Tuesday, May 31, 2011

Meditation-Related Psychosis from the Buddhist Perspective

(Used by permission from Dr. Lois VanderKooi)

Meditation-related Psychosis and Altered States of Consciousness: Experiences and Perspectives of Buddhists By Lois VanderKooi (1994)

E-mail: loisvk@earthlink.net

From her website:

“I was first trained as a lawyer and sociologist and worked as a mediator and researcher in a pilot program that assessed mediation as an alternative to court action in child custody disputes. Dealing with the wounds of custody disputes, I became interested in psychology and in 1982 began pursuing training in Jungian psychology and a Master’s degree in clinical psychology. I went on to obtain a doctorate (Psy.D.) in clinical psychology at the University of Denver and then did a two-year post-doctoral fellowship at Menninger in child and adolescent psychology. During my training, I worked on my own issues through therapy and was exposed to a wide variety of clinical approaches. I found my own work and many of the approaches valuable. I continue to learn and most recently have been certified as a Somatic Exei,encin practitioner. I also take spirituality seriously, have worked with people of different faiths, and have expertise in working within Christian and Buddhist frameworks. See resume for further details about my background.”





JUNE 16 1994


Paul Block, PhD.,.Chair

Gretchen Sliker, Ph.D.

Gary Toub Ph.D.

Dedicated To all who contributed-— Participants, consultants, doctoral committee, and friends. My heartfelt thanks for your interest in this study and generosity in sharing of yourselves and experience.


Problematic altered states of consciousness (ASC) and psychosis that occur in meditation were investigated using descriptive and phenomenological research methods. Theravada, Zen, and Tibetan Buddhist teachers and meditators were interviewed to determine possible causes and ways to handle such responses to various types and stages of meditation. Buddhist meditation practices and Buddhist and psychological literature on psychosis and ASC are reviewed. Results of the interviews suggest that people who have had prior psychosis can easily become psychotic during initial practice, but with guidance can benefit from meditation. People at a borderline level of personality organization are more likely to encounter difficulties in later stages of practice. They can benefit from initial practices that promote gaining an “observing ego” and healthy relationships and self-esteem. Suggestions for teachers regarding ways to help people at psychotic and borderline levels of personality functioning are presented.

Meditation—related Psychosis and Altered States of Consciousness: Experiences and Perspectives of Buddhists

Although meditation has been extensively studied from a variety of Western psychological perspectives, our knowledge about it is limited in certain critical respects (Carrington, 1977; Davidson, 1976; Epstein & Lieff, 1986; Shapiro, 1982; West, 1987). In particular, research has focused more on benefits of meditation than on effects that greatly disrupt functioning in some meditators, including altered states of consciousness (ASC) (such as hallucinations, delusions, and extreme emotional states) and psychotic episodes (where the meditator becomes identified with the ASC and cannot easily return to an ordinary state of consciousness. Moreover, studies have emphasized short-term physiological and psychological effects of meditation, especially Transcendental Meditation (TM), in. non-religious settings and meditators. To understand adverse effects more clearly and the impact of a spiritual dimension, we need Buddhists to inform us of their rich meditation history and the context, techniques, arid process of Buddhist meditation. Also, Buddhists in the West can offer information about adverse effects because they have worked with people who turn to meditation for psychological relief as well as spiritual development.

In Buddhist circles, gaps in knowledge also exit. These have become more apparent as Buddhism enters Western culture and teachers encounter the psychological difficulties of Western students, Traditional Buddhist literature rarely addresses psychosis or problematic ASC. Instead, Buddhist psychology focuses on components and processes of mind in terms of the ultimate goal of attaining release from the universal “delusion” of inherent selfhood. In contrast, Western psychology focuses on emotional and relational content of mind arid posits schemata of personality organization. Thus, it can offer aid in dealing with the emotional, relational, and personality structure issues that hinder spiritual development in Western students.

This study takes one step toward addressing these gaps in knowledge by attempting to summarize and synthesize knowledge from Western psychological and Buddhist perspectives. Teachers and meditators from Theravada, Zen, and Tibetan Buddhist traditions were interviewed to investigate their experiences and perspectives regarding psychosis and ASC related to meditation. The study will hopefully aid Buddhist teachers who assess and address student needs and vulnerabilities, meditators who have difficulties with meditation, and health professionals who prescribe meditation or treat people in “spiritual crisis.”

Background and Literature Review Buddhist Meditation

Because philosophy and forms of practice affect the experience of meditation (Brown, 1986), it is important to first discuss Buddhist meditation in light of its goals and modalities. Unless otherwise noted, Sanskrit, Japanese, and Tibetan rather than Chinese, Korean, or Pall Buddhist terms are used. Frequently used terms are highlighted in bold type, and a glossary is appended.

Buddhists have used meditation for over 2500 years as means of spiritual discipline and psychological transformation. The ultimate fruit of practice is transcendence of suffering by realizing the Four Noble Truths that life is basically unsatisfactory, that suffering is caused by attachment arising from ignorance about the true nature of reality, that suffering can cease with release from clinging, and that freedom is realized by living the Noble Eightfold Path: right understanding, intention, speech, action, livelihood, effort, mindfulness, and concentration. The three major defilements or unwholesome roots that condition worldly existence are overcome with realization of truth. These are attachment (lust, desire, greed), aversion (hatred, anger, aggression), and delusion (ignorance as to the true nature of existence). An enlightened one naturally embodies ultimate reality (the “Absolute” or nirvana) in ordinary life (the “Relative” or samsara) and lives with equanimity, wisdom, and compassion.

