When meditation goes wrong: part one

The popular rise of meditation

0:00ABC Listen. Podcasts, radio, news, music, and more.

0:07This will had come about in the most suspicious circumstances you could possibly imagine. Who gets what when someone dies, and who decides? The difficulty with undue influence often is proving it. Join me, Damien Carrick, for the Law Report special series on wills, Over My Dead Body. The person felt like they had no option, but it's difficult to prove that. To hear, search for The Law Report and look out for Over My Dead Body. Find it on ABC Listen or wherever you get your podcasts.

0:41Over the past decade, meditation and mindfulness have been promoted to reduce stress and anxiety and increase relaxation. Meditation and mindfulness, those are two things that, from what we understand, can really help us during very stressful moments, during this unprecedented times that we are living through right now. Improved sleep and concentration. Meditation is something more people are including in their daily routines, and we're actually learning now that the benefits go far beyond just keeping us calm.

1:12Which we need that too. From the outside, it can feel like meditation is a fix for a lot of life's biggest challenges. GPs recommend it. Corporate companies, schools, prisons, and universities have dedicated meditation programs. And the advice has been taken. For example, in the U.S., in the past two decades, meditation practice has doubled. But what if for some people, meditation can be harmful? I spent my first 20 years of meditation research promoting it, promoting the benefits,

1:48stating that there were no adverse effects, even though I never measured them. I did all the things that all the other researchers probably still do. That really didn't help the field at all and really kind of hid the fact that there are some downsides. In best practice and any kind of care for another person, you typically provide informed consent. And I think we have a similar obligation in meditation, such that those individuals have the ability to make an educated, informed decision as to whether they feel the possible benefits

2:22outweigh the possible harms or risks. I think the tradition has known about the potential for negative side effects or dangers of spiritual practice. The tradition has known about this really since the beginning.

Uncovering the downsides

2:37From ABC Radio National, this is All in the Mind with me, Sana Khadar. Today, the story of meditation that rarely gets told. And how one person went from being an evangelical mindfulness meditator to a leading researcher on the adverse effects of meditation.

2:57Science reporter Fiona Pepper is in the studio for this one. Hi, Fee. Hi, Sana. I have a confession to make. I'm a failed meditator. I've definitely tried at various times in my life and I've never really managed to do it consistently. And I've definitely struggled to do it at all. I cannot make my mind shut up. What about you, though? Are you into meditation? Yes. Look, not for many, many years now. But that's partly because I was raised in a meditating household, I suppose you could describe it as.

3:29My parents, for decades now, have practiced Vipassana meditation. Oh, that's intense. Yeah. So as a kid, it was quite normal for them to disappear on 10-day silent retreats. And we had a meditation room in our house. They have a thing called a group sit on a Sunday morning where a bunch of middle-aged people come over and meditate for 45 minutes. I mean, it sounds lovely. Exactly. So, yeah, growing up, meditation was kind of normal in my household, which is probably unusual for most Australian households.

4:07And that meant that myself and my sisters did attend these 10-day silent retreats. I've heard vaguely of Vipassana, but I've never done it. I don't think I could survive it. But, yeah, tell me what goes on. Yeah, sure. So the first one I did, I was 18 years old, and basically you meditate solidly eight, nine hours a day. And what that involves is you're concentrating on your breath, going in and out of your nose, and you're observing sensations that you might feel.

4:39And the idea is that you observe these sensations. You don't react to them.

4:45And so you said you haven't meditated for a while now. What made you want to look into the adverse effects of meditation? So it was a little while ago I came across the term meditation sickness, and it really jumped out at me because I suppose, you know, growing up meditation, we were around a lot of people who went on these meditation retreats. And anecdotally, people, you know, they might leave a course halfway through, they might talk about, you know, kind of not being the same after doing a meditation retreat.

5:18So this idea of meditation sickness was really quite interesting to me. So I dived into it and came across the work of Dr. Willoughby Britton. When I was in college, a friend of mine committed suicide, a very old childhood friend, and I was really devastated and anxious, and I didn't know what to do.

