discussing the dark side of mindfulness

The following discussion outlines my thoughts about an article a couple of friends told me about, published in The Atlantic Monthly. Entitled The Dark Side of Mindfulness, by Olga Khazan, it talks about problems people experience with meditation. The article covers a few distinct categories of difficulty.

Most worrisom are episodes of psychosis seemingly triggered by mindfulness. My guess is that most of the people who become psychotic on retreats or after starting meditation have identifiable pre-existing risk factors. Schizophrenia's onset is typically from late adolescence through early adulthood. So when young people go on intensive retreats and experience psychotic symptoms, there’s a good chance that they were on the verge of schizophrenia beforehand, and the retreats pushed them over the edge. Often people who are destined to suffer from schizophrenia first experience detachment and interpersonal difficulties, probably because they are already becoming a little atypical. The sense that something is going wrong may, in some cases, motivate turning to meditation for help. Any talk of psychosis resulting from mindfulness thus ought to specify the ages of those who experience it, as well as what happened afterward. If the subjects go on to a verified diagnosis of schizophrenia, there’s a good chance that was destined to happen anyway. The article doesn't give enough information for me to be sure, but my guess is that many who experienced psysosis were already at risk. 

Even so, some people can experience psychosis for the first time later in life. My own first episode happened at age 41, during a time of severe stress. My second (and last) happened a decade later. Much milder and without significant effect on my life, it also happened during a time of high stress. Now, in my case, both took the form of spiritual visions and realizations, so I didn't experience them as unwanted. Yet these conditions are highly unstable and can truly be alarming, both for the person going through them and those nearby. My own experience confirms it's conceivable that someone who’d never been psychotic and didn't have obvious risk factors could experience an episode as a consequence of meditation, especially if it was intensive—in other words, stressful. The point is probably that meditation teachers, and especially those who lead retreats, should be trained to recognize psychotic symptoms and deal with them appropriately, by curtailing the person’s meditation and referring to professionals. Leading retreats is a huge responsibility, in part because serious mental health problems can intrude. 

I’ve never led a long or intensive retreat, but even in daylong events attendees have (rarely) needed help with strong experiences, such as dissociation or agitation. Which brings up a second category: symptoms like panic attacks, derealization, etc. The fact I’ve seen this myself despite a gentle teaching style suggests it’s not that uncommon and doesn’t require intense practice. So far, the people who've experienced these issues these issues have been easy to help. Yet it’s possible that someday something I can’t handle will come up, and it’s also possible that people have had problems during and after my programs that I never heard about. Humility and preparedness are in order.

Obviously, I am pro-meditation. But I never say it’s the answer for everyone, and I always suggest caution. Especially if there’s a history of major trauma or serious mental illness, I advise dovetailing meditation with counseling, unless a lot of healing work has already been done. Of course, I don't always hear about attendees histories of trauma and mental illness, which is part of my rationale for keeping my teaching low key. Most of these issues become more of a risk as the practice becames more intensive. Still, because they can happen without too much intensity, being able to recognize and manage them (enough to stabilize the person and refer for appropriate help) should be a skill every teacher possesses.

I agree with the person quoted in the article who pointed out that any modality (medication, meditation, or whatever) powerful enough to make a  positive difference is powerful enough to cause adverse effects. Thus appropriate caution and a low threshold for backing off are needed. It seems like very poor advice to tell someone who feels serious distress to simply keep pushing. Better counseling would be: take a break! And if you get to the point where you’re ready to try again, also be ready to stop again.

For me, the most interesting issue in the article is mentioned only in passing. And that’s that meditation practices were developed as part of larger religious systems (Buddhism, Hinduism, etc). Those systems were never meant to optimize a person’s ability to function as a conventional, worldly worker. In fact, they often encourage withdrawal from conventional life. They foster values of harmony, non-striving, softening of egoism, reducing self-focus, etc. Thus, decreased sleep is considered a good thing, because practice is seen as more important. There isn’t a concern that lack of sleep will make one tired or less effective in the workplace. I know a few monastics, and none of them sleep more than six hours a night, because they go to bed at 10 and get up at 4 to meditate. As another example, within many contemplative traditions, softening our sense of individuality, our selfhood, is considered an important step toward spiritual maturity. Yet in the article it's presented as one of the problems mindfulness can cause (even as its desirability within Buddhism is acknowledged). The same is true of shifting our motivation away from personal aggrandizement toward selfless service, or undercutting our drive for accumulation in favor of renunciation. Those changes sounds pretty good to me now, after everything I've been through. But they would have been disruptive to me in an earlier stage of life, and they won't be desired by the average working American. Relaxation? Yes! Egolessness, simplicity, and collapse of old motivations with construction of new ones? No!

For the average person trying to survive in the workaday world, meditation often can help with stress and its many symptoms. But followed far enough, it will start to call into question much of what society considers sacred: wealth, power, achievement, looks, pleasure-seeking, possessions, status, competing, etc. These are, in fact, the sources of much of our stress. Is losing faith in them an adverse consequence? I don’t find it so, but many would, at least until they learn the value of letting them go.

Similarly, in many traditions feeling powerful currents of energy and experiencing bodily contortions that move them along are considered signs of progress.  Are ordinary Westerners likely to see them that way? In many cases such experiences will only seem frightening. These sorts of issues are not adverse effects in their original religious context, though they may require care to navigate. They’re recognized and seen as steps on the path. Yet for folks dealing with the stress of modern life and just wanting relief, they’re not going to be appreciated. In other words, meditation is doing what it has always been known to do, but we don't want what it does. We want to go so far and no farther. Knowing when to stop to avoide these effects is not so easy, especially if they aren’t talked about up front. 

A final issue worth discussing has to do with how meditation is taught. A lot of meditation instruction strikes me as excessively mental (though thankfully this is changing). There’s often a focus on the possibility of altered mental states. This feeds the same fascination that makes psychedelics enticing. Powerful states can and do happen, and they have true value. But if one is too focused on mental experience, however transcendent, it can lead to dissociation/derealization. It can even encourage a kind of moral detachment and loss of empathy. Better rounded instruction will include careful attention to bodily experiences, with compassion for emotions, all mindfully tracked with breaks as needed to avoid overwhelm and flooding. It will also be paired with deliberate cultivation of empathy and morality, with an emphasis on common humanity and non-harming. If the instruction focuses only or primarily on concentration, without care to nourish the heart, the result can be a concentrated but disconnected mind. Some of the symptoms the article describes sound like that to me.

Well, there’s a lot more I could say, I’m realizing. Overall, I liked the article and don’t have any argument with the problems it describes. Some seem like the result of bad timing—someone meditating when they’re approaching schizophrenia or someone meditating without first working through severe trauma issues. Others seem the result of suboptimal teaching, such as 1) pushing struggling students to keep meditating when better advice would be to back off, switch to movement practice, or seek other ways to curtail excessive distress; or 2) Emphasizing heady concentration practices without a complement of heart-opening and ethical guidance. And some seem like natural and expected consequences of dedicated practice, but happening in a culture that pathologizes spiritual experiences and values.

I like the way the author ended with a nod toward Buddhism’s Middle Way. That seems like good advice. It’s also worth questioning whether the tremendous amount of marketing around mindfulness is in society’s best interest. In the East, these practices were historically taught for no charge, with the option (and cultural expectation) of offering donations to the monks or teachers. The idea that teachers will be mercantile, competing for market share, is another way the practice has been removed from its healthiest context, from the ecosystem in which it evolved. Mindfulness wasn't designed to be a product or to make humans more productive. Quite the opposite. The fact we are seeing problems is, from this perspective, unsurprising.