift in mental function is often accompanied by derepression.

TM, now widely popularized, is generally considered to be a remarkably simple and benign meditation method. While the method is not commonly described as potentially dangerous, precautions include limitation of meditation to 20 minutes, twice a day, and follow-up with trained teachers. In contrast, numerous reports abound of the hazards of Zazen, the meditation form used in Zen Buddhism, which may lead to terrifying experiences and which must be handled carefully. These "makyo" are "a mixture of the real and the unreal, not unlike ordinary dreams. [The student must] never be tempted into thinking that these phenomena are real or that the visions themselves have any meaning ... above all, do not allow yourself to be enticed by visions of the Buddha or of gods blessing you or communicating a divine message. This is to squander your energies in the foolish pursuit of the inconsequential" (2, pp. 40-41). The similarity of TM and Zazen is supported by EEG studies (4).

While proposing a causal relationship between TM and the psychosis-like episodes, we cannot rigorously exclude the possibility that a disorder of thought or mood might have occurred without TM. In any case, the continued presence of an altered state of consciousness within days after beginning TM, and the occurrence of the "waking fantasies" shortly thereafter, leave little doubt of some causal relationship between the use of TM and the subsequent psychosis-like experience. In fact, we would expect the occurrence of powerfully compelling fantasies in some portion of normal individuals utilizing derepressive procedures of any form.

Despite enjoying the euphoria of her initial "waking dreams," Mrs. M. was capable of effectively grieving the loss of her expanded world-view. It is in this area, rather than in the area of the occurrence of such phenomena, that the issues of risk, and the appropriate response by TM teachers and psychiatrists, are significant. Anyone may experience a makyo, just as we all experience powerful dreams. Our hypothesis that TM has the potential of markedly decreasing repression carries several immediate therapeutic implications. First, interaction with an experienced "guide" is in general to be preferred to indiscriminate use of medication; second, such "trips," while often clinically psychosis-like, are distinct clinical entities from functional psychoses. Our scientific-medical prejudice leads us to label any unusual behavior as "sick." Tart (3) has outlined the basis for an alternate view. Mrs. M. states, "my faith in my own system's ability to guide and safeguard, my sense of identity, and my mind/body system are greatly strengthened. Life has a depth it didn't have before. I am operating at new levels of knowledge and understanding, and I have not yet discovered the boundaries of my mind."

In retrospect, it appears that appropriate management of the present case would have included decrease in or cessation of meditation time; frequent contact with an experienced teacher, whose function would be process rather than content oriented; contact with a mental health professional to assist in the grief work and suicidal ideation involved in the process of giving up the fantasy world; and use of medication to facilitate sleep and, if necessary, repression. While all these elements were present in Mrs. M.'s case, earlier recognition of the type of process involved might have decreased Mrs. M.'s suffering and risk over a period of several months. The usefulness of TM, like any process which seeks to facilitate adaptive change through decreased repression, appears to be not altogether without potential risk. The very nature of the mind and of this form of meditation carries the risk of psychosis-like and potentially dangerous regression. Appropriate recognition of inappropriate response to meditation should lead to intervention which protects without over-repression.



1 Department of Psychiatry. University of California. Davis-Sacramento Medical Center. 4430 "V" Street. Sacramento. California 98517.

2 Department of Mental Health. Sacramento County Health Agency; and Division of Mental Health. School of Medicine. University of California. Davis.

3 Medical Learning Resources, University of California. Davis.

4 Kersey, R. Teacher of Transcendental Meditation. Personal communication.


1. Gough, H., and Heilbrun, A. Adjective Check List. Consulting Psychologists Press. Palo Alto, California, 1965.

2. Kapleau, P. The Three Pillars of Zen. Beacon Press. Boston. 1965.

3. Tart, C. States of consciousness and state-specific sciences. Science. 176: 1203-1210. 1972.

4. Wallace, R. The Physiological Effects of Transcendental Meditation. Students' International Meditation Society. Los Angeles. 1970.

5. Wallace, R. The physiology of meditation. Sci. Am., 226: 84-90, 1972.

6. Whitman, A. The art of meditation. Reader's Digest, September: 130-134. 1973.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Fri Feb 22, 2019 4:14 am

Meditation may predispose to epilepsy: an insight into the alteration in brain environment induced by meditation
by Harinder Jaseja*
Physiology Department, G.R. Medical College, 8, 10-C-Block, Near Paliwal Health Club, Harishanker-puram, Lashkar, Gwalior 474009, MP, India
Received 31 August 2004; accepted 13 September 2004
c 2004 Elsevier Ltd. All rights reserved.




Stress-induced diseases in modern life are on an alarming rise not only in developed countries but also in developing ones. To alleviate stress, one practice that is being commonly and increasingly adapted to is meditation. Limited studies on meditation have reported occurrence of mental calmness along with apparently favorable changes in certain autonomic functional parameters like heart rate, blood pressure, respiration and skin resistance. Recently, meditation is also being practiced and advised for alleviation of epilepsy; however, very little work is available to comprehend effect and utility of meditation on epilepsy. Neuro-imaging and in-depth studies during the course and attainment of meditational state have revealed alteration in neuro-chemistry and neuro-physiology of brain environment that could favor epileptogenesis. The rise in brain glutamate and serotonin along with development of ‘hypersynchrony’ of EEG activity (which occur during the course and attainment of meditational state) are well documented to form the underlying basis of epilepsy. Each of the above-mentioned factors is individually capable of inducing susceptibility and decreasing threshold to epilepsy. Based on these changes in brain, this paper raises a grave possibility and risk of meditation in developing epilepsy or increasing the severity and frequency of attacks in an already epileptic state, contrary to the popular belief of its remedial role in alleviating epilepsy.


There is global increase in stress and strain of today’s life, both at home front and job place. The global competitiveness and challenges of modern life are taking a great toll on physical and mental health that is being reflected by an alarming rise in stress induced diseases.

Counseling and/or drug therapy have not been much effective in relieving stress in most of the cases. In addition, these methods cannot be applicable in many situations. Also, in those cases where they have been able to produce significant relief, the effect has been short lived.

An increasing tendency towards adapting practice of meditation for relief of stress is being observed universally as it is devoid of side effects of drugs and great compromise with life style that one is used to. Meditation is a complex process, during the course and attainment of which, multiple changes in mental, neuro-hormonal and autonomic functions occur. These changes vary from being subtle to sometimes being easily perceptible by the meditator. Due to the complexity, mystique and fascination of the mental processes and changes associated with meditation, it still remains a phenomenon of great interest to researchers and shall continue to do so for several years to come.

The biological autonomic effects on heart rate, blood pressure, respiration and skin resistance have been studied to a significant extent. However, with the advent of neuro-imaging techniques like EEG, fMRI, PET and SPECT [1–5], the cerebral and mental processes associated with meditation have attracted much interest to researchers. Undoubtedly, it is these processes that form the underlying basis of the composite effect of meditation on body and mind.

Effects of meditation on brain

EEG changes

A number of investigators have studied EEG changes in normal meditators. The effects have mainly been on alpha rhythm as observed by Bagchi & Wenger [28] and Kasamatsu & Hirai [29]. In 1961, Anand et al. [30] observed increasing amplitude and slowing frequency of alpha rhythm, which gradually spread from its normal predominant locality i.e., occipital to frontal regions. Banquet [6] also found high amplitude alpha rhythm during meditation and coined the term ‘hypersynchrony’ [6,7]. It needs to be reminded that epileptic discharges are more appropriately known as ‘hypersynchronous’ discharges, which are due to an abnormally high synchronized firing of a neuronal aggregate. Banquet also noted development of theta frequencies during meditation. These low frequency, high amplitude EEG rhythms are generally present during meditation.

Effect on prefrontal and cingulate cortex

Neuro-imaging techniques have demonstrated increased activity in prefrontal (PFC) (mainly right side) and cingulate cortex (CC) [8–11] during meditation. This leads to production of the excitatory neurotransmitter, Glutamate in the brain. This hormone is used by PFC neurons to communicate among themselves and other brain structures [12]. There is continued increase in Glutamate with continued activity in PFC during the course of meditation process.

Effect on serotonin

It has been observed that Serotonin (5-HT) increases during meditation. Secretion is increased by stimulation of lateral hypothalamus and PFC [13] that invariably occurs during meditation. Several studies have demonstrated increased urinary excretion of Serotonin metabolites after meditation [14].

Effect on inter-hemispheric coherence

Kiloh et al. [15] observed increase in inter-hemispheric coherence, symmetry and synchronization of alpha rhythm during meditation.

Thus, the neuro-effects of meditation may be summarized to produce:

1. Increase in synchrony of EEG activity (hypersynchrony).

2. Increase in inter-hemispheric coherence of EEG activity.

3. Increase in brain Glutamate.

4. Increase in brain Serotonin.

There is overwhelming evidence of hypersynchrony predisposing to epilepsy. Hyperventilation causes synchrony and precipitates epilepsy [16]. It is a provocative technique during EEG recording. Sleep also is a provocative technique, a significant number of epileptics reveal inter-ictal epileptiform activity in their EEG only during sleep [17,18]. Hypersynchrony of sleep facilitates both initiation and propagation of partial seizures [17]. It is well known that NREM sleep causes increased susceptibility to epilepsy. Spiky epileptic discharge means more synchronisation of unit cell populations and Spike is caused by synchronisation of population group 1 neurons [19]. Spikes depict interictal epileptiform activity and their correlation with intracellular recordings shows that the former are associated with firing of action potentials [20].

Increase in inter-hemispheric coherence of EEG activity may contribute in its own way towards propagation and generalization of epileptic discharges. A focal discharge restricted to a localized region can tend to become widespread precariously. Corpus callostomy is a surgical procedure performed for control of un-controllable generalized seizures, the objective being to block inter-hemispheric transmission of epileptic potentials.

Glutamate is neuro-excitatory transmitter and widely implicated in epilepsy. The epileptic focus has been shown to contain more Glutamate than in normal state [21] and potassium-stimulated Glutamate release is more in cortical slices removed from epileptic patients than normal tissue [21].

Neurons in epileptic region exhibit paroxysmal depolarization shift (PDS) that is associated with a burst of action potentials [22]; interestingly, effect of Glutamate on NMDA receptors also produces a response similar to PDS [22] and a search for Glutamate antagonists as anti-epileptics is being promoted.

Serotonin also has been implicated in epileptogenesis and anti-serotonin are found to possess anti-convulsant properties [23,24]. 5-HT 2A receptor activation causes slow depolarisations and enhancement of excitatory signals such as Glutamate [25] and Cyproheptadine, which is 5-HT 2A blocker, has anti-convulsant activity [26].


Thus, each of the above-cited effects, which invariably occur at sometime during the course of meditation can present a potential risk for epileptogenesis and/or precipitating attack(s) in an epileptic patient. Needless to say, the concurrent presence of two or more of these effects can contribute tremendously to epileptogenesis, even to the extent of rendering a normal person epilepsy-prone.

Meditation is known to produce relaxation and epilepsy after relaxation is a well-known entity [27]. Meditation is presently being advised and resorted to for alleviating epilepsy; this paper clearly outlines the risk of enhancing the epileptic state during the course and attainment of meditation state.

However, further insight into the neuro-physiological and neuro-chemical avenues associated with meditation is definitely required. The epileptic proneness and incidence of epilepsy in regular meditators needs to be elucidated. Presently, however, caution may be exercised over the practice of meditation in patients prone to epilepsy. At least, epileptic patients seeking alleviation of their attacks through practice of meditation may be warned of the potential hazard outlined in the paper.


* Tel.: +91 751 233 1147. E-mail address: dr_jaseja@yahoo.com.

0306-9877/$ - see front matter c 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.mehy.2004.09.012


[1] Herzog H, Lele VR, Kuwert T, et al. Changed pattern of regional glucose metabolism during Yoga meditative relaxation. Neuropsychobiology 1990-1991;23:182–7.

[2] Lou HC, Kjaer TW, Friberg L,. et al. A 15O-H2O PET study of meditation and the resting state of normal consciousness. Human Brain Map 1999;7:98–105.

[3] Kjaer, Bertelsen, Piccini, Brooks, Alving, Lou, 2002.

[4] Newberg AB, Alavi A, Baime M,. et al. The measurement of regional blood flow during the complex cognitive task of meditation: a preliminary SPECT study. Psychiatr Res Neuroimaging 2001;106:113–22.

[5] Lazar SW, Bush G, Gollub RL,. et al. Functional brain mapping of the relaxation response and meditation. Neuroreport 2000;11:1581–5.

