Mindfulness Meditation Research: Issues of Participant Scree

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Mindfulness Meditation Research: Issues of Participant Scree

Postby admin » Wed Feb 13, 2019 10:05 pm

Part 1 of 2

Mindfulness Meditation Research: Issues of Participant Screening, Safety Procedures, and Researcher Training
by M. Kathleen B. Lustyk, PhD; Neharika Chawla, MS; Roger S. Nolan, MA; G. Alan Marlatt, PhD
ADVANCES JOURNAL, Spring 2009, VOL. 24, NO. 1

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M. Kathleen B. Lustyk, PhD, is a professor of psychology, in the School of Psychology, Seattle Pacific University, Washington, and an affiliate associate professor, in Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle. Neharika Chawla, MS, is a pre-doctoral fellow at the Addictive Behaviors Research Center in the Department of Psychology, University of Washington, Seattle. Roger S. Nolan, MA, is a psychotherapist in Burbank, California. G. Alan Marlatt, PhD, is a professor of psychology and the director of the Addictive Behaviors Research Center, University of Washington

ABSTRACT

Increasing interest in mindfulness meditation (MM) warrants discussion of research safety. Side effects of meditation with possible adverse reactions are reported in the literature. Yet participant screening procedures, research safety guidelines, and standards for researcher training have not been developed and disseminated in the MM field of study. The goal of this paper is to summarize safety concerns of MM practice and offer scholars some practical tools to use in their research. For example, we offer screener schematics aimed at determining the contraindication status of potential research participants. Moreover, we provide information on numerous MM training options. Ours is the first presentation of this type aimed at helping researchers think through the safety and training issues presented herein.

Support for our recommendations comes from consulting 17 primary publications and 5 secondary reports/literature reviews of meditation side effects. Mental health consequences were the most frequently reported side effects, followed by physical health then spiritual health consequences. For each of these categories of potential adverse effects, we offer MM researchers methods to assess the relative risks of each as it pertains to their particular research programs.

The list of benefits associated with mindfulness meditation (MM) is growing. Interest in this ancient practice rooted in Buddhist philosophy seems to know no cultural or religious boundaries. Walsh and Shapiro write, “Meditation is now one of the most enduring, widespread, and researched of all psychotherapeutic methods.”1 Yet, while safety guidelines, participant screening procedures, and standardized researcher training exist for some behavioral medicine practices (eg, exercise per the American College of Sports Medicine [ACSM] guidelines2), these have yet to be developed and disseminated in the MM field of study.

To assist those planning studies of MM, our goals in this paper are to (1) define categories of side effects of meditation with possible adverse reactions raised in the literature and by clinicians with extensive experience in the therapeutic delivery of MM, (2) propose a procedure for screening potential research participants and suggest safety procedures within each category, and (3) reduce the risk of potential iatrogenic harm to research participants by offering suggestions for researcher training in MM. Together, the authors contributing to this paper cover a broad range of expertise, including clinicians who regularly employ MM in their practices, specialists in MM facilitation from the Theravada tradition, and senior research scholars skilled in intervention, laboratory, and behavioral neuroscience methods.

MINDFULNESS MEDITATION DEFINITION

Mindfulness meditation (MM) involves completely attending to experiences on a moment-to-moment basis in an effort to cultivate a nonjudgmental, nonreactive state of awareness.3 MM is rooted in the traditional Buddhist practice of Vipassana, which translates literally as “seeing things as they really are.”4 MM practice begins with sustained observation of the breath and expands to include awareness of physical sensations, thoughts, and emotional states as they arise in the present moment. This focus on present moment experiences trains attitudinal, relational, and cognitive capacities in practitioners with supporting changes in neurobiological substrates.5-7 According to Shapiro,8 this shift in focus from the breath to a variety of phenomena is what distinguishes MM from purely concentrative forms of meditation such as Transcendental Meditation (TM), which uses a mantra to centralize cognitive focus. Still, both MM and TM do involve concentrating on a specific object (eg, the breath); however, with MM this unified focus is then directed toward the entire field of awareness. Although meditation practices vary in the specific techniques employed, all involve a form of mental/attentional training.8,9

This overlap in meditation techniques has recently been addressed by Lutz et al,9 who offer the description of 2 meditation styles, namely focused attention and open monitoring, noting that with MM, practitioners may include both styles in their practices, whereas techniques such as TM primarily involve focused attention. We have considered this overlap in MM styles in our presentation of potential adverse effects by drawing upon MM studies as well as those reporting on related meditation techniques. We posit that when designing a study in an area of research where empirically tested safety procedures and standardized protocols are lacking, it is particularly important to consult the literature for reports of potential adverse effects attributed to the technique under investigation as well as any related techniques to maximize participant safety and facilitator awareness. As this is the case with MM, reports from small-n studies, secondary analyses, and the like involving MM-related forms of mediation warrant consideration. Beyond this, anecdotal evidence from clinicians who have observed negative consequences from MM with their patients is worth considering as well.