Meditative practices vary and reflect the culture in which they developed and the particular aspects of Buddhist philosophy adopted (Shambhala Dictionary 1991; Snelling, 1991). Many divide Buddhism into three vehicles:

Hinayana, Mahayana, and Vajrayana and categorize Theravada Buddhism as Hinayana, Zen Buddhism as Mahayana, and Tibetan Buddhism as Mahayana and Vajrayana. These divisions in part reflect age and culture: Theravada, the oldest tradition, developed in India and Southeast Asia; Ch’an (Chinese) or Zen, influenced by Taoism, was next established and developed in China, Korea, and Japan; Tibetan Buddhism, influenced by Bon religion and Indian yoga, tantra, and Buddhism, developed in the Himalayas and India. But, as Goldstein (1987) notes, the different traditions actually contain all the vehicles and are like fingers pointing to the moon, not the moon itself. The Hinayana or Small Vehicle supplies the Sutras or words of the teachings or Dharma. To understand the Dharma and put it into practice is the Mahayana or Great Vehicle. To absorb thoroughly all Dharmas, free from attachment and in possession of nothing, is the Vajrayana or Supreme Vehicle.

Another division among traditions occurs as to the nature of enlightenment, which is paradoxical and creates an ongoing dialectic. All beings have Buddha nature and are inherently enlightened, but all beings are also deluded and tainted by the three poisons or root defilements of desire, aversion, and ignorance. Some schools emphasize an intuitive, spontaneous awakening to inherent enlightenment while others emphasize a gradual unfolding of specific stages prior to enlightenment and removal of defilements (Cooper, 1992). This dialectic is also framed in terms of “sudden” and “gradual” paths (Brown, 1986).


Despite diversity, there are three areas of training which are foundational and inseparable across traditions: 1) moral discipline or precepts to increase wholesome states of mind (shila); 2) training in concentration and mindfulness (samadhi); 3) training in wisdom or insight into the true nature of phenomena (prajna). Brown (1986) and Goleman (1988) note that training generally begins with ethical and philosophical preparation, then concentration training, and finally, insight training, which integrates concentration and mindfulness.

There are two major branches of meditation practices: shamatha (samatha, Pali) and vipashyana (vipassana, Pali) (Goleman, 1972a; Gunaratana, 1985/1992; Lodro, 1992; So1e’Leris, 1986). (Because the Pali terms are more widely used, they will be used in this discussion.) Theravadins sometimes refer to samatha as tranquility meditation and vipassana as insight meditation. In Tibetan literature, samatha is also known as “calm abiding” while vipassana is known as “special insight.” Speeth (1982) differentiates these branches by noting that samatha develops narrowly focused attention while vipassana develops evenly invested panoramic attention.

Samatha practices.

Samatha (tranquility) meditation practices are not unique to Buddhism, and similar practices can be found in many religious traditions (Goleman, 1972b). Done in seclusion and quiet, samatha involves concentrating on a particular object to attain tranquility and absorption. The mind gradually withdraws from all physical and mental stimuli except the object, and the usual verbal, rational mode of thinking is suspended. Mindfulness is used to guard against active senses and thoughts, which scatter the mind, and passive dullness, which prevents clarity and focus. Body and mind become pliable as one progresses, and in the end, equanimity and one— pointed focus is achieved.

Buddhist tradition posits 40 meditative objects. Prescription of an object varies according to a meditator’s temperament and the level of concentration and absorption to be achieved. Stages of practice involve: 1) connecting the mind to the object by directing it to concentrate on the object; 2) constantly renewing attention to the object; 3) confining concentration to the object and further taming and calming the mind; 4) uninterrupted attending; and 5) dwelling effortlessly (samadhi). Samadhi is nondualistic: the subject’s consciousness unifies with the object. At its height, it involves fixed concentration (appanasamadhi), during which general awareness and particular focus on the object drop away. It is a condition for dhyana or jhana (Pall) levels of absorption (Sharnbhala Dictionary, 1991).

Samatha and the jhanas are discussed more in Theravadin and Tibetan literature than in Zen (see, e.g., Gen Lamrimpa, l)92; Gunaratana, 1985/1992; and Lodro, 1992). Jbanas are used to: 1) make the mind stable and flexible so that “special insight” or wisdom can arise; 2) purify the mind of defilements and the ten fetters that bind people to Samsara (worldly existence), namely belief in personality, skepticism, attachment to rules and rituals, sensuous craving, ill will, craving for material existence, craving for non-material existence, conceit, restlessness, and ignorance; 2) attain supernormal powers, such as ability to appear in many forms and vanish, to go through matter, to walk on water, to fly, to know past lives, to hear and see at great distances, and to read minds. The jhanas and supernormal powers are considered as inferior to “insight’ and as temptations to remain in blissful and powerful (defiled) states.

Vipassana practices.

Vipassana or insight meditation is uniquely Buddhist. Once one overcomes the five major hindrances to concentration (desire, ill will, sloth and torpor, restlessness and worry, and doubt) and achieves sufficient concentration, one can pay ‘bare attention’ to the rising and passing away of all phenomena. Sufficient concentration is known as access concentration (upacarasarnadhi) or moment-to-moment concentration (khanikasarnadhi). The former involves partial absorption in the meditative object and some awareness of environment and body. The latter involves single-minded awareness of experience in successive moments of perception. With such concentration and attention, one fully and precisely examines sensory and mental processes to realize the nature of phenomena-impermanent (anitya), unsatisfactory (dukkha), and lacking inherent essence or self (anatman). Then prajna (insight—wisdom) can arise. This involves the realization of emptiness or shunyata, which is the basis for liberation from suffering.

Realization of shunyata (emptiness) is central to all traditions, but there are doctrinal differences among them as to its meaning (Hopkins, 1983). Shunyata is difficult to describe and explain. It involves the “middle way’ in that both inherent or independent existence and total non-existence are refuted. Through insight into the components of experience, one realizes that there is no “inherently existent I” and appreciates the representational and relative nature of reality (Epstein, 1989, 1990). One adopts neither an absolutistic stance involving belief in an eternal principle (godhead, self, eternal beyond) nor a nihilistic stance involving belief in voidness.

Shunyata is related to another primary doctrine in Buddhism: conditioned arising or dependent origination (Pratitya Samutpada), which outlines how sentient beings are entangled in samsara (worldly existence) and posits that all phenomena are interdependent and mutually condition each other (Shambhala Dictionary, 1991; Snelling, 1991.)