[6] Banquet JP. Spectral analysis of EEG in meditation. Electroencephal Clin Neurophysiol 1973;35:143–51.

[7] Banquet JP. EEG and meditation. Electroencephalography Clin Neurophysiol 1972;33:449.

[8] Ingvar DH. The will of the brain: cerebral correlates of willful acts. J Theor Biol 1994;171:7–12.

[9] Frith CD, Friston K, Liddle PF,. et al. Willed action and the prefrontal cortex in man. A study with PET. Proc R Soc Lond 1991;244:241–6.

[10] Posner MI, Peterson SE. The attention system of the human brain. Ann Rev Neurosci 1990;13:25–42.

[11] Pardo JV, Fox PT, Raichle ME. Localization of a human system for sustained attention by positron emission tomography. Nature 1991;349:61–4.

[12] Cheramy A, Romo R, Glowinski. Role of corticostriatal glutamatergic neurons in the presynaptic control of dopamine release. In: Sandler M, Feuerstein C, Scatton B et al, editors. Neurotransmitter interactions in the basal ganglia. New York: Raven Press; 1987.

[13] Olds ME, Forbes JL. The central basis of motivation, intracranial self-stimulation studies. Ann Rev Psychol 1981;32:523–74.

[14] Walton KG, Pugh ND, Gelderloos P, Macrae P. Stress reduction and preventing hypertension: preliminary support for a psychoneuroendocrine mechanism. J Altern Complement Med 1995;1:263–83.

[15] Kiloh LG, Osselton JW. Clinical electroencephalography. 4th ed. London: Butterworth; 1981.

[16] Handbook of electro-encephalography and clinical neurophysiology. vol. 13, part A. Amsterdam: Elsevier Scientific Publishing Company; 1975. p. 48–9.

[17] Herman ST, Walczak TS, Bazil CW. Neurology 2001;56:1453–9.

[18] Handbook of electro-encephalography and clinical neurophysiology. vol. 13, part A. Amsterdam: Elsevier Scientific Publishing Company; 1975. p. 31, 38.

[19] Fenwick P. The relationship between mind, brain and seizures. Arch Indian Psychiat 1994;1(1):3–6.

[20] Goodman and Gilman’s The pharmacological basis of therapeutics. 9th ed., International edn.; 1996. p. 465.

[21] Rang HP, Dale MM, Ritter JM. Pharmacology. 3rd ed. 1995. p. 599.

[22] Rang HP, Dale MM, Ritter JM. Pharmacology. 3rd ed. 1995. p. 598.

[23] Vimal Chandra. Ind J Pharmacol 1972;4(3):174–7.

[24] Bapat SK, Vimal Chandra. Ind J Pharmacol 1969;1(4):32–6.

[25] Goodman and Gilman’s. The pharmacological basis of therapeutics. 9th ed. International edn. 1996. p. 256.

[26] Satoskar, Kale, Bhandarkar’s. Pharmacology and pharmacotherapeutics. 16th ed. 1999, p. 318.

[27] Epilepsy News, Sleep and Epilepsy, Mohammed I. Zahoor produced by Sleep Research Laboratory, Wallace Mendelson, Director, The University of Chicago Hospitals.

[28] Bagchi BK, Wenger MA. Simultaneous EEG and other recordings during some yogic practices. Electroencephalogr Clin Neurophysiol 1958;10:193.

[29] Kasamatsu A, Hirai T. An electroencephalographic study on the zen medication. In: Tart, editor. Altered states of consciousness; 1969. p. 501–14.

[30] Anand BK, Chhina GS, Singh B. Some aspects of electroencephalographic studies in yogis. Electroencephalogr Clin Neurophysiol 1961;13:452–6.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Fri Feb 22, 2019 4:46 am

Psychiatric Problems Precipitated by Transcendental Meditation
by Arnold A. Lazarus
Graduate School of Applied & Professional Psychology, Rutgers University
Psychological Reports, 1976, 39, 601-602.© Psychological Reports 1976
Accepted August 11, 1976.




Like many procedures, Transcendental Meditation (TM) proves extremely effective when applied to properly selected cases by informed practitioners. It is not a panacea. In fact, when used indiscriminately, there are clinical indications that the procedure can precipitate serious psychiatric problems such as depression, agitation, and even schizophrenic decompensation.

Scientific psychology has emphasized the significance of individual differences. Folklore is equally aware that "one man's meat is another man's poison." Yet popular systems and movements from psychoanalysis to Transcendental Meditation (TM) generalize and universalize, present their views and findings in absolutistic rather than probabilistic terms, and depart from established scientific pathways in several other respects. Their procrustean deftness at fitting everyone to their system damages the integrity and individuality of persons who are temperamentally and otherwise unsuited to their procedures.

Need one belabor the fact that individual differences make it essential to list indications, contraindications, and possible side-effects for everything from strawberries to penicillin, from sit-ups to saunas, or from skydiving to meditating? Research in psychotherapy has yielded the "specificity factor" -- specific techniques produce specific changes in specific patients under specific conditions.
Meditation, when shorn of its mystical connotations, is essentially a specific series of techniques much like relaxation training (cf. Benson, 1975). But as underscored several years ago (Lazarus, 1971), relaxation training is not for everyone; when properly applied to selected cases by informed practitioners, it can overcome many facets of stress, tension and anxiety.

The first "meditation casualty" I encountered was a 34-yr.-old woman who made a serious suicidal attempt following a weekend training course in Transcendental Meditation (TM). Since then I have come across several people who allege that such meditation exacerbated their depressive affect. Similarly, several agitated, restive individuals have reported that the basic procedure of repeating a mantra tended to heighten their ongoing tension and restlessness. P. Carrington in a book to be published this year [1] described three patients who "suffered a complete mental breakdown for which they had to be hospitalized, within a matter of weeks after commencing the practice of meditation." She notes that some people seem to be "abnormally 'sensitive' to meditation, and unable to take it, even in average doses." R. L. Woolfolk (personal communication, 1976) has also reported the case of a 24-yr.-old woman in whom an experience of severe depersonalization seemed to have been precipitated by Transcendental Meditation. Otis (1973, 1974) emphasized that Transcendental Meditation can be harmful. He cites data on the reoccurrence of a bleeding ulcer which was under control during the previous 5 yr., as well as the precipitation of depression and extreme agitation.

Apart from the specific casualties alluded to above, there are more subtle negative influences that probably afflict large numbers of dropouts from meditation. For example, a rather insecure young man found that the benefits he had been promised from Transcendental Meditation simply did not emerge, and instead of questioning the veracity of the exaggerated claims, he developed a strong sense of failure, futility, and ineptitude.

My clinical observations have led me to hypothesize that methods like Transcendental Meditation are most effective with certain "obsessive-compulsive" individuals whose levels of anxiety and tension are moderate rather than severe. In psychiatric nomenclature, Transcendental Meditation does not seem as effective with persons who demonstrate "hysterical tendencies" or strong "depressive reactions." And, I would hazard a guess that some "schizophrenic" individuals might experience an increase in "depersonalization" and self-preoccupation.
However, seriously disturbed psychiatric patients may learn to meditate successfully, provided adequate attention is given to various problems that tend to arise during the first weeks of practice (Glueck & Stroebel, 1975).

Transcendental Meditation and other systems of meditation and relaxation can undoubtedly prove extremely beneficial to a large number of individuals. But, like most things, there are those for whom it is contraindicated, those for whom it will be of marginal benefit, moderate benefit, etc. While the pundits of Transcendental Meditation do not make the necessary discriminations, researchers need to know (a) the precise benefits that may accrue from such procedures and (b) the drawbacks, limitations, shortcomings, risks and dangers that may exist. On the whole, we need far less proselytism and much more data.



1 Cited with permission from the manuscript of the book.


BENSON H. The relaxation response. New York Morrow, 1975.

GLUECK B. C., & STROEBEL. C. F. Biofeedback and meditation in the treatment of psychiatric illnesses. Comprehensive Psychiatry, 1975, 16, 303-321.

LAZARUS A. A. Behavior therapy and beyond. New York: McGraw-Hill, 1971.

OTIS, L. S. Transcendental Meditation. Paper presented at the American Psychological Association Convention in Montreal, 1973.

OTIS, L. S. The facts on Transcendental Meditation. Part 3. If well-integrated but anxious, try TM. Psychology Today, 1974, 7 (4), 45-46.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Fri Feb 22, 2019 5:24 am

Striking EEG Profiles From Single Episodes of Glossolalia and Transcendental Meditation
by Michael A. Persinger, Laurentian University1
Accepted December 6, 1983.
Perceptual and Motor Skills, 1984, 58, 127-133. © Perceptual and Motor Skills 1984




Transient, focal, epileptic-like electrical changes in the temporal lobe, without convulsions, have been hypothesized to be primary correlates of religious experiences. Given these properties, direct measurement of these phenomena within the laboratory should be rare. However, two illustrated instances have been recorded. The first case involved the occurrence of a delta-wave-dominant electrical seizure for about 10 sec. from the temporal lobe only of a Transcendental Meditation teacher during a peak experience within a routine TM episode. The second case involved the occurrence of spikes within the temporal lobe only during protracted intermittent episodes of glossolalia by a member of a pentecostal sect. Neither subject had any psychiatric history. These observations are commensurate with the hypothesis that religious experiences are natural correlates of temporal lobe transients that can be detected by routine EEG measures.

Religious experiences have been hypothesized to be associated with temporal lobe transients (Persinger, 1983). These phenomena are defined as brief (a few seconds), focal (deep within the temporal lobe) electrophysiological changes that reflect the conditions associated with the experience. Trigger stimuli, events that can precipitate temporal lobe transients (TLTs), include the chemistry of personal crisis (corticosteroid elevations), fatigue, hypoxia, hypoglycemia and psychotropic drugs that preferentially affect temporal lobe structures. Predisposing factors influence the potency of the trigger variable. Although most TLTs should occur as deep microseizures, some of them should be expressed occasionally in surface (electroencephalographic) measures.

Because of the focal nature of TLTs, religious experiences should be dominated by the functions associated with this part of the brain. Intense meaningfulness, focus upon the "sense of self" with respect to the limits of space and time and sudden revelations through "knowing" are dominant symptoms. Coherence at lower frequencies among temporal lobe structures (especially the hippocampus and amygdala) that have not been correlated since early childhood could allow access to and retrieval of older ontogenetic functions. These transient operations could also recruit infantile body images and reinforcement patterns, such as the expectations of parental surrogates, into the experience.

TLTs could become associated with discriminative stimuli which could control the occurrences. This is not unusual for subcortical temporal lobe structures. Learned controlled electrophysiological changes are typical of kindling phenomena in general (Gloor, 1972; MacLean, 1970; Pay, 1982). There are several anecdotal cases (Efron, 1957) of electrical seizures that were influenced (apparently) by volitional cues. The most likely discriminative stimulus would be language, specifically, a particular sequence of words with unique associations (Persinger, Carrey, & Suess, 1980). Nonsense phrases, such as mantras or infantile gibberish, are classic candidates.

The present study reports two cases of TLTs occurring during routine EEG recordings of populations of people claiming to engage in various forms of mystical experiences. Although the existence of transient and focal changes within EEG profiles in normal human beings is well documented, interpretation of these changes is difficult since behavioral correlates are either not measured or are ignored.


The first case involved a 32-yr.-old Caucasian, brunette female who had been practicing Transcendental Meditation (TM) for about 10 yr. and had been teaching the technique for an unspecified period; there was no history of psychiatric disorders. Bipolar E4S silver-plated disk electrode arrangements (Kiloh, et al., 1972) along the same horizontal plane over the temporal lobe (approximately T3-T4), occipital lobe (01-02) and frontal lobe (Fpl-Fp2) were secured by EC2 electrode cream and maintained by an adjustable headband. Continuous recordings during the latter 5 min. of standardization and throughout the 30 min. of meditation and postmeditation were completed with a three-channel Model 79 EEG (Grass Instrument; Quincy, MA). The subject sat quietly in a comfortable chair during the entire recording period. Ambient fluorescent illumination ranged between 10 and 50 lux.

FIG. 1. Electroencephalographic (EEG) recordings from temporal (T), occipital (O) and frontal (F) bipolar electrodes for a Transcendental Meditation (TM) teacher just before the onset of the electrical seizure. Maximum vertical displacements of the records are equivalent to about 50 uV. Increments on the bottom line indicate 1-second intervals.

As can be seen in Fig. 1, typical alpha frequency bursts were generated from all three leads (eyes closed) during the first portion of the experiment. However, after about 19 min. of meditation, clear delta frequencies with an aberrant spike and slow-wave-like profile emerged for about 15 to 20 sec. on the temporal lobe leads only (Fig. 2). No obvious changes occurred in the other leads. The TLT, whose amplitude was about 3X the pre- and postoccurrence activity, was followed by a silent period of a similar duration and then a return to normal amplitude and frequency.