Then the Fourth Reliance do not rely on conceptual mind. Rely on nondual wisdom experience. This is an incredibly important one and one that I work with every single day because in these particular times with everything flying around, concepts are flying like crazy. Mine are, I don’t know about yours, my mind looking for a place to land wants to come up with some kind of conclusion or position. But conceptual mind is not reliable, and of course concepts still keep coming up all the time, but can we rely, especially on our nondual wisdom experience as the precious treasure of our lineage, more precious than any conceptual teachings that we may have received. Can we allow ourselves to hold paradoxes, complexity in our experience without trying to boil it down to very simple conclusions at any given moment. What is it like for us to rely on the nondual wisdom of experience? That’s really the challenge. It’s a challenge I’m facing every day. I’m sure a lot of us are....

I want to say that in my years of practicing with the Sakyong and seeing him on his journey, I’ve seen difficult times for him. I’ve seen challenges for him, but in general, the Sakyong depicted in the news stories is not the Sakyong I know. And so maybe I’ve missed something along the way. And it absolutely breaks my heart that there have been women who have been harmed by his conduct and I realize that we as a community did not do enough to take care and to find out what happened with this women. So I hold this paradox in my heart as my path of warriorship. My love and respect for the Sakyong, his teacher and what I’ve gotten from him, and my heartbreak about the harm that has occurred that we as a community, the Sakyong as teacher did not take care of and address. So I just want to say this. Holding this paradox is my path of warriorship that sends me into lots of ups and downs.

-- Judith Simmer-Brown to Distraught Shambhala Members: “Practice More.” (Notes and Transcript), by Matthew Remski


Please note: it was not our intent to evaluate the validity of the stated side effects reported in each of the articles cited herein. Such evaluations would require assessing how predictive each potential adverse outcome was from the meditation performed, how accurate the reporting author’s analyses were, and determination of mitigating circumstances. Our intent was simply to report the possibility of these outcomes so future study designers may be aware of them and plan accordingly.

MINDFULNESS-BASED THERAPEUTIC APPROACHES

MM has been incorporated into various therapeutic interventions. These interventions are associated with beneficial therapeutic effects in cases of chronic pain,10,11 substance use disorders,12-19 depression,20-23 anxiety,24,25 and binge eating disorder. 26,27 Therapeutic interventions that involve formal training in mindfulness skills include Mindfulness-Based Stress Reduction (MBSR),28 Mindfulness-Based Relapse Prevention (MBRP),29,30 Mindfulness-Based Cognitive Therapy (MBCT),31,32 and Mindfulness-Based Eating Awareness Training (MB-Eat).33 Other approaches that incorporate components of mindfulness into their therapeutic tenants include Dialectical Behavior Therapy (DBT)34 and Acceptance and Commitment Therapy (ACT).35

The developers of each of these therapeutic interventions are well-established scholars and skilled healthcare providers. As such, these developers and/or members of their research teams have specific training in patient/participant intake procedures and methods of responding to mental health–related adverse effects. Yet, with the favorable findings being reported with MM interventions, research interest is growing rapidly and, consequently, MM effects are being investigated by members of various guilds including neuroscience, cognitive, social and physiological psychology, medicine, and nursing under the supposition that MM is by-and-large a safe behavioral medicine practice. However, systematic evaluations of its safety have not been reported in the literature. One possibility is that the absence of reported adverse effects is taken as support for MM safety. We posit the following: (1) The absence of reported procedural cautions/warnings, side effects, or adverse events in well-controlled MM clinical trials does not necessarily mean that none exist. (2) Such reporting absence may simply represent the lack of a standard for reporting these issues/events within a new and rapidly growing field of study. (3) Moreover, consent and safety procedures do not routinely get reported in clinical trials, leaving open the possibility that new MM researchers who seek to replicate published procedures may not go into the study fully prepared for what may occur nor include adequate protection for participants. It is this third effect that is our major concern and, hence, the focus of this paper.

CATEGORIES OF POTENTIAL ADVERSE EFFECTS

As demonstrated in Table 1, side effects of meditation with possible adverse reactions do occur. In light of research reports cited in Table 1 and recent reviews that discuss potential negative consequences of meditation, we thought it important to categorize potential adverse effects into (1) mental, (2) physical, and (3) spiritual health considerations. Within each category, we offer examples of specific side effects, cite cautionary reports for potential adverse effects, and label each effect as an absolute contraindication, a relative contraindication, or an issue worthy of consideration. Similar to the rationale applied to assessing safety in exercise research,2 we define an absolute contraindication as a condition or circumstance under which it is inadvisable to include a participant in a research study or carry out the research altogether. With a relative contraindication, participation may be inadvisable under some circumstances but not others. Matters worthy of concern are so named due to the theoretical/anecdotal nature of support for their consideration. To assist researchers in determining contraindication status of potential research participants, we offer step-by-step sample screener schematics to guide researchers as they develop their own research screening protocols.