Fully realizing prajna (insight-wisdom), one transcends endless rounds of birth, aging, sickness, and death conditioned by the three unwholesome roots or defilements (attachment, aversion, and delusion). One lives in peace and without fear, awake to each moment of life. One is like an empty sky, radiant and all-encompassing, offering all beings the light and warmth of the sun. “In its true state, mind is naked, immaculate… not realizable as a separate thing, but as the unity of all things, yet not composed of them; of one taste, and transcendent over differentiation” (Evans-Wentz, 1969, p. 211). Fully enlightened, one can leave samsara (worldly existence) and enter nirvana (the absolute), or one can become a Bodhisattva, an enlightened being who, moved by compassion, renounces complete entry into nirvana until all beings are liberated from suffering. It should be noted that full enlightenment is more an ideal than an attainable reality,, and it is extremely difficult to find people who have attained the last two paths of enlightenment (Non—returner and Arhat) as outlined in Hinayana literature (Brown & Engler, 1986).

While samatha (tranquility) and vipassana (insight) are crucial in all Buddhist traditions, the means to develop them vary. One major variance in early stages of training is the degree of emphasis on concentration versus mindfulness.

Theravada practices. Theravada Buddhists use detailed mindfulness practices and instructions that balance concentration and mindfulness. These practices are generally based on “Four Foundations of Mindfulness” (Sattipathana Sutta), the “Path of Purification” (Visuddhimagga), and the Grounds for Establishing Insight” (Vipassana Bhumi) (Nainto, 1989; Nhat Hanh, 1990; Sayadaw, 1971; Sole-Lens, 1986). (See Kornfield (1977) for a description of practices used by various Asian Theravada teachers; see Goldstein (1987), Goldstein and Kornfield (1987), Namto (1989), and Nhat Hanh (1987) regarding mindfulness and vipassana practices as they might, be taught in the West.)

The goal of these practices is to be continuously mindful. One may begin with samatha practices but not go to ever higher degrees of concentration and absorption. While concentration can temporarily suppress defilements, mindfulness and eventually insight into nirvana are necessary to uproot them. Students are taught to observe different aspects of body and mind slowly and mindfully and to develop a proper balance in the five spiritual faculties: confidence, effort, concentration, mindfulness, and wisdom in one’s practice. In both early and later stages of practice, one develops moment—to—moment concentration on the five aggregates (skandhas) which constitute personality and include form (rupa) and mind (nama). Form involves body senses, postures, and movement. Mind involves feeling (pleasant, unpleasant, neutral), perception, mental states and contents, and consciousness.

The Theravada teachers involved in this study generally prescribe alternate periods of breathing and walking mindfully to beginning students. Basic body postures, such as sitting, standing, and reclining, may also be mindfully noticed. When the mind wanders, the instruction is to return to the object of mindfulness. Mental noting or labeling may also be used to return to mindfulness. For example, when distracted by sound, the meditator would note “hearing” and not become lost in thoughts about the sound. Slowly, other foci of attention related to the senses and mind are added. Eating and moving are also done slowly and mindfully so that different sensations are noticed in detail. Hindrances to practice and root defilements are treated with mindfulness and antidotes. In progressing, one precisely realizes the basic components of mind and the interdependence of mind and outer reality. One gives up mental noting as “bare attention” or nonconceptual knowing is achieved. This involves pure noticing of phenomena without the usual self— consciousness and wanderings and conceptual—perceptual elaborations of the mind. For example, in seeing or hearing something, one would see only color or hear vibrations and not perceive or label in the usual attributive way. True vipassana practice begins with bare attention and awareness of the rising and passing away of all phenomena.’

Zen practices.

Zen purportedly offers a “steep” but relatively short path to awakening to the emptiness (and perfection) of all things. Though ‘practice in the midst of activity” is emphasized by some (e.g., Dogen (Dogen & Uchiyama, 1983), Hakuin (Yampolsky, 1971), and a contemporary teacher Bernard Glassman), zazen or sitting meditation has generally been favored as the means of attainment. Practice involves both concentration and mindfulness, but the mindfulness practices are not as detailed and precise, as in Theravada practice. Also, there is emphasis on direct transmission of understanding outside of orthodox teaching and on direct experience of Buddha nature with heart-mind (Shambhala Dictionary, 1991; Snelling, 1991). This contrasts with the reliance on precepts, scriptures, and stage—by—stage process found in Theravada Buddhism.

In Japan, there are two major Zen schools: Rinzai and Soto. Though similar in first and last stages of practice, they vary in practices assigned to advanced beginners. Initial instructions in both usually involve focus on breath, first counting it and then merely observing it. Once sufficient concentration is achieved, the Rinzai school tends to emphasize cutting off thoughts and merging with an object such as breath or koan to attain kensho or breakthrough to intuitive experience of nirvana. Koans involve a question that is impervious to solution by logic, induces not knowing, and thus transcends conceptual thinking. cme well—known initial koans are Chao—Chou’s dog (Mu), the sound of one hand clapping, and original face before your parents were born. (See Loon (1992) for more description about koans and Zen training and Seung Sahn (1992) for a modern version of koan study.) Rinzai practices are generally rigorous and concentrative and may lead to great doubt because the experience is like trying to smash through an iron wall. After kensho, other koans are assigned to deepen and extend enlightenment experience.

The Soto school tends to emphasize shikantaza or “just sitting,” which uses mindfulness more than fixed concentration to simply watch thoughts and sensations come and go (Goleman 1972b). One tries to realize unity of body— mind and cut through thinking. Proper posture and breathing rather than attaining kensho (breakthrough are stressed. The idea is that one sits because one is inherently enlightened. While seemingly gentle, true shikantaza is purportedly like :rying to put a fire out on one’s head because of the degree of concentration and mindfulness involved.

Teachers trained in both Rinzai and Soto traditions generally assign koans to students who are goal-oriented, perplexed, aggressive seekers and assign shikantaza to students who have faith in sitting and can let things unfold gradually. One teacher said that koans are generally not good for those who lack confidence or who belittle themselves for not achieving something. At intermediate stages of practice, koans involve more thinking and are not advisable for someone who becomes too wrapped up in thought.