FIG. 2. Topography of the electrical seizure within the temporal lobe (T) of the TM teacher noted in Fig. 1 after about 19 minutes of meditation. No changes were evident in the occipital and frontal lobe channels.

After the subject had completed the meditation sequence, the occipital EEG was dominated by the typical "beta buzz" (associated with higher than normal amplitude beta frequencies) for about 30 sec. When asked about the quality of the episode, she reported that this particular experience was especially meaningful and that she had felt being very close to "the cosmic whole." There had been no evidence of any facial movements (jerks or muscle twitches) or general body alterations during the TLT period. From a total of 10 TM practitioners monitored during mantra repetition in this laboratory, this subject was the only one to display a TLT during a meditational episode. None of the other nine reported a "peak experience, although relaxation reports were frequent.

The second subject was a 20-yr.-old blond, Caucasian female who claimed she could speak in tongues (SIT). She was one of only two volunteers who responded to a request to test people who could "speak in the spirit," from local pentecostal groups. The other volunteer, a 23-yr.-old brunette Caucasian female, did not demonstrate any unusual EEG phenomena. Both volunteers were university students.

FIG. 3. EEG profiles from a member of a pentecostal group during sequences of "voluntary" initiation of glossolalia (SIT). S refers to the spike events.

The subject was an A student who had been argumentative in several classes about religious topics and had proselytized frequently within the university. Although there was no psychiatric history, she had sought pastoral counseling. Unlike the 23-yr.-old volunteer who had "learned speaking" by watching others in a protestant pentecostal sect, the subject "had suddenly begun to speak by herself" one day as a young girl. She was Roman Catholic by early training and had recently been attracted, presumably in view of her glossolalia, to a pentecostal group.

During a 2-hr. test period, the subject sat comfortably and was requested to speak in tongues with both free and forced paradigms. Each "speaking" episode lasted about 5 to 10 min. and was followed by a 1- to 5-min. rest period. Since these episodes were reported to have both an "overt" and "covert" component, that is, vocal or non-vocal, these operations in conjunction with eyes-open and eyes-closed instructions were instituted as well. Bipolar electrode arrangements were attached to the same basic areas in the temporal, occipital, and frontal regions as reported for the TM subject, although different channels were used to measure the temporal and frontal leads. The entire session was tape recorded.

FIG. 4. Magnification of spike-like events recorded from the temporal lobe of the subject during glossolalia

Figs. 3 and 4 are representative of the phenomenon noted. Spike events began to occur from the temporal lobe electrodes within 20 min. of the recording session following about 10 min. of overt glossolalia Initially, the spike numbers were reduced when the speaking episode was terminated. However, as the session progressed, the spikes began to persist during non-SIT intervals. Neither removal and replacement of electrodes nor alteration of channel leads eliminated the phenomenon which was only recorded from the temporal lobe input. Heart rate artifacts were not evident. The subject reported that the "closest contact with the Spirit" occurred during the latter periods of the session. These periods were followed by conspicuous increases in the amount of enhanced beta activity ("beta buzz"), for 10 to 15 sec., from the temporal lobe. The effect was enhanced by simultaneously terminating the speaking episode and opening the eyes.

Close attention by a second experimenter indicated that the subject did not display any obvious facial transients or stereotyped body movements with the exception of subtle alterations in the right foot during the "covert" periods of glossolalia. This movement was regular, synchronous and similar to "foottapping" associated with musical stimuli. Inspection of the tape by two independent witnesses identified three to four distinguishable sounds that comprised the bulk of the glossolalic material. There was no apparent change in the distribution of these sounds over the session.

FIG. 5. Occurrence of spikes within the temporal lobe during non-SIT episodes for the latter portion of the 2-hr. test period. Primary changes in EEG profiles reflect typical eyes open or eyes closed consequences. However, occasional spikes were noted in the temporal lobe. Note "beta buzz" in first frame of the temporal lobe channel. The changes in frontal lobe leads coincided with vocal instructions by the experimenter for the next operation.


The delta wave and spike burst associated with the TM episode and the spike-like activity associated with glossolalia can be considered candidate TLTs. They were very brief displays that were not transcencephalic. Since the electrode arrangement involved bipolar, bilateral comparisons, there is a strong possibility that these events were localized within only one hemisphere. Both cases are commensurate with the hypothesis that TLTs, without motoric concomitants, are a portion of the electroencephalic continuum that are correlates of religious experiences.

The validity of religious experiences, if TLTs are clearly demonstrated to be persistent correlates, may involve different methodologies. From a neuropsychological perspective, these events may be considered self-limiting and perhaps even learned microseizures within the reward centers of the human brain. There is no doubt, based upon both facial expression and verbal reports, that the two episodes reported here were paired with significant and meaningful personal experiences. They were explained with religious significance.

Over the last 10 years, about 50 people, with no detectable epileptic or psychiatric history, claiming various forms of mystical states (from out-of-body experiences to "spiritual communion") have been measured in this laboratory. These two cases are the most specific TLT displays from only four possible candidates. Most "altered states," within the limits of our recordings, have been associated with enhanced bouts of alpha activity or normal alpha trains or spindles (even with the eyes open). According to the hypothesis (Persinger, 1983), most of the TLTs that are associated with religious experiences should remain within deep subcortical structures. Occasionally, a few, especially those that have been leaned or have been brought under cortical control, should be evident even with surface (electroencephalographic) measures.



1 Neuroscience Laboratory, Department of Psychology, Laurentian University, Sudbuq, Ontario, Canada P3E 2C6.


EFRON, R. The conditioned inhibition of uncinate fits. Brain, 1957, 80, 251-257.

GLOOR, P. Temporal lobe epilepsy: its possible contribution to the understanding of the functional significance of the amygdala and of its interaction with neocortical-temporal mechanisms. In B. E. Eleftheriou (Ed.), The neurobiology of the amygdala. New York: Plenum, 1972. Pp. 423-457.

KILOH, L. G., MCCOMAS, A. J., & OSSELTON J. W. Clinical electroencephalography. (3rd ed.) London: Butterworths, 1972.

MACLEAN, P. D. The limbic brain in relation to the psychoses. In P. Black (Ed.), Physiological correlates of emotion. New York: Academic Press, 1970. Pp. 129-146.

PAY, R. G. Behavioral steering in dual and social states of conation by the amygdala, hypothalamus, ventrial striatum and thalamus. International Journal of Neuroscience, 1982, 16, 1-40.

PERSINGER M. A. Religious and mystical experiences as artifacts of temporal lobe function: a general hypothesis. Perceptual and Motor Skills, 1983, 57, 1255- 1262.

PERSINGER M. A., CARREY, N., & SUESS, L. TM and cultmania. Boston, MA: Christopher, 1980.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Sun Feb 24, 2019 12:22 am

Transcendental Meditation [TM] and General Meditation Are Associated With Enhanced Complex Partial Epileptic-Like Signs: Evidence For "Cognitive" Kindling?1
by M.A. Persinger
Laurentian University
Accepted November 27, 1992
Perceptual and Motor Skills, 1993, 76, 80-82. © Perceptual and Motor Skills 1993  




The Personal Philosophy Inventories of 221 university students who had learned to meditate (about 65% to 70% Transcendental Meditation[TM]) were compared to 860 nonmeditators. Meditators displayed a significantly wider range of complex partial epileptic-like signs. Experiences of vibrations, hearing one's name called, paranormal phenomena, profound meaning from reading poetry/prose, and religious phenomenology were particularly frequent among meditators. Numbers of years of TM practice were significantly correlated with the incidence of complex partial signs and sensed presences but not with control, olfactory, or perseverative experiences. The results support the hypothesis that procedures which promote cognitive kindling enhance complex partial epileptic-like signs.

Intermittent, stereotyped stimuli that are presented at optimal interstimulus intervals are known to evoke responses whose quantitative and qualitative properties increase within susceptible media as a function of the number of stimulus presentations. Positive feedback subsequent to the resonance interaction between electromagnetic fields or mechanical vibrations and the natural frequency of the target medium is a common operation that is evident across all levels of scientific discourse. Repeated, brief presentations of electrical or chemical stimuli (Cain, 1989) to Limbic (pyriform) cortices and subcortical structures evoke successive increases in both the spatial distribution of paroxysmal (integrated) electrical discharges and the range in the characteristics of behavioral seizures.

One would expect "cognitive kindling" to occur as a function of the appropriate repetition of linguistic or ideational patterns. The subsequent changes would reflect the neural pathways by which the cognitive stimulus was mediated. Whereas negatively affective ideation concerning death to the self could ultimately recruit collateral neuropathways that mediate heightened vigilance (e.g., panic attacks), repetition of "novel" or unusual words could access other pathways that mediate positive affect. Although experimental kindling of limbic seizures in human beings would be unethical, there are multiple anecdotal cases where repeated meditation was associated with increased indicators of complex partial seizures (Persinger, 1984). For example, Young (1984) reported more frequent and intense incidences of lights and movements in the upper left visual field (indicative of right temporal lobe stimulation through Meyer's loop) as a function of meditation trials.

Because meditation, and Transcendental Meditation in particular, are operationally a cognitive kindling process (specific stimuli for 20 minutes once per day), one would expect meditators to display an increase in the range of complex partial epileptic-like signs (Persinger, Carrey, & Suess, 1980). To test this hypothesis, the Personal Philosophy Inventories (Persinger & Makarec, 1987) of 1,081 university students (ages 18 to 60 years), collected over 11 consecutive years (1981 to 1992), were evaluated. All analyses involved SPSS[x] software on a VAX 4000 computer. Two hundred twenty-one subjects indicated that they had learned to meditate; specific questioning during two of the years indicated that approximately 65 to 70% had taken Transcendental Meditation. Those who had learned meditation were significantly (F[1,1060] = 64.16, p< .001; eta = .25; there were no age data for 16 subjects) older (M = 28.6, SD = 10.3 yr.) than those who had not (M = 23.8, SD = 6.9 yr. old) learned. There was no disconcordance between the numbers of men and women who had learned to meditate (X[2]<2.98, p> .05).

Two-way analyses (sex, meditation) of variance (all dfs = 1,1077) and covariance (for age: dfs = 1,1076) for the dusters of control (for yes-responding and mundane phenomenology) items and complex epileptic items (Persinger & Makarec, 1987; Makarec & Persinger, 1990) showed that people who had learned to meditate displayed significantly (F=39.27, p<.001; eta = .19) more complex partial epileptic-like signs (M = 35%, SD = 21%) than those who had not (M = 27%, SD = 17%). There were neither sex differences (F = .007, p> .05) nor an interaction of sex by meditation (F = .66, p > .05). Covariance for age (F = 19.31, p< ,001) enhanced the difference (F = 54.77, eta = .23) between meditators and nonmeditators. There were no statistically significant differences between meditators and nonmeditators on the control clusters (F = 1.23); women endorsed more of these items (F = 18.47, 14.82) than did the men [grand M = 78 (10%)]. Covariance for age did not diminish the sex differences.

To discern which subclusters of complex partial epileptic-like signs were specifically elevated in the meditators, one-way analyses of variance (all dfs = 1,1079) were completed for each of 13 clusters of items that were derived from the major scale; these items infer temporal lobe phenomenology (Persinger & Makarec, 1990). Meditators endorsed significantly (p < .001; eta in parentheses) more experiences of paranormal phenomena (.16), automatic behaviors (.11), writing (keeping notes about personal thoughts .13), profound experiences from reading/reciting poetry/prose (.21), religious experiences (.21), visual anomalies (.15), auditory (hearing inner voice). vestibular (vibrational) experiences (.19), and sensations of "cosmic consciousness" (.21). There were no differences (F<2.00, p> .01) between meditators and nonmeditators with respect to olfactory, depersonalization, widened affect, limbic motor, or perseverative experiences. Discriminant analyses indicated that the three most important variables were religious, auditory-vestibular, and paranormal experiences.

To discern "duration dependency" of the effect, the 56 subjects (a subset of the 221 meditators in the previous analysis) who reported they had taken Transcendental Meditation specifically (most of these questionnaires were collected between 1981 and 1984) were compared to age-matched nonmeditators (n = 27) from this period. The former claimants were classified according to the duration of practice: 1 year, 2 years, 3-5 years, and more than 5 years; the consistency of practice was not assessed. One-way analyses of variance between people who had learned Transcendental Meditation specifically and the reference group (n = 27) indicated the former showed significant (F[1,181] = 50.25, p< .001) elevations in complex partial epileptic-like signs [44 (19)%, 15 (13)%], but not Ln (F< 1.50) control experiences [79 (13) %, 76 (13)%].