Category 1: Mental Health Considerations

As can be seen in Table 1, adverse effects on mental health are the most frequently reported negative consequences from meditation. Of those mental health consequences listed in Table 1, the reports of severe affective and anxiety disorders as well as temporary dissociative states and psychosis give primary cause for concern.36-38 One example of a severe anxiety disorder is Posttraumatic Stress Disorder (PTSD). PTSD is a diagnosis characterized by the aftermath of a traumatic event (eg, combat, sexual assault), during which a person experiences feelings of intense fear, helplessness, and horror. Symptoms include intrusive recollections and re-experiencing in the form of distressing memories and flashbacks; avoidance of thoughts, feelings and situations associated with the traumatic event; emotional numbing; and hyperarousal.39 Because the practice of MM is contrary to the avoidance that is characteristic of PTSD,40 when individuals initially engage in MM they may, thus, encounter avoided affect and experiences in a form that is extremely distressing (eg, flashbacks, intrusive thoughts and memories) and may put them at risk for potential retraumatization. In order to address contraindication status (eg, absolute, relative, matter worthy of consideration) for participants with a history of trauma or a diagnosis of PTSD, we must first identify the specific research purpose.41 To illustrate, we provide a sample screener schematic for PTSD in Figure 1.

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Table 1. Side Effects of Meditation With Possible Adverse Reactions

Source and Study Design / Adverse Effects / Category of Side Effects* / Meditation Type / Meditation Duration/Intensity Description


Castillo43: multiple case study / • In all cases there were reports of Depersonalization, Derealization. Note: 3 of the 6 cases experienced symptoms after extended residential courses / MH / TM / Individual practices (daily frequency/duration not reported) and extended residential courses.

Chan-Ob and Bonnyanarunthee 36: multiple case studya / • Case 1: Reports of psychotic symptoms, including Hallucinations, Fear of persecution, Disorientation, Poor insight and judgment, Reduced food intake (note: patient’s prior history of hypophagia not reported), Insomnia reported as complete sleep loss (note: patient’s prior history of insomnia not reported); • Case 2: Reports of psychotic symptoms, including Hallucinations, Delusions of grandeur, Thought disorder, Loss of appetite (note: patient’s prior history of hypophagia not reported), Inability to sleep (note: patient’s prior history of insomnia not reported) / MH, PH/MH, PH/MH, MH, PH/MH, PH/MH / specific type not reported / Case 1: symptoms reported after a 7-day intensive meditation retreat where it was suggested that one “…meditate all the time” (p 926); Case 2: symptoms reported after 3 consecutive nights of walking meditation throughout the night.

French et al79: single case study / • Feelings of anxiety, Feelings of intense dysphoria, Feelings of mania, including/euphoria/grandiosity, Reports of psychosis-like behavior / MH, MH, MH, MH / TM / Individual practice (daily frequency/ duration not reported)

Jaseja51: review / • Increased epileptogenisis susceptibility / PH / Various methods / This is a theory paper reporting EEG and neurochemical meditation effects.

Kennedy80: multiple case study / • Case 1: Reports of depersonalization and derealization, including Autoscopy, Double vision, Grandiosity/elation; Case 2: Reports of depersonalization and derealization, Feelings of anxiety / MH, MH / MM / Two cases with individual practices. Case 1: meditation described as awareness training and yoga (daily frequency/ duration not reported); Case 2: regular Arica practiceb (reports practice on most days of the week for an unspecified duration)

Lazarus81: multiple case summary / • Feelings of depression, including Attempted suicide following a weekend training course in TM (note: details of the attempt and patient’s history of prior suicide attempts not reported), Feelings of anxiety, including Tension, Restlessness/extreme agitation, Reports of severe depersonalization / MH, MH, MH, PH / TM / The author summarizes a collection of clinical observations precipitated by individual TM practice (daily frequency/duration not reported).

Persinger49: single case study / EEG revealed focal, temporal lobe, epileptic-like electrical changes recorded after 19 minutes of TM. / PH / TM / 10-year TM veteran observed during a 30-minute session

Persinger82: survey study / Significantly more complex partial epileptic-like signs (ascertained from an author generated inventoryc) observed in meditators compared to nonmeditators./ PH / TM / 1081 university students were surveyed; 221 of those surveyed were experienced meditators

Sethi and Bhargava 83: multiple case study / • Case 1: Reports of psychosis, including Delusions of persecutions/reference, Auditory hallucinations; • Case 2: Reports of religious delusions / MH, MH/SH / Type not specified / Case 1 participated in 4 days of intensive meditation in isolation; Case 2 participated in a 6-day residential retreat

Shapiro38: secondary analysis on a convenience sample / • Feelings of depression, including Decreased life motivation/boredom, Increased negativity/self-judgment, Feelings of anxiety, including Panic and/or tension, Feelings of dissociation, including Disorientation/confusion, Feelings of meditation “addiction”, Reports of pain / MH, MH, MH, MH, PH / Vipassana / Residential retreat; 2-week or 3-month duration with formal practice occurring a minimum of 10 hours/day.

VanderKooi84: multiple case study / • Case 1: Report of psychotic break with Hallucinations, Religious delusions; • Case 2: Report of psychosis, including Hallucinations, Intense fear and loneliness; • Case 3: Report of psychosis, including Hallucinations, Religious delusions / MH/SH, MH, MH/SH / Zen, TM, MM / Three cases of psychosis following residential retreats. Case 1: 7-day Zen retreat, Case 2: 10-day Theravada retreat, Case 3: weekend MM retreat.