In both koan and shikantaza practices, thoughts lessen and then stop, and then the thinker disappears and sarnadhi occurs. Samadhi is the gateway to the experience of shunyata (emptiness) and prajna (insight—wisdom). Perhaps, as one teacher said, in Rinzai, one shakes fruit from the tree and lets it ripen; in Soto, the fruit ripens on the tree. In both, kensho (breakthrough) is but an early point in practice. Fruit must be eaten, digested, and transformed repeatedly for realization to function in daily life.

Tibetan practices. Tibetan Buddhism adds another rich, complex layer. While utilizing sarnatha and vipassana practices, Tibetans excel in scholarship and philosophical debate and use complicated rituals, mantras, mandalas, visualizations, and other meditative practices (Goleman, 1972b). In the West, the most well—known Tibetan schools are Nyingmapa, Kagyupa, and Gelugpa. The latter is the most recent tradition and holds political leadership in Tibet. A major part of its approach is Lamrim or “graded stages of the path,” which involves much analytical meditation (Gyatso, 1991; Pabongka, 1991). Kagyupas rely less on dialectical investigation and practice mahamudra. Mahamudra begins with preliminary practices and samatha practices and leads to transformation of all experience by the qualities of emptiness and clarity (Brown, 1986; Namgyal, 1986; Shambhala Dictionary, 1991). Nyingmapas also rely less on dialectical investigation. Their teaching is based on dzogchen, which posits that mind is by nature pure and undefiled. One is freed from samsara by directly experiencing this “naked” mind (Shambhala Dictionary, 1991).

In general, Tibetans emphasize transforming emotions more than other traditions do. (Theravada treats them with mindfulness, and Zen tends to minimize them.) Another difference is related to teachers. In all traditions, one relies on and becomes intimate with a teacher who is experienced in meditating and has attained some degree of enlightenment. But, in Tibetan tradition, guru—yoga is used. This involves visualizing one’s lineage and earthly teacher as Buddhas and merging with those.

Similar to Theravada and Zen, initial stages of Tibetan practice involve study, samatha (tranquility) and then vipassana (insight) practices. One teacher said that he defines meditation as increasing wholesome states of mind and decreasing negative emotions, and in his tradition, study of traditional texts is considered meditation. The samatha practices are first used to calm and focus the mind, and in some training, they are then used to develop deep concentration and samadhi (absorption). Vipassana practices are begun when adequate concentration is achieved. Analytical meditations are also used to logically analyze the nature of reality and prepare for realization of ultimate reality. Moreover, there are practices to develop wholesome mind states, such as compassion, kindness, empathic joy, and equanimity, and transform unwholesome states, such as greed, envy, anger, apathy, and hatred. There are also practices to develop the altruistic aspiration to attain enlightenment for all beings (bodhicitta) and to take in the darkness and pain of others’ suffering and give out light, healing, and awakening (tonglen).

Initiation into esoteric Tantric practices may occur in later stages of practice. Involving primal energy and emotion, these supposedly are quick paths to enlightenment (i.e., take only one lifetime) and provoke a wakefulness that is very sharp in its ability to cut through habitual mind and pride. But, they are dangerous in terms of amplifying tendencies toward self— deception and releasing primal energies. Therefore, they are reserved for those with adequate character and foundation in philosophy and meditation. They also require the careful guidance of a qualified, experienced teacher.

In the West, Tantric practices are rarely taught. In the Kagyu tradition (which influenced many Westerners through Chogyam Trungpa Rinpoche), advanced students may be instructed in ngondro practice, which involves four foundation practices: 1) 100,000 full prostrations to a visualized form (to surrender); 2) -100,000 recitations of the 100 syllable Vajrasattva Mantra (to be purified); 3) mandala offering in which one visualizes giving everything in the universe to the lineage one has entered; 4) guru-yoga practice in which one unifies with the mind of one’s teacher. These practices evoke resistance and reveal the confusion and tenacious defilements of one’s mind. They precede Yidam practice, which involves visualizing and becoming ‘Yidams’ (roughly translated as deities). Yidams represent different aspects of one’s mind and are both real and imaginary, external and internal. Their qualities range from peaceful and benign to wrathful and terrifying.

Meditation Retreats

Meditation retreats have traditionally been used as a way to train meditators in samatha and vipassana practices. Besides meditation practices, factors such as structure, length of time, and milieu of a retreat affect one’s experience of meditation. Generally, the longer a retreat is and the more meditation that occurs, the more intensive is the experience. Again, the traditions vary in particulars.

To experience these variables, I attended retreats (nine altogether) led by various Theravada, Zen, and Tibetan teachers. All except one were weekend retreats. That one (Theravada) was two weeks long. The following are my general impressions about similarities and differences in retreats, at least as they are held in the West for beginners. (My experiences are not necessarily representative of all retreats because random sampling procedures were not used and the retreats attended were short.)

Some similarities were rules enforcing silence, adequate food and sleep, teacher “dharma” talks and instruction, group question and answer periods, and some form of ritual and structure as to how time is spent. Generally, people were silent except for discussion periods with the teacher. The Zen and Tibetan retreats involved three meals and at least six hours of sleep. Three meals and that much sleep were also available in Theravada retreats, but people were encouraged not to eat after noon and to decrease sleep when able. (As rneditation progresses, metabolism slows down and two to three hours of sleep can be sufficient. Too much food and sleep decrease alertness. In some Zen circles, cutting down on food and sleep is also encouraged.) Teachers were available for individual instruction but the amount of time available varied according to group size. In largar groups, the teachers met with small groups rather than individuals. In all retreats, people honored the teacher’s role arid paid respect. Overall, following a “middle way,” teachers encouraged effort and prudence. They also encouraged people to ask questions and talk about difficulties experienced in meditation. Anecdotal data suggest that the teachers I experienced were more gentle and open to dealing with emotional issues than others can be.