The strongest (p<.001) correlations (Spearman rho) between the duration of reported meditation experience and the phenomenological clusters were for: complex partial epileptic-like signs (.60) and sensed presence (.39) while the weakest correlations (p> .05) were for olfactory (.11), widened affect (.19), and control (.10) responses. These results support the hypothesis that meditation techniques encourage complex partial epileptic-like signs.

The positive association between the self-reported duration of meditation (an inference of repeated trials) and the frequency of complex partial epileptic-like signs (but not control experiences) suggests a specific "dose-dependence" relationship. Obviously a third factor, that enhanced the symptoms and encouraged continuation of meditation, could have been present. However, a causal relationship could explain the development of frank epileptic displays over the temporal lobe (Persinger, 1984) in subgroups of prolonged meditators as well as the myoclonic and limbic motor disorders that have been claimed by some experienced TM teachers who subsequently withdrew from the organization (e.g., TM-Ex Newsletter, PO Box 7565, Arlington, VA 22207).

If the general hypothesis is valid, then the elevation of complex partial epileptic signs among patients who display the phobic anxiety depersonalization syndrome (Harper & Roth, 1962), general anxiety, or the posttraumatic stress disorder may reflect variants of cognitive kindling that access different neuropathways which subserve these adverse experiences. Although meditation may enhance complex partial epileptic-like phenomenology and anxiety (Persinger & Makarec, 1987), one must emphasize that moderate elevation of these indicators in the normal population is also associated with creativity and suggestibility. These characteristics can sometimes facilitate adaptation.



1 Please send reprint requests to Dr. M. A. Persinger, Behavioral Neuroscience Laboratory, Laurentian University, Sudbury, Ontario P3E 2C6, Canada.


CAIN, D. P. Excitatory neurotransmitter in kindling: excitatory amino acid, cholinergic, and opiate mechanisms. Neuroscience and Biobehauioral Reviews, 1989, 13, 269-276.

HARPER, M., & Roth, M. Temporal lobe epilepsy and the phobic anxiety-depersonalization syndrome: Part I. A comparative study. Comprehensive Psychiatry, 1962, 3(3), 129-151.

MAKARECK, K, & PERSINGER, M.A. EEG validation of a temporal lobe signs inventory in a normal population. Journal of Research in Personality, 1990, 24, 323-337.

PERSINGER, M.A. Striking EEG profiles from single episodes of glossolalia and Transcendental Meditation. Perceptual and Motor Skills, 1984, 58, 127-133.

PERSINGER, M.A., CARREY, N., & SUESS, L. TM and cultmania. Boston, MA: Christopher Publ., 1980.

PERSINGER M.A., & MAKAREC K. Temporal lobe signs and correlative behaviors displayed by normal populations. Journal of General Psychology, 1987, 114, 179-195.

YOUNG, M.L. Agartha: a journey to the stars. Stillpoint, N H : Walpole, 1984.

Accepted November 27, 1992.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Sun Feb 24, 2019 1:26 am

Relationship of meditation and psychosis: case studies
by Sujata Sethi, Subhash C. Bhargava
Department of Psychiatry, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Aust N Z J Psychiatry. 2003;37(3):382.



The word meditation is much used these days, covering a wide range of practices with an ultimate aim of controlling the mind and enhancing psychological health. Altered perceptions, and surfacing of repressed memories and conflicts have been reported during meditation [1]. There have been few reports of precipitation of psychosis in vulnerable individuals [1,2]. We discuss the possible factors operative in the precipitation of psychosis in two meditators.

Case 1 Mr A, a 20-year-old male, presented with a one-month history of aggressive behaviour, inappropriate laughter and suspiciousness. Examination revealed delusions of persecution and of reference, and auditory hallucinations. Prior to the onset of illness he had been practicing intensive meditation for 4 days without communication of any kind with outer world; he had also been fasting, and sleep had been reduced. There was no previous personal or family history of psychiatric illness. A diagnosis of schizophrenia was made. Treatment with olanzapine was started with good response. The patient discontinued treatment after 3 months and again became symptomatic. Treatment was reinstituted and he responded rapidly.

Case 2 Mr D, a 30-year-old married male, was brought home by his colleagues from a meditation retreat centre as he started to exhibit bizarre behaviour on the sixth day of the retreat. At the time of examination, he appeared to be perplexed and exhibited bizarre religious delusions. His sleep was markedly disturbed. He was hospitalized and treated with risperidone. The final diagnosis was schizophrenia. Reportedly, he had had two previous psychotic episodes, each one after attending the annual religious retreat, and with complete interepisode recovery.

These cases raise the issue of whether meditation can induce psychosis. Fischer [3] described perception– hallucination–meditation on a continuum; creative, psychotic and ecstatic experiences on one end and hypoarousal states of Zazen and Samadhi on the other. Normal persons may travel freely between states [3]. Vulnerable individuals may get stranded at this stage and eventually have a psychotic breakdown, especially under stress. People with a previous history of psychosis have been recognized as more vulnerable to have a psychotic breakdown during intensive meditation [1]. Also, it is arguably not the meditation alone that is causal; the associated fasting, and sleep and sensory deprivation could be other factors contributing towards the precipitation of psychosis. On the other hand, there are data to suggest that meditation in moderation can be helpful in treating a range of psychopathology [4]. Review of the history from the two reported patients, as well as from the their families, did not suggest that these patients were psychologically unwell prior to attending the meditation courses.

Attending meditation retreats is a common and regular practice in northern India. When carried out under proper guidance and in moderation, meditation can enhance psychological wellbeing [1].



1. Walsh R, Roche L. Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. American Journal of Psychiatry 1979; 136:1085–1086.

2. Chan-ob T, Boonyanaruthee V. Meditation in association with psychosis. Journal of Medical Association of Thailand 1999; 82:925–929.

3. Fischer R. Cartography of the ecstatic and meditative states. Science 1971; 174:897–903.

4. Shafii M. Adaptive and therapeutic aspects of meditation. International Journal of Psychoanalysis and Psychotherapy 1973; 2:367–382.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Mon Feb 25, 2019 5:44 am

Buddhist Teachers' Experience With Extreme Mental States in Western Meditators
by Lois VanderKooi
The Journal of Transpersonal Psychology, 1997, Vol. 29, No. 131
Copyright © 1997Transpersonal Institute



Boulder, Colorado

In the past thirty-five years, Buddhism and its sophisticated meditation practices have attracted a large number of Western students, especially those in search of a psychologically oriented spirituality. Based on descriptive and qualitative research, this paper focuses on extreme mental states that can occur in emotionally fragile Western students undergoing intensive meditation and the adaptations that teachers have made to deal with these difficulties. Implications for the clinical use of meditation will also be addressed.


Goals and Methods of Practice

Freud approached Eastern practices with misgiving, equating mystical states with "oceanic feelings" and a search for "restoration of limitless narcissism" and the "resurrection of infantile helplessness" (Freud, 1961, p. 72). As Epstein (1986, 1988, 1995) points out, Freud was unaware of Buddhist methods and goals which involve the dismantling of narcissism and the notion of inherent selfhood. The process of reaching nirvana or the "Absolute" (italicized terms are defined in the glossary) is far from blissful, and nirvana is far from narcissistic grandiosity and self-absorption.

Buddhist training involves moral discipline (shila) to increase wholesome states of mind, training in concentration and mindfulness (samadhi), and training in wisdom or insight into the true nature of phenomena (prajna) (Brown, 1986; Goleman, 1988). The ultimate fruit of training is to end suffering by realizing the Four Noble Truths: that life is basically unsatisfying, that suffering is caused by attachment arising from ignorance about the nature of reality, that suffering can cease with release from clinging, and that freedom is realized by living the Noble Eightfold Path: right understanding, intention, speech, action, livelihood, effort, mindfulness, and concentration. The three major defilements conditioning worldly existence, namely attachment (lust, desire, greed), aversion (hatred, anger, and aggression), and ignorance are overcome with realization of shunyata. Shunyata or "emptiness" is difficult to describe and explain, and there are doctrinal differences as to its meaning (Hopkins, 1983). It involves the "middle way" in that both inherent or independent existence and total non-existence are refuted. Through insight into the components of experience, one realizes that there is no "inherently existing I" and appreciates the representational and relative nature of reality (Epstein, 1989, 1990). One adopts neither an absolutistic stance involving belief in an eternal principle (godhead, self, eternal beyond) nor a nihilistic stance involving belief in voidness. One realizes that phenomena are interdependent and mutually condition each other. Realizing shunyata and interdependence, one lives with equanimity, wisdom, and compassion, fearless and awake to each moment of life. "In its true state, mind is naked, immaculate ... not realizable as a separate thing, but as the unity of all things, yet not composed of them; of one taste, and transcendent over differentiation" (Evans-Wentz, 1969, p. 211). It should be noted that there are degrees of enlightenment, and full enlightenment is more an ideal than an attainable reality. Brown and Engler (1986) found it extremely difficult to find people who had attained the last two paths of enlightenment (Nonreturner and Arhat) as outlined in early (Theravadan) traditional literature.

Buddhist meditation can be divided into two major branches, samatha, which stabilizes the mind, and vipassana, which is uniquely Buddhist and the basis of insight (Goleman, 1972a, 1972b; Gunaratana, 1985/1992; Lodro, 1992; Sole-Leris, 1986). Samatha practices involve concentrating on a prescribed object to attain tranquility and absorption. The mind gradually withdraws from all physical and mental stimuli except the object, and the usual conceptual mode of thinking is suspended. Mindfulness is used to guard against active senses and thoughts, which, on the one hand, scatter the mind, and, on the other hand, lend to a passive dullness which prevents clarity and focus. Body and mind become pliable as one progresses, and, in the end, one experiences samadhi or dwelling effortlessly, mind unified with object. In the Theravadan tradition, once adequate mindfulness and concentration are achieved, vipassana meditation begins. This involves paying "bare attention" to the rising and passing away of phenomena. One fully and precisely examines sensory and mental processes, moment by moment, to realize the nature of phenomena -- impermanent (anicca), unsatisfactory (dukkha), and lacking inherent essence or self (anatta). It is said that one of these marks of existence can serve as the gateway to nirvana and liberation from suffering.

As outlined by the Yisuddhimagga (a fifth-century work that supposedly collects the Buddha's teachings on meditative states), the process of realizing nirvana is fraught with troubling and sometimes excruciating states (Brown & Engler, 1986; Namto, 1989; Nyanamoli, 1976). Initially, confusion, hallucinations, disturbing feelings, and involuntary movements can occur as one gains knowledge of mental and physical states through increasing concentration and mindfulness. As samadhi is achieved, "pseudo-nirvana" experiences of rapture, tranquility, and bliss can be accompanied by frightening images, uncomfortable body sensations such as itching, heat, and stiffness, and gastrointestinal problems of nausea, vomiting, and diarrhea. Then, sadness, irritability, extreme fear, and a deep sense of the insipid nature of life may manifest as one becomes more and more aware of the arising and passing away of phenomena. A desire for deliverance can emerge, and one may wish to discontinue practice. For example, the body may itch as though being bitten by ants. Later, when deciding to practice to completion, one may feel odd sensations such as being slashed by a knife. Finally, as equanimity is achieved and mindfulness and concentration become balanced and natural, practice becomes smooth and one may be able to meditate for hours.

There are many types of meditative practices, and even within the major divisions of Theravada (Southeast Asia), Zen (China and Japan), and Tibetan (Himalaya region) traditions, practices vary. Theravada practices (see e.g., Goldstein, 1987; Goldstein & Kornfield, 1987; Kornfield, 1977; Namto, 1989; Nhat Hanh, 1987) usually involve detailed mindfulness of the aggregates which constitute personality, namely those of form (body senses, postures, and movement) and mind (feelings of pleasantness, unpleasantness, or neutrality, perception, mental states and contents, and consciousness itself). Initial practice involves developing concentration and mindfulness by alternating periods of sitting and walking meditation. The meditator focuses on the breath, then other sensations while sitting, and on the components of movement while walking slowly. When the mind wanders, mental noting is used to return to mindfulness. For example, when distracted by sound, the meditator notes "hearing" versus becoming lost in thoughts about the sound. Gradually, as skill develops, other objects are the focus, and the meditator develops "bare attention" or an awareness of phenomena without the usual self-consciousness and conceptual-perceptual elaborations. For example, in seeing or hearing something, one may see only color or hear vibrations.