5:55And I really didn't want to take medication, and so my father sent me a book called A Path with Heart that was by a very famous meditation teacher, Jack Kornfield. And the first half of that book was really just about how to work with difficult thoughts and emotions, and it really just spoke to me. And that book became kind of my Bible for probably the next 10 years. So that's Willoughby Britton. She's an associate professor of psychiatry at Brown University Medical School and the director of the Clinical and Effective Neuroscience Lab.

6:33In her early 20s, that book transformed both Willoughby's personal and professional life. And so yeah, that was my gateway drug. Can I ask what meditation were you practicing? Kind of a range, but I did take the Jon Kabat-Zinn's Mindfulness-Based Stress Reduction. I actually got trained as a teacher in that tradition. So mindfulness, which means a lot of things, but, you know, following your breath, learning how to label thoughts and emotions.

7:06So intense retreats or more kind of daily practice? I mean, more daily practice. I was in graduate school, but I definitely did retreats as well. Then, while at graduate school, for her dissertation, Willoughby looked at the effects of mindfulness meditation on sleep. At that point, I had been meditating, you know, five years and was in that phase where I was extremely enthusiastic. You could call me probably an evangelist. And I was going to prove to everyone that not only was meditation good for sleep, but how it also improved depression.

7:42Because lingering sort of problems with sleep can lead to relapse and depression. And there weren't that many studies that measured sleep in the lab with brainwaves. So I was going to be one of the first to sort of show conclusively in the lab that meditation improved sleep. So after several years and many hundreds of nights of staying up watching people sleep, I got the data back. And it was exactly the opposite of what I thought.

8:15Much to Willoughby's surprise, meditation was actually making people more awake. No matter how I looked at it, if I looked at how fast their brainwaves got, their brainwaves got faster, which means that they were more awake. They had less slow-wave sleep. They had more awakenings. And so in the middle of my quest to prove and promote meditation, I got some, you know, sort of negative results. But at the time, this evangelical meditator wasn't interested in engaging with these results.

8:50My first confession is that I did not publish them. One, I might have done something wrong. And two, it was definitely not promoting the practice, which was kind of what I thought I was doing. Then a couple of years later, a conversation with a meditation teacher started to change the way Willoughby felt about the results from that sleep study. And I mentioned my data, and she kind of chastised me and said, you know, all you psychologists are just trying to make meditation into a relaxation technique.

9:21Everyone knows that if you meditate enough, you stop sleeping. Then, not long after that conversation, Willoughby was doing a clinical residency at Brown University's inpatient psychiatric hospital. And during that one year, there were two meditators that came off retreat who were psychotic. And that seemed like a lot to me in one year. It was like some of the most extreme patients that I saw in that hospital all year, and they were both meditators.

9:51So Willoughby went back to that same teacher to get their advice. And I said, well, have you ever seen this before? And she didn't say anything, but I remember the look on her face was like, oh, yes, this is definitely a thing that she's seen before. And she was really sorry that I asked.

10:11And so that was very shocking to me. And I thought about that a lot and wondered what other assumptions psychologists and other sort of health care providers are making about meditation. And then also, what other information are meditation teachers sitting on that is not getting to the public? From ABC Radio National, you're listening to All in the Mind. I'm Sana Kadar. Today, reporter Fiona Pepper is digging into the untold story of meditation and the adverse effects it can have for some people.

10:48Willoughby's arc is so fascinating, Fiona. And also very interesting how she didn't publish those results initially because they contradicted what she expected. You know, I'm so curious how often that actually happens in research. Oh, absolutely. Because I imagine you research something because you have a natural kind of draw to it. But when the results don't match with your attitude towards that practice, it puts you in a difficult position. Interestingly, though, Willoughby's now considered a world leader in this area, but she is far from the first person to have recognised this issue.

Historical and global perspectives

11:25It was in my second year of med school that I came across a patient. While taking history, we found that he was meditating more than his usual self, like up to six to eight hours a day. That's Pawan Sama. He's an assistant professor in the Department of Psychiatry at the Putnam Academy of Health Sciences School of Medicine in Kathmandu. And I spoke to him from his home. The recording isn't great. Now, because Nepal is considered the home of Buddha and Buddhism, I was keen to hear a non-Western perspective on these potential side effects of meditation.