Differences were found mostly in ritual and structure. Zen retreats were the most formal: people wore dark clothes or robes, cushions were in rows and people usually meditated facing a wall, meals were served and eaten in stylized “oryoki” fashion, chants and bowing occurred at certain junctures, walking as a group was done between sitting periods, and there were work, teaching, discussion, and rest periods. Good zazen (sitting meditation) was encouraged, and one tried to sit still for a designated period of time (25-45 minutes). In this regard, some retreats were more demanding than others. Because of the degree of ritual, structure, and demand, the “group” feeling was strongest in Zen.

Though structured, Theravada and Tibetan retreats offered different milieus and were more relaxed than Zen retreats. In contrast to the simple, spacious Zen milieu, Tibetan milieu seemed complex, busy, and colorful. Theravada milieu fell somewhere in between Zen and Tibetan milieus in being plainer and less aesthetic. In Tibetan and Theravada retreats, people dressed as they pleased and sat where they wanted, In contrast to Zen retreats, less emphasis was placed on posture. Also, meals were not ritualized, and chanting and bowing were less frequent. Overall, Theravada retreats emphasized slowness and mindfulness much more than the others. Also, sitting and walking periods were equal in time, whereas in Zen and Tibetan retreats, walking was briefer and done more to sustain sitting than to build mindfulness and concentration. In one Theravada retreat, sitting and walking were done in the privacy of one’s room, and each meditator’s practice was individualized.

One final difference should be mentioned. Intensive Zen retreats usually last at most for seven days. Theravada and Tibetan retreats can extend for months, and even years. In the West, the longest retreats are typically three months long. In all traditions, ending retreat and reentering the complexity and busyness of ordinary life can be problematic. The mind generally becomes quite open and vulnerable or less defensive during retreat and one may feel assaulted and overwhelmed outside of retreat. At several of the retreats that I attended, reentry was facilitated by having a social gathering with food at the end of the retreat. Reportedly, in three-month Theravada retreats, one talks and interacts with other meditators and staff during the last five days (Brown & Engler, 1986).

Buddhist Literature on Stages of Practice, Psychosis, and ASC

It is known that psychosis and ASC can occur in meditation. A critical question that has not been adequately addressed in writings on meditation is: “At what stage of practice are ASC and psychosis likely to occur?” Practice is complex, involves more than meditation, and varies for individuals, and it is difficult to outline stages of practice. The following is an attempt to do so at a general enough level to capture some consistencies. ASC and emotions that may occur are included. But, as teachers in this study noted, not much is written about these. Even less has been written about psychosis.

Theravada literature.

In Theravada literature, the Visuddhimagga (fifth entury work that supposedly collects the Buddha’s teachings on meditative states of consciousness) and “A manual for checking vipassana progress” offer a general map of the stages of vipassana (insight).meditation and the ASC that may occur (Brown, 1986; Brown & Engler, 1986; Goleman, 1972a; Namto, 1989). The following summarizes these descriptions, focusing on troublesome ASC and emotions. This should be used as a guide for practice. There are 16 stages altogether. (See also, Sayadaw, 1971.

Stages 1 (Knowledge of the distinction between mental and physical states) & 2 (Knowledge of the cause-effect relationship between mental and physical states) involve deepening concentration and increasing mindfulness. Hallucinations, feelings of disturbance, and involuntary movements can occur. Many mental images may arise and disappear slowly and one can feel confused and distracted.

In stage 3 (Knowledge of mental and physical processes as impermanent, unsatisfactory and not—self) as samadhi is achieved, pseudo—nirvana phenomena may occur. These can induce attachment to the experience of a particular phase and include different experiences of light and color and feelings of rapture, tranquility, and bliss. Frightening images may also occur. Tears and body sensations, such as stiffness, heaviness, heat or energy pulsations, and twitching or itching, can arise. Nausea, vomiting, and diarrhea as well as body movements can accompany some forms of rapture. Tranquility can be signified by clarity and feelings of lightness and smoothness. Bliss may involve desire to meditate a long time, gratitude, and pride. Confidence and zeal can occur with bliss and lead to over-exertion. With strong mindfulness, one may notice phenomena melting into the past and become concerned with the past and able to recall past lives. One may falsely believe that insight- wisdom is attained and think excessively. Then equanimity can arise. When too strong, it can lead to absent-mindedness and inattention to bodily needs. Finally, one can be delighted and satisfied with the various signs of “progress.” After overcoming these imperfections of insight, genuine insight practice can begin. Concentration and mindfulness are balanced rather than fluctuating, and mindfulness is precise and constant.

Stage 4 (Knowledge of arising and passing away) is entered. Mental images disappear quickly with acknowledgement and a non—hallucinatory clear bright light may appear. Abdominal movements may cease and one may feel as though falling into an abyss.

Stage 5 (Knowledge of dissolution of formations) is entered. Sadness and irritability may occur when the passing away of phenomena is seen clearly. In addition to form disappearing, the mind of the knower seems to disappear and then acknowledges its disappearance. At times, only the rising and passing away of phenomena occurs while the “self” seems to disappear. Then both form and consciousness disappear. These may cease briefly or for several days until boredom occurs. One may also see objects “vibrating.”

Stage 6 (Knowledge of the fearful nature of mental and physical states) involves fear, and one can be afraid of everything, even harmless objects. This is related to losing one’s “self.” Pain in the body can be experienced. One may feel utterly alone and weep at the thought of loved ones. One cannot find enjoyment in anything.

Stage 7 (Knowledge of mental and physical states as unsatisfactory) involves further misery and disgust. Life seems bad and tiresome, and one can feel bored and uneasy. A deep sense of the insipid nature of life prevails.

Stage 8 (Knowledge of disenchantment) involves intensification of the sense of unsatisfactoriness. One realizes the interdependence of events (dependent origination) and their dissolution. One only wishes to escape from the world, realizing that nothing is lasting. Stage 9 (Knowledge of the desire for deliverance) is the “rolling the mat” phase as one may desire to leave practice as restlessness increases and mindfulness is low. The body may itch as though being bitten by ants.