Zen practices tend to focus more on concentration than detailed mindfulness, at least initially. Meditators are usually instructed to focus on the breath, first counting it and later just being aware of it without letting the mind wander. In the Rinzai tradition, once sufficient concentration is achieved, a koan, or question impervious to solution by logic, may be assigned. Some well-known initial koans are Chao-Chou's dog (Mu), the sound of one hand clapping, and your original face before your parents were born. The meditator becomes absorbed in the koan and eventually experiences kensho or breakthrough to an intuitive, nonconceptual experience. After that, other koans are assigned to deepen and extend the enlightenment experience (Loori, 1992). Shikantaza or "just sitting" is an alternative route and involves mindfulness as well as concentration by simply watching thoughts and sensations come and go (Goleman, 1972b). Rather than striving for kensho, proper posture and breathing are stressed, both to unify body-mind and to cut through attachment to the thinking mind. In both koan and shikantaza practices, attachment to thoughts lessens and then stops, and then the thinker too may disappear. Eventually, after years of practice, shunyata may be realized, and this realization penetrates daily life.

Tibetans utilize initial practices similar to those of Theravada and Zen except that they do not use koans (Gen Lamrimpa, 1992; Gyatso, 1991; Lodro, 1992; McDonald, 1984; Wangchen, 1987). Some schools emphasize philosophical analysis and study of texts, considering these as meditation because they help create wholesome states of mind and lay a foundation for later realization. Mandalas, visualizations, mantras, poly tone chanting, and complicated rituals are also used, which in conjunction with Tibetan cosmology and understanding of mind, can make practice complex indeed (Goleman, I972h). At advanced stages, more esoteric Tantric practices may he undertaken. Involving primal energy and emotion, these supposedly are quick paths to enlightenment ( i.e., they take only one lifetime) and provoke a wakefulness that is sharp in its ability to cut through habitual mind and pride. Because they can be dangerous and involve psychotic-like experiences, these practices require the guidance of a qualified teacher, and adequate ego strength and foundation in philosophy and meditation on the part of the practitioner.


Western psychology has usually focused on the short-term physiological and psychological benefits of meditation outside of a Buddhist context (see e.g., Carrington, 1977; Shapiro, 1982; West, 1987). As mentioned above, this study focuses on the experience of Buddhist teachers in dealing with problematic states that occur in some students during intensive meditation, some examples of which are described. Traditionally, although dealing with nonordinary states of consciousness (NSC) that occur during meditation, Buddhists did not deal much with extreme mental states, such as psychosis, because very troubled people were restricted from entering practice. With a focus on how prana or energy moves through channels in the body, Tibetan teachers probably have the most complex understanding of how extreme mental states can occur during meditation which is improperly done or excessive (Epstein & Rapgay, 1989). Buddhists also have not traditionally focused on dealing with students' personal history, emotions, and relationship problems. These have become more pertinent in the practice of Western students who often turn to meditation for psychological relief and help with problems in these areas. Brown and Engler (1986) note that unlike people in the East, many Westerners practice a form of self-exploratory therapy while meditating and consequently fail to develop the concentration and mindfulness which is necessary for formal meditation.

Descriptive and phenomenological research methods were used in this study because of 1) the historical and cognitive-subjective nature of the data, 2) difficulties in measuring such data "objectively" and in using a rigorous research design, and 3) the study's exploratory nature (Polkinghorne, 1989). Semi-structured interviews were conducted with a total of twelve experienced and sanctioned teachers, four each from Theravada, Zen, and Tibetan traditions, and four college-educated meditators who had major difficulties with meditation and volunteered to talk about their experience. Subjects were recruited through therapist and Buddhist contacts in Colorado. The teachers were asked about their meditation techniques and process and their experience with handling both vulnerable meditators and extreme mental states. The meditators were asked about their spiritual and psychological history and about the difficulties they encountered. Besides interviewing these subjects, the author attended nine meditation retreats led by various Theravada, Zen, and Tibetan teachers to gain personal experience with the meditation retreat milieu.

Three vignettes are presented to illustrate the range of motivations, personality structure, and experiences that meditators may have, and then teacher experiences are summarized to illustrate how they have adapted meditation practices to deal with meditator difficulties. Identifying information has been changed to protect confidentiality.

Meditator Experience (Three Vignettes)

Cracking the shell: Quest of unraveling.

Sara comes from an upperclass, ambitious family, which has no history of major mental illness. Her father, a successful businessman, wanted Sara to follow in his steps. She accordingly began work on a MBA, which was antithetical to her true desire to be an artist. In college, she generally felt depressed, saw a therapist a few times, and frequently turned to alcohol. She had an experience, however, while writing a paper about Blake, that everything was in her mind. This was freeing, and she felt that she had glimpsed a higher state of consciousness. After a year of misery in graduate school, she dropped out and turned to Zen, which was attractive because its simplicity and meditation practice promised freedom of mind despite life circumstances. Also, the Zen meditators seemed to constitute a more like-minded, understanding family than her family of origin.

Sara began working odd jobs and participating in all the activities of her Zen center. She attended morning, evening, and all-night sittings and seven-day retreats. The center was large, and she was "just a beginner," which meant that she did not have a position or duties. The center had a hierarchy of students with senior students playing major roles. Those who had "broken through" wore a special cloth, setting them apart. An "all or nothing" attitude pervaded the atmosphere, and people were encouraged to go to the extreme of practice. It was believed that the harder one worked, the longer and more one-pointedly one focused in meditation, the more likely one would experience kensho. The teacher, an American trained in Japan, was generally distant and formal. Sara admired him from afar, and they did not know each other well. She only talked with him during retreat interviews in which the teacher guides and tests each student's progress in meditation.

Sara does not remember whether students were screened in terms of their ability to handle meditation (this was in the mid-1970s). She said that one "had to be a good and devoted sitter" to attend a retreat. She never felt at risk in sitting strenuously and sat at least two hours a day when not in retreat. She had no problems until the retreat that preceded her psychotic break. That retreat occurred after she had seriously meditated for a year and a half. It was a seven-day retreat following another seven-day retreat that had ended a week before.

The retreat was intense. Sara meditated day and night with breaks for meals, chanting, work, and rest during the day and breaks for juice at night. She said that, fiercely intent on going deeper, she was able to sit full-lotus and did not experience pain. She had intense makyo (nonordinary sensations, perceptions, and emotions) but did not fear going crazy. The makyo involved mostly positive imagery except near the end, when there were demon-like faces. She also experienced going down a shaft, opening doors to different realities. At the end, she experienced an overwhelming sense of holiness and felt she had tapped into universal mind. She was able to let the makyo go and was sure she had broken through, as she could answer most of the teacher's questions, and he hugged her and seemed to appreciate her experience.

Following the retreat, Sara told others that she had broken through. Word got back to her teacher, and he told her otherwise. She thought that he just wanted her to go deeper, so meditated more. She experienced being like a bird in an egg, tapping to get out, and suddenly she heard tapping from the other side. She felt that God was revealing Himself and tapping to free her, and she was ready to "throw herself into the fire of consciousness to break through to His love." That was when she consciously decided to let her mind go. After that, everything seemed symbolic and had cosmological dimensions. She found her mind racing as she tried to figure everything out. She thought and thought and wandered around looking for her teacher, who she believed was God. Finally, she was hospitalized and received antipsychotic medication.

In the next few years, Sara went on and off medication and required further hospitalization. She returned to the Zen Center, but did not heed advice to take her medication, and eventually was not allowed to be there. She thought that she was going through an enlightening experience and did not understand people's concern. She felt hurt that they pushed her away.

Sara's experience in the mental health system was taxing. Few understood her experience and most were condescending. She felt that her mind was "unraveling," with all the major fears, desires, and "skeletons from the past" emerging into consciousness. She was helped most by a Buddhist psychiatrist who acknowledged the value and spiritual dimension of her experience and helped her remain grounded with medication and questions about mundane things.

Sara received a diagnosis of schizophrenia.
In trying to understand her experience, she assumes that she has some genetic, biochemical proclivity for psychosis and that her lack of control over the unraveling resembled schizophrenia. At the same time, the spiritual quest and her sense of release from past karma seemed different. Once the "unraveling" was complete, she felt more stable and peaceful than ever before and was able to discontinue medication.

Currently Sara meditates an hour a day. She follows her breath, thinks about things (though not in the prior searching way), and listens to her inner life. She lives alone and tries to live according to her ideas of simplicity and mindfulness. She believes that more intense meditation would be harmful. She also feels her spirituality is closer to Christianity at this point, in part because of her experience of God tapping at her shell.
She says that she does not often share her unique, personal, and somewhat mystical spiritual beliefs with others.

Terror alone: Snapping and song yet unsung.

Ada grew up in a "workaholic" home with parents too busy and striving to pay attention to a little girl. Sweets were soothers, and "happy and good" were the ways to be. As an infant, she was left to cry for hours, and she remembers three times of terror as a young child when she did not know where she was while in a familiar place. As a teenager, she experienced ecstasy while intensely writing poetry, which she felt was an avenue to a different type of consciousness.

Ada's involvement in meditation began in 1967 with TM (Transcendental Meditation), which helped calm her after a breakup with the "love of her life," Paul. Nine months later she entered a year-and-a-half practice of Vedanta, a form of Hindu mysticism, which involved meditating on a spiritual passage. Ada "upped the ante" after reading books by Watts (1957) and Kapleau (1965/1989) which describe Zen enlightenment experiences. She began practicing in earnest after meeting a Japanese Zen master in 1970 who was "dear and warm." Paul, also excited about Zen, came back into her life, and they sat and studied regularly with a group. It was a "high" time.

Ada was attracted to the "intensity, high drama, and do or die effort" of Rinzai Zen. It felt good to "bust her butt" and survive the pain of extended sitting. She does not remember which practice her teacher taught, but knows that she pushed herself to the limit. She took his words "just sit" to heart after seeking his help regarding a career in opera and a failed relationship with Paul. Thinking that her problems would be solved if she became enlightened, she meditated as much as possible. She attended at least one extended retreat a month with various teachers. When not in retreat, she sat for at least four hours a day and otherwise tried to remain in the moment. She felt peaceful and loving, more like herself than ever before. Veils fell from her eyes, and she experienced "everything just as it is." Yet, she still was unsure about her career. Conversations with others seemed trivial, and she cut off relationships and discontinued therapy. In retrospect, she thinks that her practice was an evasion of painful feelings, which would make themselves known at some point.

After six months of such practice, Ada attended a ten-day Theravada retreat involving concentration and mindfulness practices done alone in one's room. The teacher checked on each person daily and gave group talks. Ada had intense makyo during the retreat: crackling electricity traveled up and down her spine, and she felt profoundly relaxed as she recalled early memories of sounds and sights. Near the end of the retreat, she woke to an "absolute state" that she believed was kensho. First came cosmic pulsation with things flowing towards a single point and erupting back through it. Then appeared a sheet-like image with elements of reality floating. As she looked at them, she realized that they were her and that there was nothing in the universe except her. Rather than joy, she felt extreme fear and loneliness. The next morning, when she yearned for affirmation and advice, her teacher responded, "Now you know that you're afraid of being alone."

After the retreat and during the month prior to her "breakdown," Ada had another unbearable experience of loneliness. She also took LSD for the third time in her life and had a "terrifying trip" that involved disintegrating into bones. She willed herself out of that by refusing to accept it. She also was deeply "grabbed" (influenced) by Janov's "Primal Scream," and thought that if she reached and released her primal energy, she would be free. Then something "snapped," and she felt tremendous grief, then rage and terror. Only months later did she connect this experience to her grief about losing Paul.

The next few years were like "heavy labor with no rest" and "being in a tunnel without light." Ada could not talk about her pain and felt that people would lock her up if she did. She reentered therapy and tried other things as well: encounter and therapy groups, energy and body work, and Arica training, which involves meditation, yoga, body work, and psychological processing. The therapies never quite enabled her to reach and release her core problem. She also meditated and attended retreats, but found that her energies were too high to feel safe with meditation. She did not know how to transition back into the world of ordinary experience. She met with a Zen teacher who was also a psychoanalyst, but was not able to heed her advice because she (Ada) was too "freaked out" and emotionally disconnected. This teacher affirmed her kensho and "ripe" concentration practice, but advised that she needed more balance-work, singing, and a light meditation practice. Throughout this difficult period, she experienced one sign of hope: a dream of herself holding a tennis racket that resembled an Ankh, Egyptian sign of life.