Yorston85: single case study / • Feelings of mania, including Increased talkativeness, Overactivity/restlessness, Distractible, Sexual disinhibition, Reports of psychotic symptoms, including Thought disorder with flight of ideas, Grandiose delusions, Insomnia involving 5-days of reported sleeplessness (note: prior history of insomnia not reported). / MH, MH / Yoga and Zen (Sesshin) meditation / Yoga was described as a weekend class. Sesshin was described as an intensive weekend event. The patient also participated in a 2-month Zen Buddhist retreat (frequency/duration of daily practice not reported).

*MH=Mental Health, MM=Mindfulness Meditation, PH=Physical Health, SH=Spiritual Health, TM=Transcendental Meditation

aSymptoms for the third case are not reported due to the presence of a known psychotic illness prior to the meditation course. bArica is a multifaceted practice involving kath-channel breathing, mantrams, and yantras (see: http://www.arica.org for more information). cThe Personal Philosophy Inventory47,80 assesses 13 clusters of complex partial epileptic items, which identify temporal lobe phenomenology. In addition to the specific references listed, this table was compiled from the review articles of Arias et al68; Perez-De-Albeniz and Holmes36; Melbourne Academic Mindfulness Interest Group44; Lansky & St. Louis.48


As depicted in Figure 1, if the purpose of the study is to improve symptoms for a clinically diagnosed condition such as PTSD, then the study is classified as a clinical intervention. We posit that it is highly unlikely that such studies would receive Institutional Review Board (IRB) approval or extramural funding without the necessary safety precaution of including a clinician trained to treat PTSD on the research team; this is due to the fact that PTSD is an absolute contraindication under such circumstances. This is not to say that MM interventions for PTSD should not be performed. Support for the contrary comes from reports of beneficial findings from empirically validated treatments for trauma and PTSD that include a MM component.42 We address further positive MM outcomes in our discussion.

If, however, the purpose of the study is to investigate the effects of MM on a subclinical outcome (ie, not a diagnosable condition/illness) or to test an explanatory model (eg, a test of MM mechanisms of action), then including someone with PTSD in this example becomes a relative contraindication and screening at the outset of the study would assess inclusion: Basically, if conditions are met to provide adequate participant safety, such as inclusion of a trained clinician on the research team and obtaining informed consent, then inviting that participant to join the study may be appropriate if he or she meets all other inclusion criteria. For the researcher interested in exploring MM effects who is not clinically trained and does not have a member of their research team who is, we offer another option in our screening protocol (Figure 1) that will provide increased safety for potential participants. The option is to omit participants with mental health concerns such as PTSD in this example.

Image
Figure 1. Sample Screener Schematic for Posttraumatic Stress Disorder as an Example of a Mental Health Consideration for Studies of Mindfulness Meditation Effects

Finally, including a clinically trained person on the research team or having such a person available for consultation and referral throughout the duration of the study may achieve maximum safety in MM research. For each of the mental health consequences listed in Table 1, a screener schematic similar to Figure 1 could easily be generated by replacing PTSD with each condition of concern.

For example, another primary mental health concern associated with meditation as reported in the literature is temporary depersonalization, or feelings of being detached from one’s mental processes or body. Certain types of meditation (eg, concentration practices like TM) have been found to induce depersonalization, possibly due to the related sensory deprivation. 43 Shapiro38 reports on 2 incidences (i.e., 7% of the sample studied) in which attendees at Vipassana retreats experienced severe enough symptoms that they stopped meditating. One had practiced 2 years or less prior to attending a 10-day retreat, which left him “totally disoriented. . .confused, spaced out”38. The other had 7 years or more of practice experience prior to attending a 3-month retreat. In a narrative he provided to the researcher he wrote “the mind set values that the retreat cultivated felt out of sync with the world. [Symptoms included]. . .lots of depression, confusion…severe shaking and energy releasing”38. Still, a recent study by Michal et al44 found an inverse relationship between mindfulness, which was operationally defined by self-reports using the Mindful Attention and Awareness Scale and depersonalization. It is unclear whether this association would generalize to interventions that involve MM practice. Until such time as empirical evidence is available, we offer our screener schematic to guide researchers in assessing contraindication status associated with depersonalization.

Another primary adverse effect within this mental health category is psychosis, which represents a loss of contact with reality and is characterized by the presence of symptoms including delusions, hallucinations, disorganized speech, and/or disorganized behavior.38 The sensory deprivation and lack of sleep that are sometimes associated with intensive meditation practice may serve as triggers for psychotic episodes among those who are predisposed to such a condition. As can be seen in Table 1, several case reports of psychotic episodes precipitated by meditation exist in the literature. While this may be attributed to meditation intensity, such as participation in residential retreats, the limited and preliminary nature of this evidence warrants a cautious approach to using meditation with individuals predisposed to psychosis. Cautions seem particularly important for individuals with acute psychosis, mania, or suicidality and those noncompliant with prescribed antipsychotic medications. For example, as detailed in Table 1, most reported instances of postmeditation psychosis followed very intensive meditation practices. 36, 83,85 The one report of attempted suicide following an intensive TM training course81 presented in Table 1 is hard to interpret given that the details of the attempt and the patient’s history of prior suicidal attempts are not reported. Thus, the conservative approach to protecting research participants would be to adjust the screener schematic we provide in Figure 1 to assess acute psychosis, mania, or suicidality so that the contraindication status of such individuals can easily be determined.