12:02And Pawan says this patient presented with active schizophrenic symptoms, including delusions and auditory hallucinations. We treated him as like a usual case of schizophrenia. And after that, when he went back to his place and he again started meditating, then he again came back with the symptoms. So we thought that it could be induced by meditation. This encounter left such an impression on Pawan and his team that in 2019, they published a research paper titled Meditation-Induced Psychosis, based on treating that one patient.

12:36Since that initial case, Pawan says... Meditation-induced kind of things are not very common. So we see one or two cases in a year.

12:48As early as 1976, a key figure in the development of cognitive behavioural therapy, Arnold Lazarus, published a paper called Psychiatric Problems Precipitated by Transcendental Meditation. He suggested that indiscriminate meditation could induce depression, agitation, and even schizophrenic decompensation. But the earliest understandings of these potential problems came way before the 1970s.

13:21Yeah, I think the tradition has known about the potential for negative side effects or dangers of spiritual practice. The tradition has known about this really since the beginning. That's Pierre Sargero. He's a professor of Asian history and health humanities at Penn State University. About 20 years ago, when I was working on my dissertation, I came across some writings from about 1,500 years ago that were talking about meditation as a form of healing or as a form of therapy for different kinds of ailments.

13:58And what I noticed, though, was that those texts were also talking about meditation as a source of illness, as a source of both mental and physical problems and conditions. And so that was when I first became aware that this was a thing that was talked about, known about within the Buddhist tradition. Historically, there's even a range of names given to the issue. For example, in Chinese, it's known as... Chan bing, which translates to directly as meditation sickness, is the native term there.

14:31That term in Japanese, the same term is zen byou, and that is often translated into English as zen sickness. Zen just means meditation in Japanese. In sort of the Tibetan world, as well as in Southeast Asia, it's understood through a framework, a medical framework of winds. So it's considered to be a wind disorder. That's one of the common terms that you find across cultures as well. See, that is fascinating for me to hear, because as someone who kind of only really has a pop psychology level understanding of meditation and what it's about and what it can do,

15:11this is really interesting to know that the tradition, it's a known thing that things can go very wrong with meditation. Why hasn't that bubbled up into the pop psychology version of how it's communicated? Why don't people know about this more generally? I mean, I think it counters what we want to think meditation does for us, right? I think the other thing is meditation is like a very solo practice. So it can be hard to know, you know, maybe I'm doing it wrong or, you know, it's, we're all doing it as individuals. But yeah, I found it fascinating speaking to someone like Parwan, who's based in Kathmandu, in Nepal, the home of Buddha, and there's a lack of awareness.

15:49But interestingly, talking to him, if he kind of associates any kind of negative side effects to meditation, there's pushback. And that's relatively common too. It's not necessarily welcome information. Yeah. And I guess, you know, pop psychology generally likes easy fixes as well. The nuance can get lost.

The Varieties of Contemplative Experience

16:12Yeah.

The Varieties of Contemplative Experience

16:13So getting back to Willoughby, Britain, two decades after discovering this issue, she published the first significant research that she had conducted with a team. It took almost 10 years to complete. And it was called the Varieties of Contemplative Experience Study. The team interviewed more than 60 Buddhist meditation practitioners and more than 30 Buddhist meditation teachers about the types of challenges they had experienced personally or observed in their students.

16:48The study then identified what these meditation-related adverse effects could look like. And difficulties with sleep was just one of them. Insomnia is actually one of the most common meditation-related challenges. And so that was a pretty easy one. And that there were even, you know, Buddhist texts that said that a good meditator only sleeps for four hours. It's actually a sign of concentration, which was basically my neurological understanding of why it happens.

17:21Because despite this common belief that meditation has a relaxing effect, Willoughby instead found that meditation can lead to hyperarousal and alertness. But beyond sleep, that Varieties of Contemplative Experience study published back in 2017 identified more than 50 categories of meditation-related challenges across seven different domains. And the key domains identified included somatic, cognitive, perceptual, connitive, sense of self, and social.