Twenty years later and after even more therapy, Ada still struggles.
She believes that she has a borderline personality disorder and agrees with Engler's (1986) idea that you cannot go beyond yourself until you have a self. She does not meditate much for fear of what might come up but has worked with a Theravada-Zen teacher who meditated with her, demystified "enlightenment," and gave her feedback about her meditation. The technique of noticing what is prominent in the body and being with it helped her with pain a few times and offers hope. Ada says that when she first practiced, teachers were not psychologically sophisticated enough to ask about students' lives or to process emotional issues. She believes that she could have benefited from a moderate, gentle practice and advice to work, sing, and learn to relate better. I needed someone to investigate my big hurry and terrible race toward enlightenment, and to say that I was running from something."

Lost in thought: Twenty-four-hour practice.

Rose's family history involves mental illness: two siblings suffered psychosis or suicidal impulses, and her father, a physician and researcher, is riddled with phobias and compulsions. Rose's first psychotic episode occurred when she was nineteen and her second a year later. They were triggered by relationship stresses involving family and two gestalt therapists who she experienced as using her to work on their marital problems. The third occurred at age thirty-seven and the fourth at age thirty-nine. These related to not knowing her limits and becoming overextended and "lost" without realizing it. The last involved meditation, a "twenty-four-hour practice" as Rose calls it.

Rose first read a Buddhist book in her mid-twenties. She likes philosophy, thinking about mind and spirituality, and is interested in other cultures, and found Buddhism intellectually stimulating. Also, she felt frustrated with her psychosis and disliked the "deadening" effects of medication. She saw that TM helped a friend become less flighty and more able to be alone, and she hoped that meditation would help her gain control of her mind and be more content with herself. She did not begin meditating until her mid-thirties, however. At that time, stress over having a boyfriend in prison and exposure to Trungpa Rinpoche's (1969) Meditation in Action prompted her to seek instruction. She was told to follow her breath while sitting comfortably and to label any thoughts that arose as "thinking" and return to her breath.

Rose had two consecutive meditation instructors; she did not feel comfortable with either. She thought one was too strict and pushy about a particular type of training. She felt too intensely about the other and also worried that she was insensitive to him. Generally, she feels hemmed in and controlled by others' instructions. She ended up meditating on her own with little instruction and no supervision. She practiced at most three hours a week and generally did not meditate daily or at the same time every day.

Five years later, Rose met a Tibetan teacher who seemed to her to know what he was doing. He was not pushy about the practice, was careful about the effect of his words, and would stop if someone said he was going too far. He also tolerated doubt and skepticism and wanted people to think for themselves. She went to a weekend retreat that he led and was interviewed. Her only strange experience came before the interview. She felt driven to get up enough nerve to even have the interview and then experienced seeing a series of faces as she looked in a mirror. She had an "ordinary, down-to-earth conversation" with the teacher but did not mention the faces.

Rose did not tell her teachers about her prior psychotic episodes. They may have known about them through her therapist, but, if so, did not mention them to her. Her goal to overcome psychosis through meditation was never clarified.

The Tibetan teacher emphasized a "twenty-four-hour" practice of mindfulness as well as sitting meditation. This appealed to Rose and she began sitting for hours, letting her mind wander while half noticing her breath and other things. She discontinued her antipsychotic medication on her own a few months after the retreat. She also was working less, so she had less structure and contact with people. Moreover, the Los Angeles riots occurring after the Rodney King verdict of 1994 upset her greatly. Due to a foot injury, she then lost her usual way of stabilizing her mind, which was running. Running relaxed her and slowed her mind so that thoughts came more gradually and were more to the point. Around the same time, she saw another face in the mirror and began having intense fantasies involving reincarnation and Christian symbols. These experiences became more important than details of her everyday life, and she lacked her usual awareness and her usual fear that she was going too far. Her psychotic break occurred six months after the retreat.

Rose was hospitalized and she resumed medication. Her diagnosis has been paranoid schizophrenia. She finds the diagnosis hurtful and limiting, a label of being different and "all washed up." It also pressures her to become well and "enlightened." "Psychosis does not mean you're better or worse than others; it's just what has happened to a person in her life."

For her practice Rose now uses a Yoga tape that helps induce sleep through relaxation of different parts of the body. She thinks about seeing the Tibetan teacher again but does not feel ready to face questions about why she wants to meditate and see him. Her spirituality is private. She is trying to regain a sense of wonder and to accept her life, freed from the compulsion to be like everyone else.

Teacher Experience. Understanding of nonordinary states of consciousness (NSC).

The Buddhist teachers interviewed in this study (four Zen, four Theravadan, four Tibetan, all teaching in the U.S.) understand NSC as phenomena that often emerge as practice progresses. Similar to the "unstressing" cited in TM literature (Carrington, 1977; Goleman, 1971), NSC common in early phases of Buddhist meditation include disturbing emotions and fantasies, perceptual aberrations and hallucinations, memories, and proprioceptive sensations and movements (see also, Epstein & Lieff, 1986; Komfield, 1979). A Zen teacher noted that NSC at a later "preawakening" phase are different from earlier NSC. They tend to be either very alluring, often involving religious symbols and blissful feelings, or very frightening and evocative of doubt. Two Tibetan teachers noted that in advanced Tantric practices, visions of deified aspects of mind (yidams) can resemble psychosis in that they are both real and imaginary, external and internal.

The teachers defined psychosis as a problem of overidentifying with NSC and being unable to disidentify and let go. Also, several teachers said that psychosis involves an inability to function and respond in normal ways. Some Zen teachers noted that samadhi and kensho can involve a loss of functioning that can last from minutes to hours, however.

The teachers posited various reasons for NSC, some related to meditation and others not. All correlated NSC with deepening concentration, which seems to settle the usual discursive mind and allow other layers of mind to emerge, layers seen as tainted by the defilements of existence. The Theravadans especially emphasized that NSC emerge and become problematic when concentration is not balanced with adequate mindfulness, which can cleanse the mind of these defilements. Zen teachers suggested that incorrect posture and breathing also contribute. Tibetan teachers spoke of how an improper use of certain advanced meditation practices leads to an incorrect flow of energy in the body. All of the teachers noted that excessive effort and striving creates problems with NSC; the Asian teachers said that perhaps this was a bigger problem for meditators in the East because they have been culturally conditioned to seek enlightenment. Factors not related to meditation include health imbalances arising from lack of sleep, poor diet, and stress.

Dealing with NSC.

NSC are relatively common during intensive, prolonged meditation, and teachers are accustomed to dealing with them. Some Theravadans estimated that during a three-month retreat, about half of the students experience NSC. In dealing with these, teachers generally assure students that such phenomena occur with deepening practice but will pass. They try to help the student just observe the experience without denying, rejecting, or indulging it. They may supportively listen, such as when memories of trauma emerge, or on the other hand, they may make light of NSC that the student mistakes for enlightenment. Theravadans tend to focus on "mindfulness in the present moment" and may have the student "mentally note" the experience without getting caught up in its content. Zen teachers may correct the student's posture and breathing. A Tibetan teacher noted that he circumvents problems with NSC by checking for health imbalances that cause difficulties and has students start with a short practice and gradually increase time meditating as they gain insight.

When NSC is more extreme, a student may become paralyzed and unable to follow meditation instruction. At this point, most teachers advocate decreasing concentration on the meditative object, such as a koan or the breath; instead they ask the student to develop a more panoramic mindfulness of internal and external stimuli. This can mean "lightening up" and just watching the mind without judgment and effort to practice. Theravadans may have the student focus mindfully on the body or what is happening presently in the mind. Zen teachers may switch a student from a more concentrative koan practice, which tends to suppress unconscious material, to shikantaza or breath practice, which allows material to emerge more naturally and slowly. Teachers may also have more frequent interviews with the student, decrease the student's sitting time, and involve the student in "grounding" physical activities. A Tibetan and Theravadan commented that they sometimes confront a student's NSC as being "crazy." Some Theravadans have found that acupuncture treatment and heavier meals of meat and pasta can be helpful as well.

The teachers identified a number of signs that these extreme NSC could foreshadow a psychotic break. These include obsession with the NSC, more negative, fearful, and bizarre NSC, fear of going crazy, aberrant behavior, and emotionally disconnected "schizoid" states. One teacher thought that people prone to psychosis have more rage and self-pity and fewer moments of sadness and clarity than those who are not prone. Another teacher said that lack of humility is a sign of difficulty. These warning signs generally signal a need to discontinue or lighten up in practice.

The teachers found that psychosis, estimated to occur in far less that one percent of meditators, can develop at either initial or advanced stages of practice. During initial stages, it can rather easily occur in people with a history of psychosis; it relates to the student's inability to use meditation practices to stabilize the mind as defenses are relaxed. A Zen teacher said that he knows of a few cases where psychosis occurred after a retreat. He finds that stripped of their usual defenses, students can become depressed and overstimulated when they reenter ordinary life. In more advanced stages, psychosis is very rare because meditators have developed more equanimity or ability to observe and let go of mental content. Psychosis at advanced states usually relates to excess concentration and overexertion. The Tibetans called this a "sokrlung" disorder, which involves energy moving improperly in the body. Several teachers noted that Western meditators tend to give up meditation when they encounter difficulty. Few reach advanced stages of practice where meditation-related psychosis can occur.

If psychosis occurs in initial phases of practice, the student is asked to discontinue meditation and may be asked to leave the retreat or be hospitalized if they cannot return to ordinary functioning. A Theravadan said that, for more advanced meditators who develop true meditation-related psychosis, he may ask the student to focus on the state of mind as an object of mindfulness. If that fails, he may try to get at the deeper meaning of the problem or change the object of mindfulness. A Tibetan advised that advanced meditators need a qualified teacher to help with the practice used and to differentiate between psychotic states and true spiritual visions. Another Tibetan noted that advanced practices are meant to provoke confusion and extreme states. He tries to help people find balance between withstanding discomfort and knowing their limits so that they do not damage themselves.

Adapting to Western students.

The teachers reported that they have learned more about psychology in working with Western students, some with major mental illness and many with motivation to deal with psychological problems. Several teachers noted that they consult with mental health professionals regarding severe psychological problems in their students. Teachers who were demanding of students twenty years ago have become more moderate and gentle. They now believe that vigorous approaches help some students, but that in general, pushing students to "break through" does not facilitate integration of enlightenment experience and can damage students who are psychologically fragile. They emphasized knowing students so that practice can be tailor-made for each student's temperament and needs. Teachers with students who have a major mental illness said that they advocate moderation, teach initial mindfulness-breath practices, and increase their monitoring of the student's practice. Two said that metta or loving-kindness meditation can help as well, because such students often suffer from poor self-esteem. Many also encourage utilization of Western medication and therapy and restrict such students from attending retreats that last more than two days. Teachers also have instituted screening questionnaires and interviews to assess students' ability to handle meditation, asking about things such as prior history of psychosis and health status. Such screening has virtually eliminated problems with students becoming psychotic during initial practice, even though some students lied about their history. Teachers still have difficulty assessing students who do not have a history of psychosis. One noted that he knows of several high-functioning, articulate, and humorous people who had brief psychotic episodes during advanced Tibetan practices. Generally, teachers reported that too much effort and too much or too little anxiety can signal difficulties and that high-strung, emotionally volatile people have more intense and frequent NSC. The teachers tend to deal with these people by supportively listening and guiding, paying more attention than before to psychological issues. The Zen teacher who noted students' vulnerability after retreats has also started checking on fragile students a few days after a retreat.


It is apparent that Buddhist teachers have become more psychologically sophisticated in working with Western students over the past thirty-five years and have adapted traditional meditation practices to deal with extreme mental states that may arise during intensive meditation. The meditator vignettes illustrate some of the difficulties that can occur when a student's life, motivations, and vulnerabilities are not well understood, and when a student leaves the monitored and protected retreat milieu. The experiences of Sara and Ada suggest that narcissistic issues around grandiosity and borderline issues around abandonment can be activated in more advanced stages of meditation. They also illustrate how extreme effort to attain enlightenment can itself be a symptom and can create harmful imbalance in the mind and daily life. With such students, teachers may need to emphasize other aspects of Buddhist training besides meditation, e.g., relationships in the community (sangha) and moral precepts (shila). Rose's experience suggests that it may be difficult for students with a major mental illness to openly discuss their concerns with a teacher. Teachers may need to be more active with such students in discussing mental illness and being clear and supportive in their suggestions for practice. They can also foster community understanding and support.

Implications for the Clinical Use of Meditation

Meditation can enhance self-awareness and self-regulation, goals of most psychotherapies in working with a broad range of patients. Similar to expressive psychotherapies that aim at uncovering the unconscious, meditation has "derepressive" and destabilizing effects (Wilber, 1986). In both meditation and psychotherapy, one must deal with issues of personality structure, motivation, resistance, and relationship as the mind opens up to itself and becomes more integrated and stable.