If proposed study outcomes do not include assessment of mental health, the general consensus among MM investigators is to still screen for mental health concerns as precautions.45 However, we must underscore that no standard exists for this practice nor do all empirical reports published provide details on this screening, leaving open the possibility that an investigator new to this field of research may fail to exercise such precautions. In addition, the means by which researchers determine the current and/or past mental health status of potential research participants is with structured psychiatric interviews. There are a few types of structured interviews available for research purposes such as the Composite International Diagnostic Inventory.46 Interviewer training is a prerequisite to use, in part, because the administration of these interviews is potentially harmful to respondents in and of themselves. For example, to screen for clinical levels of anxiety, participants are asked to recall stressful or potentially traumatic events, and these recollections may produce negative emotional reactions symptomatic of the anxiety condition. As we propose in our screener schematic, adding appropriately trained clinical professionals to the research team would improve participant safety.

Category 2: Physical Health Considerations

As reported in Table 1, adverse effects on physical health are the next most frequently reported negative consequence of meditation; these involve neurological and somatic problems. Based on the extant literature, the neurological concern surrounding meditation is increased epileptogenesis (ie, risk of seizures). Seizures are sudden disruptions in the brain’s electrical activity that give rise to altered consciousness and/or behaviors. Epilepsy is the clinical diagnosis for a condition characterized by recurrent seizures. According to the Epilepsy Foundation of America, more than 3 million Americans suffer from seizure disorders, and it is estimated that 6% of the US population will experience a seizure in their lifetime.47 While often scary to observers, most seizures are not life threatening. Conversely, status epilepticus, or longlasting/ continuous seizure, causes unconsciousness and respiratory distress.48 Moreover, the burden associated with a seizure occurrence extends beyond the actual event in terms of lifestyle limitations (eg, loss of driving privileges).

As reported in Table 1, occurrences of seizures during meditation exist.49,50 An emergent body of literature evinces electroencephalographic (EEG) alterations from meditation including MM. According to Jaseja, meditation-induced neuronal hypersynchrony and neurochemical increases in glutamate and serotonin may decrease the seizure threshold.51 Given that increased cortical gamma wave synchrony has recently been observed during MM in both experienced practitioners52 and meditation novices,5 screening for seizure history in potential MM research participants is warranted to maximize participant safety. Furthermore, the work of Jha et al53 reveals that subsystems of attention including focusing components are implicated in MM. This is noteworthy given that focused attention is epileptogenic54- 56 and is listed by the Epilepsy Foundation of America as a seizure trigger.57

Therefore in Figure 2, we provide a screener schematic for this neurological concern in adults as an example for the physical health considerations category. In instances where the research question involves the use of MM therapeutically for epilepsy, we label this as a neurology study, which would be performed under the care of a physician.

Based on the evidence referenced in Table 1, another physical health consideration with meditation is somatic discomfort or pain. In the manualized mindfulness-based therapies previously mentioned (eg, MBSR), consideration of discomfort is addressed by providing postural options for MM practitioners (eg, the use of a chair rather than sitting on the floor). Furthermore, some forms of MM involve physical activity (eg, walking meditation) that prevents the muscle/joint strain of maintaining a single posture during a MM session. Yet some scholars have begun to consider the need to deconstruct mindfulness-based therapy options in order to systematically investigate efficacy-effectiveness and explanatory models of the meditation components.41 With this movement, new considerations for participant safety are warranted. If, for example, a researcher wishes to systematically investigate the effects of a body-scan form of MM compared to Hatha yoga (a movement form of MM) on an outcome, kinesthetic concerns arise warranting participant screening for neuromuscular/joint-related illnesses negatively affected by maintaining a particular posture through the duration of a MM session.

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Figure 2. Sample Screener Schematic for Seizure Disorder/Epilepsy as an Example of a Physical Health Consideration for Studies of Mindfulness Meditation Effects in an Adult Sample

One such neuromuscular/joint-related illness is arthritis, a collective term used to label painful joint diseases. Common forms include rheumatoid arthritis, an autoimmune disease causing chronic pain, inflammation, and stiffness in several joints: and osteoarthritis, which is due to a loss of cartilage between joint bones typically affecting fewer joints more intermittently than the rheumatoid form. Immobility exacerbates both forms of arthritis, while moderate-intensity exercise is associated with symptom improvements.58,59

Sedentary MM results in joints being held in a certain position for up to 30 minutes or more. This may result in uncomfortable kinesthetic sensations (Table 1) from inactivity or fatigue of postural muscles if a certain posture is held for the duration of the practice. This type of discomfort is exacerbated in persons with arthritis,60 so to provide maximum safety for arthritic research participants active forms of MM (eg, walking) are advised. However, if the research goal is to test sedentary MM effects on some other outcome than arthritis symptoms, arthritis should be treated as a relative contraindication and would follow that pathway for screening in our Figure 2 schematic.