17:57So there was a real range of experiences. But generally speaking, these adverse effects fell into two categories of either hypoarousal or hyperarousal responses. Hyperarousal meaning... Anxiety, fear, insomnia, involuntary movements, tics, emotional flooding, like everything that's sort of, you'd call them positive symptoms, meaning that there's something added, there's something extra. In contrast, the hypoarousal symptoms were more along the lines of...

18:32If something's missing or taken away from your normal experience, that's often hypoarousal. So lack of emotions, not having a sense of self, losing your sense of self. Those would be like more on the hypoarousal or dissociation. And Willoughby says these hypo or hyperaroused symptoms impacted people's motivation levels. So people either became super motivated, like, you know, shave your head, go join a monastery, like meditate as many hours as you can a day, or the complete lack of motivation where people like literally stared at a wall for two years and didn't leave their house.

19:13As well as this, Willoughby says she saw many examples of dysregulated arousal where individuals experienced a mix of the hyper and hypoaroused symptoms. Additionally, she treats people with symptoms of psychosis. You know, a much smaller percentage are people that are struggling with a kind of psychotic syndrome. In terms of how long these various symptoms lasted, Willoughby says the median duration was generally between one to three years, but...

19:47Some people's symptoms lasted for more than a decade. And there was a considerable amount of impairment where some people were hospitalized, some people became suicidal. Many people had to take time off work or were fired or had to take time off school. So it can be, you know, quite a significant impairment in functioning.

Brain mechanisms and risk factors

20:09And I was curious to know why. What is actually happening to the brain when you meditate? So there's a lot of different possibilities. I think one of the more intuitive ones is to think of meditation like a attention-enhancing drug. And if you think of the other intention-enhancing drugs that we use, like coffee and caffeine and Ritalin and amphetamines and cocaine, they're all stimulants.

20:40And they work through different mechanisms, but all of them are the case that if you take a little bit of it, you become more alert and your attention does improve. You take a little more and you start to not be able to sleep. Take a little more and you're going to get anxious. Take a little more, you're going to probably have a panic attack. And you take a little more and you might become psychotic. So there is a sort of a continuum there of your attention systems and your arousal systems are very overlapping in the brain.

21:15Some of them are exactly the same, like the reticular activation system. And then a number of neurotransmitters like neuropinephrine and dopamine, they are related to both arousal and attention. And so if you start to crank up one, then you will also crank up the other. And it's, you know, some people can drink coffee like my mother. She can drink coffee and go to bed right afterwards. Other people can't touch it. And so I think there's an individual, you know, sort of constitutional sensitivity to certain kinds of, you know, you could say agents, drugs or practices that cause that.

21:55So that's one mechanism. The other theory is around homeostatic neuroplasticity, which is the idea that brain cells like to have a certain level of stimulation and that meditation, you know, you're sitting quietly in a, usually in a room that's quiet. Um, your eyes are closed or fixed, so you're not getting a lot of visual input and you're using your concentration to, to basically block out, you know, external, um, stimulation.

22:28And so it, it acts in a kind of sensory deprivation type of way. And, and so, and you're not moving either. So there's no kinesthetic stimulation. And when you do that, the various parts of the brain are kind of deprived of input. And so they will upregulate themselves in order to maintain this set point of stimulation. It's very similar to like when you go into a dark room and you come out and it's very, very bright and you can barely see. It takes a while to adjust. Same kind of idea. But that can happen in pretty much any brain area.

23:00Right. Okay. So your brain is generating its own activity to make up for the lack of sensory input or stimulation. And that can be the cause of these adverse effects. But there was something else that I needed to clarify.

23:17Was there a definite causal relationship with meditation? So that's a great question. And in our study, we used 11 causality criteria that federal agencies use to be able to establish causality for sort of medical procedures like vaccines or something like that, that you want to be able to prove that, that, that caused the problem without having to do a randomized control trial where you're going to harm a bunch of people.