Stage 10 (Knowledge which investigates the path to deliverance and instills a decision to practice to completion) may involve the sensation of being slashed with a knife and other distracting disturbances. Drowsiness, stiffness, heaviness, and heat may occur.

Stage 11 (Knowledge which regards mental and physical states with dispassion) involves equanimity. Mindfulness and clarity are present and natural. Practice is smooth, and one may lose track of time and sit for hours. Certain psychosomatic diseases may be cured.

In stages 12-16, insight knowledge occurs. Nirvana is approached by way of one of the three marks of existence: impermanence (anicca), unsatisfactoriness (dukkha), or emptiness of self (anatta), and everything drops away (“cessation’). The path is entered and the fruit of the path attained. One experiences deep peace and stillness, the “supreme silence.” Defilements are abandoned and destroyed. When first experienced, this moment of realization does not last for even a second. Then comes contemplation of the basis for deliverance, the path, and tie fruit and review of defilements remaining.

Zen literature.

Zen does not offer such a detailed map. Its “Oxherding Pictures” depict the process of realization, but relate more to overall levels of realization than to specific meditation stages (see, e.g., Kapleau, 1965/1989 and Loon, 1992; I also draw upon talks by Danan Henry of the Denver Zen Center). But, some analogies can be made as to meditation, and some teachers refer to the pictures when talking about the occurrence of ASC.

Picture 1 refers to commencing the search for true self (the ox). A quest and aspiration for realization are necessary. In meditation, a breath practice helps calm the mind, and at a certain point, mindfulness is used to examine the mind and its defilements.

Adequate concentration marks the entrance into stage 2-”Finding the tracks.” Great faith, doubt, and determination are developed as one tries to make intellectual understanding experiential. As Kapleau (1965/1989> notes, one’s effort is powered by a painfully felt sense of bondage and frustration with life, fear of death, and conviction that one can attain liberation. Work on the first koan or shikantazais begun, and little by little, surface mind settles. As this happens, ASC, including hallucinatory phenomena and repressed material about present and past lives, may emerge. In intensive sitting, the mind may become denuded of concept-forming activity and one may enter samadhi and briefly experience kensho (breakthrough)-”body and mind falling away” and emptiness.

Stage 3 ‘Seeing the ox” signifies breakthrough: glimpsing self nature or empty oneness, but lacking clarity. To increase clarity, other koans are introduced, or with shikantaza students, daily activities are penetrated so that one “just does.”

stage 4 “Catching the ox” involves struggling with one’s mind and defilements as one tries to manifest realization.

Stage 5 “Taming the ox” involves further struggle and discipline, but at times, practice comes naturally and suffering is transcended. One deepens samadhi to overcome disturbances. True shikantaza can be experienced: one realizes “just sitting” and samadhi and kensho are the same. The intense concentration of koan work can also cause sudden explosions of kensho. Living a life of truth becomes more important than kensho, however.

Stage 6 “Riding the ox home” involves effortless practice. Morality (shila), samadhi, and insight-wisdom (prajna) are all present. Koan study continues. At this point, one has practiced for years, and commitment no longer wavers.

Stage 7 “Ox forgotten, self alone” involves nonduality: the interpenetration of nirvana (the absolute and samsara (the relative). One forgets self and is not attached to anything. Mind before consciousness (Buddha-Mind) is experienced. “Abiding nowhere,” “Nothing to do,” “Enlightened by 10,000 things” begin to happen. One begins to perceive that mind has no abiding place anywhere. One is at “home” and no longer has to search and strive. All phenomena are perceived with equanimity and wisdom and are experienced as dharma (the teaching).

Stage 8 “Ox and self forgotten” is depicted by a circle. There is no sense of self or other, and ideas of enlightenment have vanished. One is like an empty sky. This is shunyata, complete falling away of body and mind. “The great matter” and “great death” are realized.

Stage 9 “Reaching the source” involves dwelling in one’s true abode, tranquilly observing the creation and destruction of form. The precepts are thoroughly understood and morality is a natural manifestation of one’s life.

Stage 10 “Entering market with helping hands” depicts Bodhisattva (enlightened being) in the world: transparent, both true self and selfless, compassionate, and with beginner’s mind, experiencing life with immediacy and full awareness.

Tibetan literature.

Tibetan literature is even more difficult to summarize! Lodro (1992) describes the process of attaining “calm abiding’ and just begins discussion of “special insight” in 388 Pages. Gyatso (1991) discusses Lamrim (Gelugpa practice that precedes Tantric practice) in 227 pages. See also, Gen Lamrirnpa (1992), McDonald (1984), and Wangchen (1987). Because elements of the Theravada and Zen maps are found in Tibetan literature and due to the lack of a Tibetan map that is specific and general enough to easily outline stages of practice and ASC that occur in those stages, I will not attempt a summary. Instead, I will focus on Tibetan understanding of imbalance, which relates directly to troublesome states of mind and psychosis (Epstein, 1990; Epstein & Rapgay, 1989). (For those who seek a map, Brown’s (1986) discussion is helpful. He distinguishes mahamudra (Kagyupa practice) from the Theravada process outlined above. Although using similar practices, these paths resulted in a different understanding of ultimate truth due to different philosophical bases.)

Tibetan medicine and religion posit that mind is dependent on prana (Ch’i in Chinese), which is a vital force or energy that moves in channels (nadis) throughout the body. Rlung is the movement of prana prominent in processes involving motion or flow (nervous, vascular, and muscular systems) and serves as the foundation for mental and sense consciousness. Mind, like a person on a horse, rides upon this energy. Mental disturbance is reflected in an alteration of the flow of rlung, which is affected by certain extremes in mental and physical behavior. Meditation is viewed as a way to direct and control this energy. Improper meditation practices, however, can lead to imbalance in this energy and a movement of prana into wrong channels. This leads to a sok-rlung” disorder in which a kind of manic or agitated state occurs. The person becomes anxious, restless, emotional, and unable to concentrate. This disorder is more likely to arise in concentrative practices where the meditation object is not suitable, or where the concentration is tarnished by negative states of mind or not balanced with mindfulness. Also, it may occur if the mind is not concentrated with proper effortlessness. In the latter case, the mind is said to rise up when forced to concentrate and the pranic current rises, producing sok-rlung symptoms. Also, this rise occurs when obsessive inner thoughts about progress arise in a mind at a level of concentration (appanasamadhi) when external sensory inputs no longer occur.