As also pointed out in Table 1, physical health concerns included loss of appetite, reduced food intake, and difficulty sleeping. These findings must be interpreted with caution as the reporting authors cited in Table 1 do not provide information on participants’ prior history with hypophagia or insomnia. Moreover, such side effects may not be adverse events. For example, hypophagia may be health promoting if it is the result of reduced anxiety leading to reductions in stress-induced eating.
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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Wed Feb 13, 2019 10:05 pm

Part 2 of 2

Category 3: Spiritual Health Considerations

In Table 1, we also reference studies in which negative consequences to spiritual health, specifically cases of religious delusions, have been reported. Spirituality can be defined as the subjective dimension of religious experience.61,62 As a measurable construct, spirituality is multifaceted with components, including a search for truth and meaning in life with some level of transcendence and personal transformation.63 Spiritual wellbeing has been operationally defined as one’s overall sense of life purpose and satisfaction and one’s sense of well-being in relationship to God or other deity.64 This interconnection between religious and existential well-being encompassing one’s spiritual health may serve as a point of concern in MM research given the references to religious delusions we include in Table 1.

Protection from harm in this category is not a matter of screening per se; rather, it involves obtaining informed consent. For example, to adequately inform participants of their involvement in a study where they will engage in MM, the meditative components would be disclosed and questions regarding meditation are likely. Therefore, initially, it may be necessary to discuss with participants any negative associations of MM borne out of misunderstandings from history in an effort to abate any fears participants may have of violating their own foundational religious tenants by engaging in meditation. Briefly, MM practices are deeply rooted in the Buddhist tradition and are practiced in Buddhist monasteries throughout Southeast Asia. It was to these monasteries that Westerners began to travel to in the 1960s and 1970s specifically to learn to meditate. Some of these Western practitioners returned to the United States and pursued careers in psychology and medicine, and out of this fusion of Eastern and Western practices, the mindfulness tradition was acculturated.65,66 What may still linger in laymen’s thinking are the associations of MM with the 1960s and the monastic lifestyle, which in Western culture may carry certain stereotypes and expectations. While researchers could point out that traditions other than Buddhism, such as Hinduism and Christianity, recommend meditation to their followers or incorporate meditation as a form of worship (ie, TM or centering prayer, respectively), further elaboration will require education on the part of the researcher. Therefore, there is no clear-cut schematic we can offer researchers to address these spiritual concerns. Instead, to maximally protect participants by facilitating the acquisition of informed consent, MM specific education would be helpful.

It may also be necessary on occasion to address unrealistically positive associations or expectations associated with meditation, such as the attainment of blissful states or an escape from one’s day-to-day experience. Although MM practices may lead to states of peacefulness and deep relaxation, these expectations are secondary to the goals of the MM, which are to encourage nonjudgmental openness and awareness of all phenomena, including those that are challenging or unpleasant. Thus, an understanding of these goals is extremely helpful in clarifying misconceptions. In Table 2, we provide the type, source, and contact information for numerous educational opportunities in MM. Even a trained clinician or other healthcare provider may lack the ability to address participants’ questions regarding the spiritual nature of MM if their training did not include such study. We are not suggesting that knowledge of the dogma of all religious practices is necessary, rather the simple understanding of how MM differs from or compliments other techniques and practices would allow one to address concerns that may preclude garnering informed consent.

Another issue related to research safety, and one that is actively being debated among MM experts, is MM training for researchers. Although the general consensus is that training is needed, no standard exists.45 In Table 2, we provide researchers with numerous training options. Formal training exists for the few mindfulness-based interventions developed thus far. For example, clinically-oriented researchers interested in investigating the effects of a mindfulness-based approach to preventing relapse related to depression or substance use have available to them course options for in-depth training in these therapeutic approaches (MBCT31,32 and MBRP,29,30 respectively). For researchers investigating MM effects using methods other than the formal mindfulness-based interventions, we list online courses and resources for informal training (Table 2).

Table 2. Sources for Mindfulness Training

Type / Source / Web Address

Formal Training* / -- / --


MBSR / --Center for Mindfulness in Medicine, Healthcare, and Society, University of Massachusetts Medical School (Jon Kabat-Zinn and Saki Santorelli) / http://www.umassmed.edu/cfm/index.aspx

MBCT / University of Toronto, Department of Psychiatry; University of Oxford, Department of Psychiatry (Zindel Segal, Mark Williams and John Teasdale) / http://www.mbct.com

MBRP / Addictive Behavior Research Center, University of Washington, Department of Psychology (G. Alan Marlatt) / http://depts.washington.edu/ abrc/MBRP.htm

MB-EAT / The Center for Mindful Eating, Indiana State University, Center for the Study of Health, Religion and Spirituality (Jean Kristellar) / http://www.tcme.org

MB-CP / The Professional Development and Teacher Training Program at The University of California San Francisco Osher Center for Integrative Medicine / http://www.osher.ucsf.edu

