For mindful teaching of mindfulness – The Psychologist

This letter was written by colleagues in response to my recent interview with Jon Kabat-Zinn. The letter has just been published in The Psychologist. For mindful teaching of mindfulness – The Psychologist.

Can Mindfulness Meditation Induce Psychotic Episodes?

Can Mindfulness Meditation Induce Psychotic Episodes?

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

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

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

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

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

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

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

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

Ven Edo Shonin & Ven William Van Gordon

 

References

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