Besides the sok-rlung disorder, Tibetans recognize other types of madness, seven altogether, which may involve the imbalance of bodily processes besides rlung and the invasion of a harmful spirit. Because these types are not directly related to meditation, they will not be discussed (refer to Epstein & Rapgay, 1989, for more information.)

Effects of Meditation: Psychological Literature.

While literature on beneficial effects of meditation involves much research data (Shapiro 1982; West, 1987), literature on adverse effects is largely anecdotal, and no one has factored out effects of other variables such as the aloneness, silence, and reduced food and sleep that often accompany intensive meditation. Spontaneous muscular-skeletal movement, proprioceptive sensations, and intense emotional states (known as “unstressing” in TM literature) often occur and can take extreme forms during extended meditation sessions. These may relate to release of past physiological and emotional stresses stored in the mind and body (Coleman, 1971). Severe anxiety, depression, depersonalization, derealization, panic, and emergence of overwhelming repressed material sometimes occur, especially in people with traumatic backgrounds and longstanding emotional problems (Carrington, 1977; Epstein & Lieff, 1986). Extreme dysfunction, such as psychosis, is rare, but does happen, especially during intensive meditation in people who have a history of psychosis (“A forum,” 1988; Kornfield, 1989; Walsh & Roche, 1979). A reoccurrence of psychosis may be part of practice because what one fears most tends to emerge in practice (Kornfield, 1989). Also, serious pathology may emerge when the will for practice is so strong that it overrides usual defense mechanisms (“A Forum,” 1988). This idea is supported by Glueck and Stroebel (1975), who assessed the effect of TM on psychiatric inpatients and found that psychotic episodes were precipitated in Dire ho, against instructions, meditated more than twice a day for longer periods than the usual 20 minutes. Also, Sangharakshita (1980) notes that a Burmese method of respiration-mindfulness led to “extreme nervous tension and a schizoid state” in a number of people and hospitalization for some (p. xv). (This method may resemble the Sunlun practice, which involves intense effort, heavy breathing, concentration on pain, and sitting motionless for 2-3 hours. See Kornfield (1977) for a description of this practice.)

While extremely dysfunctional states are rare, ASC are common (Kornfield, 1979) and “primary process” thinking tends to increase in beginning phases of meditation (Brown & Engler, 1986; From, 1977). This cognitive mode involves more images, “drive” (sexual/aggressive) content, and preverbal and nonverbal processes than does “secondary process’ thinking, which is verbal and oriented to reality testing, goals, logic, and abstraction. Brown and Engler (1986) suggest that many Westerners may do a form of self-exploratory therapy when they become aware of the contents of their mind and consequently fail to develop the concentration and mindfulness necessary for formal meditation. Kornfield (1979) found chat many Westerners in. initial stages of intensive Vipassana meditation experienced unusual mental and physical phenomena, such as spontaneous movement, altered body-image perceptions, altered visual perceptions, powerful imagery, vivid dreams, intense feelings, and mood swings. These phenomena were uncommon in control subjects who received the instructions and teaching of the experimental group, but who meditated much less (1-2 hours/day vs. 12-15) and were not in a disciplined, silent retreat milieu. Concentration appeared to be a major factor in increasing the frequency and duration of these altered states.

Kornfield (1979) notes that traditional Western psychology considers these phenomena pathological rather than normal responses to meditation in predominantly healthy individuals. Respect for such phenomena as spiritual experiences may be growing, however (Chandler, Holden, & Kolander, 1992). Sourcebooks, such as Bragdon’s (1988), and support networks, such as the Spiritual Emergence Network, have been developed to aid people in “spiritual emergence.” The Grofs (1986, 1990) and Lukoff (1985) highlight the need to differentiate pathology from spiritual experiences and crises that can be transformative. They offer schemata of differential diagnosis and propose treatment alternatives to medication when certain criteria are met, such as lack of organicity, adequate pre-episode functioning, and abilities to relate, cooperate, work intrapsychically, maintain physical health, and refrain from acting upon impulses. This spiritual emergence movement has impacted diagnostic criteria in the forthcoming DSM—IV, the main diagnostic manual used by mental health professionals (“Diagnosing,” 1992).

Differentiation of spiritual and psychotic! psychosis proneness.

If phenomena are similar in spiritual-mystical and psychotic states, what makes these states different and who is prone to psychosis? Chapman and Chapman (1980) take an empirical approach to these questions. They suggest that these experiences fall on a continuum as to degree of deviancy. Factors that make for less deviancy are: incomplete belief in the experience; presence of cultural support for the experience; brevity; facilitation by hypnogogic or hypnopompic states; the subject talking about past rather than present experience; other factors that make the experience seem closer to normal. They recognize that fairly well-functioning people can have occasional psychotic or psychotic-like experiences, so factors such as level of stress and functioning are also considered in assessing someone’s stability. As to the issue of proneness, Chapman, Chapman, and Raulin (1976, 1978) and Eckbad and Chapman (1983) developed paper-and-pencil tests to measure several variables that purportedly are precursors of schizophrenia such as magical ideation, anhedonia (defect in experience of pleasure) and perceptual aberration (distortion in perception of body and other objects). Research on these tests’ validity has mostly involved undergraduates (Lenzenweger & Loranger, 1989). L. Chapman (personal communication, August 13, 1993) believes that the Perceptual Aberration and Magical Ideation scales could be useful screening tests for meditators if they are answered in terms of non- meditative states of consciousness.