Informal Training Available Online / -- / --

eMindful.com / -- / http://www.emindful.com

Mindful Healing Series / -- / http://www.aliveworld.com

Dharmaweb / -- / http://www.dharmaweb.org

Other Organizations That Offer Seminars/Educational Opportunities

Insight Mediation Society / -- / http://www.dharma.org

Mind and Life Institute / -- / http://www.mindandlife.org

Dharma Ocean Foundation / -- / http://www.dharmaocean.org

Mindful Awareness Research Center / UCLA Semel Institute / http://marc.ucla.edu/

Omega / Institute for Holistic Studies / http://www.eomega.org

Mindsight Institute / Dan Siegel / http://mindsightinstitute.com

Other Organizations That Offer Residential Retreats

Plum Village Practice Center / Thich Nhat Hanh / http://www.plumvillage.org

Spirit Rock / Founded by Dharma Foundation / http://www.spiritrock.org

Shambhala Mountain Center / Founded by Chögyam Trungpa Rinpoche / http://www.shambhalamountain.org

Common Ground Meditation Center / Mark Nunburg / http://www.commongroundmeditation.org

ART / Awareness and Relaxation Training / http://www.mindfulnessprograms.com

Hollyhock / -- / http://www.hollyhock.ca/cms

Dharma Ocean Retreat Center / Reggie Ray / http://www.dharmaocean.org

Santa Barbara Institute for Consciousness Studies / B. Alan Wallace / http://www.sbinstitute.com

Other Resources

The Meditation Spot / Contains numerous resource links / http://www.aboutmeditation.com

The Institute for Meditation and Psychotherapy / -- / http://www.meditationandpsychotherapy.org

*MBSR=Mindfulness-based stress reduction, MBCT=Mindfulness-based cognitive therapy, MBRP=Mindfulness-based relapse prevention,M B-EAT=Mindfulness-based eating awareness training, MB-CP=Mindfulness-based Childbirth and Parenting, ART=awareness and relaxation training, UCLA=University of California, Los Angeles.


We stress again, that currently no prerequisite training standard for researchers exists. As such, MM interventions may be taught and investigated by well-intentioned but inadequately trained researchers creating another safety issue: iatrogenic harm. Another option for researchers interested in investigating the effects of MM but lacking the personal skills and expertise required to conduct these interventions is to hire an MM expert who can both deliver the intervention and guide the researcher in development and execution of the research protocol.

And finally, related to the subject of training is the issue of self-practice. While the popular opinion is that maintaining a MM practice is a necessary first step towards credible and safe MM instruction,45 again, no standard for this exists. We suggest that just as it would be unrealistic to expect someone who had never exercised before to have the cardiorespiratory endurance, physical strength, and simple know-how to instruct a group exercise class, it is also unrealistic for someone with no meditation experience to have the mental endurance, flexibility, and ability to model MM for research participants. In the Buddhist tradition, MM teachers were seen as experienced guides escorting individuals on a deep inward journey.67(p74) Keeping with this tradition then, if a MM researcher plans to conduct a research study without the guidance and support of an MM expert and has not visited this territory before, his or her ability to safely guide a research participant will be limited. The mindfulness-based interventions listed in Table 2 all consider modeling an attitude of openness and nonjudgement to be a foundational skill to teaching MM; these are skills that come from personal practice. Further, MM essentially involves private experience, and it is therefore quite difficult, if not impossible, to understand unless one has done it oneself. Therefore, an inexperienced researcher may be unable to answer participant questions, again preventing the acquisition of informed consent. Therefore in Table 2, we offer numerous resources to assist researchers in developing their own self-practice.

Furthermore, we suggest that those new to MM consult with a more experienced practitioner. Interestingly, this is how the practice of MM was shared historically within the Theravada tradition. Theravada means “way of the elders.” This tradition stresses the importance of passing foundational teachings along generational lines. The elders shared the guidelines regarding the training of teachers and students and the standards of safety built into this type of training. More advanced practitioners have years of personal experience from their own practice and instruction to draw upon in teaching novices. This leadership can help novices deal with their own insecurities or perceived barriers to MM such as feelings of skepticism, embarrassment, and self-judgment while offering tools to guide them on their paths.68 While it appears that rich training from spiritual teachers has informed a few of the developers of mindfulness-based methods (eg, in Coming to Our Senses, Jon Kabat-Zinn writes of his studies with Zen master Seung Sahn,69 and Alan Marlatt writes of numerous spiritual teachers including Pema Chödron in his Personal Journey68), this practice does not appear customary among MM researchers, which is curious given how common consulting and interdisciplinary collaboration has become in scholarly activities.

DISCUSSION

Our purpose was to address issues of participant screening, research safety, and researcher training in the MM field of study; it was not to evaluate the validity of reported adverse events in the studies cited. Rather, the studies cited herein were used for the purposes of creating guidelines and assessing potential areas of difficulty. We summarize research that supports 3 categories of health-related concerns that may be negatively affected by MM, namely, physical, mental, and spiritual health considerations. Drawing upon the extant literature, we provide examples of risks within each of these categories, and we provide step-by-step participant screening schematics or offer research safety procedures applicable to MM research. Given that no standard for prerequisite training or self-practice exists for MM researchers we provide many resources for MM training and education in an effort to reduce iatrogenic harm.