This study has a number of implications for therapists who "prescribe" meditation or work with patients who meditate as a spiritual practice: 1) Most people will not have difficulties with meditation unless they meditate intensively. This is consistent with Glueck and Stroebel's (1975) findings that psychiatric patients benefited from TM at prescribed twenty-minute periods twice a day, but were prone to psychosis when meditating more. 2) Some meditative practices are more appropriate than others, depending on a patient's needs. Initial concentrative practices that focus on the breath can help patients calm themselves but, if engaged in over an extensive period of time, may result in NSC that are experienced as troublesome. Initial mindfulness practices involving breathing, mental noting, and awareness of body sensations may help patients become more grounded in the present. Metta meditation (Salzberg, 1995) can help develop a sense of kindness towards oneself and others. Any physical activity, including martial arts and yoga, can be an antidote for overwhelming thoughts and emotions. 3) Most meditators will discontinue meditation when frustrated or remain beginners because of the dedication, perseverance, and time it takes to develop meditation skills. As Allen (1995) points out, meditation and other self-regulation techniques are simple but require motivation and practice. Because of self-hatred, patients often fail to do things to care for themselves. Thus, resistance to self-care must be explored and encouragement to begin and maintain practice must be given. 4) Although Westerners tend to focus on Buddhist meditation, other aspects of Buddhist training, such as being a member of a community and practicing moral precepts, may be equally or more helpful for psychological and spiritual development.

In sum, Buddhist practices, as being adapted by teachers in the West, seem to offer a promising avenue of psychological and spiritual development. Possibilities for further study of the interface between Buddhist practice and Western psychology abound. For example, one could focus on the nature and use of transference in student-teacher relationships. A teacher in this study noted that he treats students differently at different stages of their practice: he is a parent in initial phases, a guide as the student becomes more independent, a spiritual friend who can also learn from the student, and finally not a teacher at all. Sexual relationships and the power differential between teachers and students have been topics of animated discussion and could be studied as well.


kensho-Zen expression for the experience of awakening or breaking through normal consciousness to realize one's true nature and the nonduality of the "Absolute" (nirvana) and "Relative" (samsara).

jhana (Pali) (dhyana. Skt.)-a degree of absorption on a continuum (eight jhanas altogether), beginning with a full break with normal consciousness that is characterized by absorption in the meditative object to the exclusion of other thoughts and sensory awareness.

koan-Zen teaching phrase or story that presents a paradox unsolvable through logic or reason. In concentrating on a koan and attempting to solve it, one is forced to transcend discursive thinking and realize a world beyond dualism. It is used to promote initial kensho and subsequently, to deepen realization.

makyo--Zen term for the deceptive, illusory sensations and feelings that arise in meditation.

nirvana (nibbana, Pali)-the "absolute" or unconditioned, uncreated, unformed realm beyond and underlying consensual. phenomenal reality (samsara), Awakening to nirvana and realizing it in samsara is the goal of meditation.

prajna (panna, Pali)-"insight wisdom." The definitive moment of prajna is insight into emptiness [shunyata], which is the true nature of reality.

prana-life force. "wind," or energy that in Eastern thought circulates through channels in the body and supports life processes.

Rinzai-one of the two major schools of Japanese Zen. Koans are an integral part of its practices.

samadhi-nondualistic state of consciousness reached when the mind becomes absorbed in an object through focus on the object and calming the mind.

samatha (Pali) (shamatha, Skt.)-"calm abiding" or "dwelling in tranquility." One of the two major branches of meditative practices in Buddhism. Samatha calms the mind and culminates in samadhi and jhana levels of absorption.

samsara-the "relative" or conventional, phenomenal reality conditioned by the three "unwholesome" roots (attachment, aversion, ignorance) that tie beings to worldly existence, which involves birth, sickness, old age, and death.

shikantaza- "just sitting," A form of Zen practice that involves a neutral, mindful observation of thoughts and sensations as they come and go.

shila (sila, Pali)-precepts or ethical guidelines for those on the Buddhist path. More broadly speaking, it refers to morality based on insight-wisdom.

shunyata (sunnata;Pali)-"emptiness." Central notion of Buddhism that phenomena, including "self," have no inherent or independent existence.

vipassana (PaU) (vipashyana, Skt.)-"special insight" or "clear seeing." One of the two major branches of Buddhist meditation practices. Vipassana develops prajna or insight-wisdom. It is sometimes used to describe Theravada meditation practices, which involve careful cultivation of mindfulness in early stages of practice. Technically, true vipassana does not begin until mindfulness and concentration are well-developed and balanced.

yidam-"deity" that practitioners visualize in advanced Vajrayana practices. Yidams involve primal energy and emotions.


ALLEN, J.G. (1995). Coping with trauma: A guide to self-understanding. Washington, DC: American Psychiatric Press.

BROWN D, P. (1986). The stages of meditation in cross-cultural perspective. In K. Wilber, J. Engler & D. P. Brown (Eds.), Transformations of consciousness: Conventional and contemplative perspectives on development (pp. 219-283). Boston: Shambhala.

BROWN D. P. & Engler, J. (1986).The stages of mindfulness meditation: A validation study. In K. Wilber, J, Engler & D. P. Brown (Eds.), Transformations of consciousness: Conventional and contemplative perspectives on development (pp. 161-217).Boston: Shambhala.

CARRINGTON P., (1977). Freedom in meditation. Garden City, NY: Anchor Press.

ENGLER J., (1986). Therapeutic aims in psychotherapy and meditation: Developmental stages in the representation of self. In K. Wilber, J. Engler & D.P. Brown (Eds.), Transformations of consciousness: Conventional and contemplative perspectives on development (pp, 1751). Boston: Shambhala.

EPSTEIN M., (1986). Meditative transformations of narcissism. Journal of Transpersonal Psychology, 18(2), 143-158.

EPSTEIN, M., (1988). The deconstruction of the self: Ego and "egolessness" in Buddhist insight meditation. Journal of Transpersonal Psychology, 20(1), 61-69.

EPSTEIN M., (1989). Forms of emptiness: Psychodynamic, meditative, and clinical perspectives. Journal of Transpersonal Psychology, 21(1),61-71.

EPSTEIN, M., (1990). Psychodynamics of meditation: Pitfalls on the spiritual path. Journal of Transpersonal Psychology, 22(1),17-34.

EPSTEIN, M., (1995). Thoughts without a thinker. New York: Basic.

EPSTEIN, M. & LIEFF, J. (1986). Psychiatric complications of meditation practice, In K. Wilber, J. Engler & D.P. Brown (Eds.], Transformations of consciousness: Conventional and contemplative perspectives on development (pp. 53-63). Boston: Shambhala.

EPSTEIN, M. & RAPGAYL. (1989). Mind, disease, and health in Tibetan medicine. In A.A. Sheikh& K.S. Sheikh (Eds.), Eastern and Western approaches to healing: Ancient wisdom and modern knowledge. New York: Wiley.

EVANS-WENTZ,Y., (1969). The Tibetan book of the great liberation. London: Oxford.

FREUD, S. (1961). Civilization and its discontents. In J. Strachey (Trans. & Ed.), Standard edition of the complete psychological works of Sigmund Freud, 21, 57-145. London: Hogarth Press. (Original work published 1930).

GEN LAMRIMPA. (1992). Samatha meditation: Tibetan Buddhist teachings on cultivating meditative quiescence (B.A Wallace, Trans.). Ithaca, NY: Snow Lion.

GLUECK, B.C. & STROEBEL, C.F. (1975). Biofeedback and meditation in the treatment of psychiatric illnesses. Comprehensive Psychiatry, 16, 303-321.

GOLDSTEIN, J., (1987). The experience of insight. Boston: Shambhala.

GOLDSTEIN, J. & KORNFIELD J., (1987). Seeking the heart of wisdom. Boston: Shamhhala.

GOLEMAN, D. (1972a). The Buddha on meditation and states of consciousness. Part I: The teachings. Journal of Transpersonal Psychology, 4(1), 1-44.

GOLEMAN, D. (1972b). The Buddha on meditation and states of consciousness. Part II: A typology of meditation. Journal of Transpersonal Psychology, 4(2), 151-210.

GOLEMAN, D. (1988). The meditative mind: The varieties of meditative experience. Los Angeles: J.P. Tarcher.

GUNARATANA, H. (1992). The path of serenity and insight. Delhi, India: Motilal Banarsidass. (Original work published 1985).

GYATSO T., (1991) Path to bliss: A practical guide to stages of meditation. Ithaca, NY: Snow Lion.

HOPKINS, J., (1983). Meditation on emptiness. London: Wisdom.

KABAT-ZINN, J., (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Bantam Doubleday.

KABAT-ZINN, J., MASSION AO, KRISTELLER J., PETERSON LG., FLETCHER KE., PBERT L, LENDERKING WR, & SANTORELLI SF, (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry. 149, 936-943.

KAPLEAU, P. (1989). The three pillars of Zen. New York: Anchor Books. (Original work published 1965).

KORNFIELD J., (1977). Living Buddhist masters. Santa Cruz, CA: Unity Press.

KORNFIELD, J (1979). Intensive insight meditation: A phenomenological study. Journal of Transpersonal Psychology. 11(1),41-58.

LoDRO, G. (1992). Walking through walls: A presentation of Tibetan meditation. (1. Hopkins, Trans. & Ed.), Ithaca, NY: Snow Lion.

LOORI D.. (1992). The eight gates of Zen. Mt, Tremper, NY: Dharma Communications.

McDONALD K., (1984). How to meditate. London: Wisdom.

NAMTO S.S. (1989). Insight meditation: Practical steps to ultimate truth. Bangkok, Thailand: Amann Printing.

NHAT HANH, T. (1987). The miracle of mindfulness (Rev. ed.), Boston: Beacon Press.

NYANAMOLI (Trans.) (1976). Yisuddhimagga: The path of purification by Buddhaghosha. Boulder, CO: Shambhala.

POLKINGHORNE D.E., (1989). Phenomenological research methods. In R. S. Valle & S. Halling (Bds.), Existential-phenomenological perspectives in psychology: Exploring the breadth of human experience (pp. 41-60). New York: Plenum Press.

SALZBBURG, S., (,1995). Loving kindness: The revolutionary art of happiness. Boston: Shambhala. Shambhala dictionary of Buddhism and Zen. (1991). (M.H. Kohn, Trans.) Boston: Shambhala.

SHAPIRO D. H. (1982). Overview: Clinical and physiological comparison of meditation with other self-control strategies. American Journal of Psychiatry, 139, 267-274.

SOLE-LERIS, A.,(1986). Tranquility and insight. Boston: Shambhala.

TRUNGPA, C. (l969). Meditation in action. Berkeley: Shambhala,

WANGCHENG, N., (1987). Awakening the mind of enlightenment. London: Wisdom.

WATTS, A.W., (957). The way of Zen. New York: Random House.

WEST, M.A. (Ed.). (1987). The psychology of meditation. New York: Oxford.

WILBER K., (1986). The spectrum of development; The spectrum of psychopathology; Treatment modalities. In K. Wilber, J. Engler & D.P. Brown (Eds.), Transformations of consciousness: Conventional and contemplative perspectives on development (pp. 65159). Boston: Shambhala.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am

Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Mon Feb 25, 2019 7:47 am

Mania precipitated by meditation: A case report and literature review
by Graeme A. Yorston
St. Andrew's Hospital, Northampton, UK
Mental Health Religion & Culture, November 2001




Meditation is a popular method of relaxation and dealing with everyday stress. Meditative techniques have been used in the management of a number of psychiatric and physical illnesses. The risk of serious mental illness being precipitated by meditation is less well recognized however. This paper reports a case in which two separate manic episodes arose after meditation using techniques from two different traditions (yoga and zen). Other cases of psychotic illness precipitated by meditation and mystical speculation reported in the literature are discussed.