23:48They're called the Bradford Hill criteria. And some of the criteria are things like it happened after meditation. The person thinks that it was meditation related. The teachers think it was meditation related. When they stopped meditating, the effect went away. When they started meditating, again, it came back. You meditate more and it happens more often. One of the other ones is there wasn't an alternative explanation. So if somebody had maybe, like, sense of self is a really good example.

24:20If they had, like, a dissolution of their sense of self, but they'd previously had that same experience on a drug, then, and it was just kind of repeating itself during meditation, then they were excluded from the study. So there were rules that there couldn't be a better explanation or if the person was like, oh, and I had hepatitis at the same time. It was like, nope, that could have accounted for some of your symptoms. So we were really careful about that. On top of that, Willoughby says that each of the 59 categories had at least four meditators who had spontaneously reported these symptoms.

24:55So we're pretty confident, and also I've seen it now thousands of more times. And in terms of who was most susceptible to these adverse effects of meditation, initially, Willoughby says there were a lot of assumptions made about the meditator. The most common response is to locate the problem within the meditator, and that could be a pre-existing condition, a mental health issue, a trauma history. It could also be that they didn't meditate correctly, they meditated too much, they weren't adequately prepared, they didn't have correct supervision.

25:32But for starters, Willoughby says the majority of the participants in the study were considered meditation experts with over 10,000 hours practice behind them. So this idea that they weren't practicing properly was easily dismissed. And... I think it's important to understand that psychiatric history and trauma history are risk factors, meaning that they do increase the likelihood of having adverse effects. But that doesn't mean that people who don't have psychiatric or trauma histories won't have any problems.

26:07And a lot of the people that have psychiatric and trauma history do really well with meditation. Okay, so there's really a wide variety of ways that things can go wrong for people when meditating. Absolutely. There are so many different symptoms that Willoughby identified. And so what happened next? Like, what was the response to the study?

Public response and Cheetah House

26:29So, as we've established, Willoughby wasn't the first to discover this issue. But when that specific paper was published in 2017, it got picked up by the press and the response was massive. The lab started getting phone calls of people who were like, you're the only ones I've ever seen who knew anything about this. You know, everyone I've been to is like, meditation doesn't have side effects. It's like, you know, there's no problem there. And no one had ever heard of it.

26:59And so, I mean, we got hundreds of calls. We had so many calls at the lab that we had to turn off our phone because it was like interfering with research. And that was when the idea for Cheetah House first began. It's a not-for-profit service that offers support to meditators in distress and aims to educate meditation teachers and clinicians about the risk of meditation. We have 150 appointments a month and we've serviced thousands of meditators in more than 20 countries.

27:33Next time, in part two of this two-parter on what they don't usually tell you about meditation, we hear from people who have accessed the Cheetah House support services after experiencing these side effects while on retreats or even after using meditation apps. My reality just sort of, it shattered. It was really terrifying. I was so terribly sad. Just, you know, not just lost and bewildered, but just heavy.

28:05It was very, very like I didn't know what to do, you know. I hardly slept until I slept for about three hours. My mind was just fizzing like a sort of lemonade bottle. I became increasingly manic and psychotic. But I still could function. Plus, mindfulness meditation is used in a lot of schools. But does it help at all? We look at the evidence. We did the Myriad trial because there was a lot of interest in teaching mindfulness to children in schools. And our view was that the evidence was way behind the enthusiasm.

28:40In today's episode, you heard from Associate Professor Willoughby Britton from the Brown University Medical School. You also heard from Assistant Professor Pawan Sarma from the Patton Academy of Health Sciences in Kathmandu. And Professor Pierce Salguero from Penn State University. This episode of All in the Mind was reported by science reporter Fiona Pepper. And thanks to producer Rose Kerr, senior producer James Bullen, and sound engineer Isabella Troppiano. I'm Sana Khadar. Thank you for listening.

29:11I will catch you next time. You've been listening to an ABC podcast. Discover more great ABC podcasts, live radio and exclusives on the ABC Listen app. You've been listening to an ABC podcast. You've been listening to an ABC podcast.