We recognize that limitations to safety assertions exist at this time. For example, the majority of the reports cited in Table 1 are case studies or secondary analyses reporting adverse effects in a post-hoc fashion. For example, the cited case reports of psychotic episodes precipitated by meditation occurred in participants attending intensive meditation retreats rather than brief mindfulness interventions.70 These retreats are not only rigorous in the intensity and duration of meditation practiced, but any adverse effects of MM are confounded by factors such as sensory deprivation, loss of sleep, and fasting, all of which may serve as precipitants for a psychotic episode. Thus, it is difficult to interpret the direct nature of the relationship between meditation and adverse outcomes based on these and similar reports.

The greatest limitation lies in the simple impracticability of directly and systematically investigating meditation-induced harm. Thus, as we posited earlier, a cautious approach to using meditation in research is warranted in the face of the limited and preliminary nature of current evidence in order to maximize participant safety.

It is important to note that MM practice is different from interventions such as MBSR that includes MM practices along with a discussion of the effects of stress or MBCT that is an integration of MM with cognitive-behavioral exercises and activities. However, the practices included in these interventions are traditional MM practices (eg, body scan, sitting meditation). Further, these practices are at the core of these programs and designate these programs as being “mindfulness-based.” Thus, it is our opinion that the considerations that exist for these interventions should be the same as those that exist for other MM practices.

As a show of our strong support for clinical investigations of MM therapeutic effects, we point out that an emergent body of research suggests therapeutic benefits for some of the risks we have listed here. To date, research evinces benefits from mindfulness-based interventions for several mental illnesses, including mood,71 psychotic,72 and anxiety disorders24 as well as prenatal stress and depression.73 Similarly, therapeutic benefits from mindfulness-based interventions exist for physical ailments including neuromuscular disorders,74,75 chronic pain10,76 and neurological conditions.77,78 Again we underscore that these clinical interventions are being carried out by those with specific training aimed at protecting the patients they serve. Furthermore, administrators of some mindfulness-based interventions (eg, MBSR), require that patients receive a complete medical examination prior to participating in the program.28 Yet it is because of our support for and our active involvement in MM research that we recognize a lack of reporting of safeguards. In this paper, we summarize research safety concerns, offer participant screening guidelines, and provide information on MM training and education, in an effort to reach the scientific community-at-large. For it remains of utmost importance that scholars protect research participants, especially those who belong to high-risk/special populations, by appropriately assessing risk and determining contraindication status until such time as empirical evidence proves the safe inclusion of all persons in general MM research.

_______________

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Re: Mindfulness Meditation Research: Issues of Participant S

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Depersonalization and Meditation
by Richard J. Castillo
Castillo, Richard J Psychiatry; May 1, 1990; 53, 2; ProQuest pg. 158
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PSYCHIATRY, Vol. 53, May 1990

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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.

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).

MEDITATION AND DEAUTOMATIZATION

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).

DEPERSONALIZATION, MEDITATION, AND ANXIETY

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.

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.

INTERVIEWS WITH MEDITATORS

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.

DEPERSONALIZATION AND MEDITATION

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).

CONCLUSION

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.

_______________

REFERENCES

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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.

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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.
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Re: Mindfulness Meditation Research: Issues of Participant S

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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  

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Abstract

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 REPORTS

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.

DISCUSSION

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).

Image
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.

SUMMARY

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.

REFERENCES

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.
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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.

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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.

CASE REPORT

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."

Image
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."

Image
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.

DISCUSSION

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.

_______________

Notes:

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.

REFERENCES

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.
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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.

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Summary

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.

Introduction

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].

Conclusion

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.
_______________

Notes:

* 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

References

[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.
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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.

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Summary.

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.

_______________

Notes:

1 Cited with permission from the manuscript of the book.

REFERENCES

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.
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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

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Summary

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.

METHODS AND RESULTS

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.

Image
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.

Image
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.

Image
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.

Image
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.

Image
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.

DISCUSSION

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.

_______________

Notes:

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

REFERENCES

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.
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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  

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YOU ARE REQUIRED TO READ THE COPYRIGHT NOTICE AT THIS LINK BEFORE YOU READ THE FOLLOWING WORK, THAT IS AVAILABLE SOLELY FOR PRIVATE STUDY, SCHOLARSHIP OR RESEARCH PURSUANT TO 17 U.S.C. SECTION 107 AND 108. IN THE EVENT THAT THE LIBRARY DETERMINES THAT UNLAWFUL COPYING OF THIS WORK HAS OCCURRED, THE LIBRARY HAS THE RIGHT TO BLOCK THE I.P. ADDRESS AT WHICH THE UNLAWFUL COPYING APPEARED TO HAVE OCCURRED. THANK YOU FOR RESPECTING THE RIGHTS OF COPYRIGHT OWNERS.


Summary

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.

_______________

Notes:

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

REFERENCES

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.
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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.

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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].

_______________

References

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.
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