Meditation as a method of relaxation and dealing with everyday stress is becoming increasingly popular in the West with an estimated six million practitioners in the USA alone (Graham, 1986). A variety of techniques are in use but most owe their origins to oriental practices. Meditation has also been used as a therapeutic tool in psychiatry for behaviour modification (de Silva, 1984), as part of a holistic programme for chronic schizophrenia (Lukoff et al., 1986) and as an adjunct to dynamic psychotherapy (Kutz, 1985). A number of recent studies have examined the effects of meditation on physical illness (Kabat-Zinn et al., 1998;Wenneberg et al., 1997)

Meditation is generally considered safe with beneficial effects on mental health rather than as a potential trigger for psychiatric illness but there are reports in the literature of the hazards of meditation: Walsh and Roche (1979) described three cases of psychotic illness precipitated by meditation in subjects already diagnosed as suffering from schizophrenia who had discontinued medication. Garcia-Trujillo et al. (1992) described a further two cases of acute psychosis precipitated by oriental meditation in subjects previously diagnosed as schizotypal personality disorder. Chan-Ob and Boonyanaruthee (1999) report a further three patients who presented with psychotic symptoms after practicing meditation. French et al. (1975) reported a single case of ‘altered reality testing’ after transcendental meditation. The precipitation of psychotic illness by Jewish mystical speculation has also been reported (Greenberg et al., 1992). Krieger and Zussman (1981) reported a case of a brief reactive psychosis in a Thai immigrant to the USA which occurred after confronting a family Buddhist mortuary ritual.

A review of the literature failed to reveal any cases of affective disorder being precipitated by meditative techniques. This paper reports a case in which two separate manic episodes were precipitated by periods of intense meditation using techniques from two different traditions (yoga and zen).

Case report

Miss X, a 25-year old self-employed, university graduate presented with a two week history of increased talkativeness, sleeplessness, over-activity and disinhibited behaviour. The onset followed a weekend yoga course that encouraged psychological release. She telephoned her instructor frequently, often in the middle of the night, offering undying love. She also pushed her hand through a window and sustained minor lacerations. There was no past psychiatric history but she had experienced brief periods of low mood 10 and six years previously which had resolved without psychiatric intervention. There was a family history of depression in her father who had received electro-convulsive therapy, and of late life depression in her paternal grandmother. Her birth and milestones were normal. There was no history of illicit drug use.

She was admitted informally to hospital but was detained when she became irritable and aggressive and insisted on leaving. At interview she shouted and tried to embrace some members of staff, but struck out at others. There was pressure of speech, thought disorder with flight of ideas, her mood was elevated and there were grandiose delusions including the belief that she had some special mission for the world: she had to offer ‘undying, unconditional’ love to everyone. She had no insight. A diagnosis of manic episode was made and she was treated with haloperidol 10mg daily and lorazepam up to 4mg daily and her symptoms were gradually controlled over the next six weeks. She refused mood-stabilizing medication.

At outpatient follow up she was noted to be mildly hypomanic on two occasions (the second after a sesshin or intensive Zen meditation weekend) but these episodes responded to chlorpromazine without admission to hospital. She agreed to a trial of carbamazepine 800mg daily which she took for two years. She also underwent twice weekly psychodynamic psychotherapy for over two years.

Two months after entering a Zen Buddhist retreat that she had been associated with for two years, she re-presented with a five-day history of sleeplessness, decreased appetite and labile affect. At interview she laughed inappropriately and had outbursts of activity – lying on her bed one moment, jumping off the next. She made stereotypical praying movements, was sexually disinhibited, restless, distractible and irritable. She was thought disordered with pressure of speech. Though admitted informally she soon insisted on leaving and attacked a member of staff. She was detained and transferred to an intensive psychiatric care unit for three days where treatment with haloperidol 6mg and lorazepam 3mg was commenced. Her mental state settled over the next eight weeks. She continued to refuse mood stabilizing treatment and re-entered the Buddhist retreat.


The precipitation of mania by meditation has not been described before yet descriptions of the altered state of consciousness (ASC) associated with contemplative practice abound in the mystic literature of different religions (Buckley, 1981). Zen is a Japanese school of Buddhism – the word itself derives from Sanskrit dhyana or meditation and it is meditation or mindfulness that forms the essence of the Zen philosophy of life. A euphoric state of enlightenment called satori is sometimes achieved by experienced monks (Humphreys, 1962). Thapa and Murtha (1985) compared the subjective accounts of ASCs in subjects with complex partial seizures, schizophrenia and meditators from ashrams and other religious organizations in India. They found the core experiential characteristics of perceptual distortion were common to all three ASCs but important differences existed such as only the meditative ASC being accompanied by a positive emotional effect. The authors did not include manic patients in their study so were unable to make direct comparisons with the experiences in mania. Lukoff (1988) however reported in a single case study that seven of the eight dimensions of mystical experience described by Stace (1960) were experienced by a manic patient.

There is evidence that mystical experiences have a neuro-biological basis possibly in the right temporal lobe (Fenwick, 1996) and contemplative meditation which can lead to such experiences can be studied in experimental conditions (Deikman, 1963, 1964). Lou et al. (1999) have shown a differential cerebral blood flow distribution in meditative states and normal consciousness.

Students practise Zen to develop concentration without thinking (Watts, 1962) but this can be difficult and novices are often bombarded by distracting stimuli – both external and intrapsychic which can continue after the meditation session leading to insomnia. There is evidence to suggest sleep deprivation may act as a final common pathway in the onset of mania (Kasper & Wehr, 1992; Wehr, 1991; Wright, 1993) and it is possible that it was the pressure of thought stirred up by meditation that disrupted the patient’s sleep and precipitated the manic episode in this case and in two of the cases reported by Chan-Ob and Boonyanaruthee (1999). Interestingly the patient herself likened both episodes of mania to a release of tension and blocked energy from years of not dealing with emotions in a helpful way.

Other evidence for psychological precipitants for mania comes from life events (Sclare & Creed, 1990) and expressed emotion (Miklowitz et al., 1986) research. These factors appear to be most important in the first episode of illness, the effects lessening with each subsequent episode. These observations have been suggested as evidence in support of the kindling hypothesis (Silverstone & Romans-Clarkson, 1989). The move to the retreat and adoption of a different lifestyle in this case must have been a significant stressor. Indeed, religious change in itself can be associated with psychiatric illness: Witztum et al. (1990) showed high rates of serious mental illness in converts to ultra-orthodox Judaism in Jerusalem and speculated that, for some, the conversion may have been an attempt to control emerging signs of psychiatric illness.

Other more established risk factors for mania in this case are the positive family history of affective disorder and the discontinuation of carbamazepine (Scull & Trimble, 1995).

The orthodox psychiatric diagnosis in this case was bipolar affective disorder. Grof and Grof (1986) have argued however that traditional psychiatric thinking fails to recognize the difference between mystical and psychotic experiences, tending to underestimate the potential for a healing and positive transformation of what the authors term a transpersonal crisis. It is important to remember that other cultures have and do classify what we now call psychoses in different ways and that, as Carey (1997) has advocated, knowledge drawn from different approaches should be respected and allowed to contribute to the scientific study of mental illness. The absence of previous reports of mania precipitated by meditation despite its apparent potency at inducing euphoric states of consciousness suggests that adequate practice and supervision may enable the subject to learn to control the emergence of intrapsychic material. If this is so, then it could have implications for reducing the risk of relapse in this patient and potentially in others. Thus, although our understanding of the psychology and neurobiology of meditation is growing (see West, 1987) for a comprehensive review) it deserves more study.



BUCKLEY, P. (1981). Mystical experience and schizophrenia. Schizophrenia Bulletin, 7, 516–521.

CAREY, G. (1997). Towards wholeness: transcending the barriers between religion and psychiatry. British Journal of Psychiatry, 170, 396–397.

CHAN-OB, T. & BOONYANARUTHEE, V. (1999). Meditation in association with psychosis. Journal of the Medical Association of Thailand, 82(9), 925–930.

DE SILVA, P. (1984). Buddhism and behaviour modification. Behavioural Research and Therapy, 22, 661–678.

DEIKMAN, A.J. (1963). Experimental meditation. Journal of Nervous and Mental Disease, 136, 329–343.

DEIKMAN, A.J. (1966). Implications of experimentally induced contemplative meditation. Journal of Nervous and Mental Disease, 142, 101–116.

FENWICK, P. (1996) The neurophysiology of religious experience. In D. BHUGRA (Ed.) Psychiatry and Religion (pp. 167–177). London: Routledge.

FRENCH, A.P., SCHMID, A.C. & INGALLS, E. (1975). Transcendental meditation, altered reality testing and behavioral change. Journal of Nervous and Mental Disease, 161, 55–58.

GARCIA-TRUJILLO, R., MONTERREY, A.L. & GONZALEZ DE RIVIERA, J.L. (1992). Meditacion y psicosis. Psiquis Revista de Psiquiatria Psicologia y Psicosomatica, 13(2), 39–43.

GRAHAM, H. (1986) The human face of psychology: humanistic psychology in its social and cultural context. Milton Keynes: Open University Press.

GREENBERG, D., WITZTUM, E. & BUCHBINDER, J (1992). Mysticism and psychosis: the fate of Ben Zoma. British Journal of Medical Psychology, 65(3), 223–235.

GROF, C. & GROF, S. (1986). Spiritual emergency: The understanding and treatment of transpersonal crises. Special Issue: The psychotic experience: disease or evolutionary crisis? ReVision, 8(2), 7–20.

HUMPHREYS, C. (1962). Teach Yourself Zen. Aylesbury: English Universities Press.

KABAT-ZIN, J., WHEELER, E., LIGHT, T., SKILLINGS, A., SCHARF, M.J., CROPLEY, T.G., HOSMER, D. & BERNHARD, J.D. (1998). In uence of mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy. Psychosomatic Medicine, 60 (5), 625–632.

KASPER, S. & WEHR, T.A. (1992). The role of sleep and wakefulness in the genesis of depression and mania. Encephale, 18 Spec No 1, 45–50.

KRIEGER, M.J. & ZUSSMAN, M. (1981). The importance of cultural factors in a brief reactive psychosis. Journal of Clinical Psychiatry, 42(6), 248–249.

KUTZ, I. (1985) Meditation as an adjunct to psychotherapy: an outcome study. Psychotherapy and Psychosomatics, 43(4), 209–218.

LOU, H.C., KJAER, T.W., FRIBERG, L., WILDSCHIODTZ, G., HOLM, S. & NOWAK, M. (1999). A 150-H2O PET study of meditation and the resting state of normal consciousness. Human Brain Mapping, 7(2), 98–105.

LUKOFF, D. (1988). Transpersonal perspectives on manic psychosis: creative, visionary and mystical states. Journal of Transpersonal Psychology, 20, 111–140.

LUKOFF, D., WALLACE, C.J., LIBERMAN, R.P., & BURKE, K. (1986) A holistic program for chronic schizophrenic patients. Schizophrenia Bulletin, 12, 274–282.

MIKLOWITZ, D.J., GOLDSTEIN, M.J. & NUECHTERLEIN, K.H. (1986). Expressed emotion, affective style, lithium compliance and relapse in recent onset mania. Psychopharmacology Bulletin, 22, 628–632.

SCLARE, P. & CREED, F. (1990). Life events and the onset of mania. British Journal of Psychiatry, 156, 508–516.

SCULL, D.A. & TRIMBLE, M.R. (1995). Mania precipitated by carbamazepine withdrawal. British Journal of Psychiatry, 167, 698.

SILVERSTONE, T. & ROMANS-CLARKSON, S. (1989). Bipolar affective disorder: Causes and prevention of relapse. British Journal of Psychiatry, 154, 321–335.

STACE, W. (1960). The teachings of the mystics. New York: Mentor.

THAPA, K., & MURTHY, V.N. (1985). Experiential characteristics of certain altered states of consciousness. Journal of Transpersonal Psychology, 17, 77–86.

WALSH, R. & ROCHE, L. (1979) Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. American Journal of Psychiatry, 136 (8), 1085–1086.

WATTS, A.W. (1962) The way of zen. Harmondsworth: Penguin Books.

WEHR, T.A. (1991) Sleep loss as a possible mediator of diverse causes of mania. British Journal of Psychiatry, 159, 576–578.

WENNEBERG, S.R., SCHNEIDER, R.H., WALTON, K.G., MACLEAN, C.R., LEVITSKY, D.K., SALERNO, J.W., WALLACE, R.K., MANDARINO, J.V., RAINFORTH, M.V. & WAZIRI, R. (1997) A controlled study of the effects of the transcendental meditation program on cardiovascular reactivity and ambulatory blood pressure. International Journal of Neuroscience, (89) 15–28.

WEST, M.A. (1987) The psychology of meditation. Oxford: Clarendon Press.

WITZTUM, E., GREENBERG, D. & DASBERG, H. (1990) Mental illness and religious change. British Journal of Medical Psychology, 63, 33–41.

WRIGHT, J.B. (1993) Mania following sleep deprivation. British Journal of Psychiatry, 163, 679–680.
Site Admin
Posts: 31711
Joined: Thu Aug 01, 2013 5:21 am


Return to Psychology

Who is online

Users browsing this forum: No registered users and 1 guest