A more theoretical approach has been taken by a number of authors who are familiar with Buddhism as well as psychodynamic, developmental, and transpersonal psychology. Wilber (1986) proposes a hierarchical “spectrum” model of development that involves “prepersonal,” “personal,” and “transpersonal” stages. These stages involve different kinds of personality organization and pathology. The prepersonal stages involve psychotic, borderline (between psychotic and neurotic), and neurotic organization and pathology. Wilber (1986) and Engler (1986; Nisker, 1988) suggest that “uncovering” therapy and meditation can be harmful to people with psychotic or borderline organization. The recommended intervention for psychotic organization, which may involve schizophrenia and bipolar (manic—depressive) diagnoses, is medication, external structure, and supportive therapy. The borderline level includes characterological or personality disorders, including the narcissistic and borderline disorders, which supposedly stem from arrest in developing a separated-individuated “self” due to constitutional factors and failures in parental empathy and responsiveness to needs. They can involve psychosis at times of stress and require ego and self “structure-building” rather than uncovering therapy or meditation. To undergo “derepressive” meditation practices, such people need a healthier sense of self and more “ego strength,” including abilities to observe self, tolerate intense emotional states, and experience feelings without acting on them. For people with neurotic organization, however, meditation can be helpful because its derepressive effect enables “regression in service of the ego.” In other words, neurotic repression is overcome and unconscious material can be made conscious and integrated.

Epstein (1986, 1998, 1989, 1990), in contrast to the above authors, believes that meditation can help transform borderline and narcissistic pathology. At deeper levels of practice, concentration and insight practices enable knowledge of the insubstantiality of selfhood and balances that knowledge with calmness.. Thereby, a transcendence of narcissism is promoted. He does not recommend advanced insight practice for people at a borderline level of organization, however, because it involves relinquishing fundamental beliefs about self and world and experiencing terrifying upsurges of regressive material. For such people, he recommends preliminary concentrative and mindfulness practices that promote ego development through stabilizing emotions and gaining an observing stance and more cohesive sense of experience. Epstein (1993) also recommends that people continue taking prescribed medication while meditating. (See also Epstein & Lieff, 1986.)

Diagnosing personality structure.

The three levels of organization (psychotic, borderline, and neurotic) are not always easy to discern: people are complex and can display features from different levels. Moreover, psychological theorists vary in how they diagnose, understand etiology, and treat the different levels (see e.g., Chatham, 1989 and Goldstein, 1985). Goldstein recommends an assessment of overall ego functioning. He says that at the borderline level, ego strengths involve relatively intact reality testing, thought processes (secondary process), interpersonal relationships, and adaptation to reality. Under stress and in nonstructured situations, however, a borderline level person may grossly distort reality and become briefly psychotic. Also, their relationships lack empathy and depth and are largely need fulfilling. Moreover, there are often difficulties underlying their adaptations. Ego weaknesses involve poor impulse control and frustration tolerance, proclivity to use primitive defenses (such as projection, denial, acting out, and good/bad splitting rather than more adaptive repression, humor, and sublimation), identity diffusion (unstable sense of self and others with multiple contradictory images of self and others), and affective instability arid intensity (usually depressive or ii.ie.) Goldstein suggests that the relative ego strengths distinguish the borderline from the psychotic level and the ego weaknesses distinquish the borderline from the neurotic level.

Further diagnostic tangles arise in differentiating borderline and narcissistic disorders. Narcissistic pathology involves grandiosity, extreme self-involvement, and lack o empathy. Pursuing perfection, the narcissist seeks objects to mirror his/her grandiosity. Underneath a facade of achievement, lie emptiness, rage, and intense envy. (Teachers may encounter narcissistic pathology in students who are perfectionistic, develop strong idealizing transferences, seek to be mirrored as special, and become enraged or humiliated when criticized.) Borderline pathology involves fear of engulfment and abandonment by others. Others and self are experienced as all good or bad (splitting defense). The person may cling to rewarding objects and withdraw from or attack withholding objects. (Teachers may encounter borderline pathology in students who have intense anger, trouble regulating emotions and impulses, stormy relationships, and identity issues. Generally, narcissists have a more polished, “hard” facade while borderlines tend to have more crises and are more prone to psychosis and suicide attempts.)

As the literature review suggests, we know that meditation can involve problematic ASC and that some people are more vulnerable to these states than others. Much of our knowledge is speculative and theoretical, however, and few have studied Western Buddhists’ experiences of meditation—related ASC and psychosis. This study is an initial attempt to increase our knowledge about these experiences.


Descriptive and phenomenological research methods are used because of the historical (ex—post facto), experiential, and cognitive-subjective nature of the data, the difficulties in measuring such data “objectively” and using a more rigorous (control) research design, and the exploratory nature of this study (Polkinghorne, 1989). Subjects were recruited from the Colorado—New Mexico area, which has a large number of Buddhist organizations and activities, including visits by teachers who live elsewhere. Because sampling was not random, the results can not be claimed as representative of all Buddhists. Four teachers from each of the three main traditions (Theravada, Zen, and Tibetan) were interviewed, however, to assure some representation of the different traditions.

Teachers were recruited through a phone call1 letter, and copy of the interview questions. They qualified as informants if they were recognized as a qualified instructor by their tradition and had experience with more than 100 students and with students at different levels of practice. A semi- structured interview format (see Appendix A) was used to ask teachers about: the frequency of psychosis and ASC and conditions and stages of practice in which these states are likely to occur; ways in which psychosis and ASC are differentiated; screening and diagnostic methods used to assess student vulnerability to psychosis; personality characteristics and symptoms that indicate vulnerability; meditation practices that increase and decrease susceptibility to psychosis and difficulties with ASC; ways used to help with psychosis and problematic ASC when they occur.

Student meditators who had experienced serious problems in response to meditation were recruited through local Buddhists and therapists and an advertisement in the Rocky Mountain Spiritual Emergence Network newspaper. To preserve confidentiality, potential subjects contacted me by phone if interested in participating in the study. Then they received the interview questions (see Appendix B) and a letter explaining the study. They qualified if they had major difficulties related to meditation and could talk about their experience. A semi-structured interview format was used to ask about their spiritual and psychological history and the difficulties they encountered.

Interview questions were formulated by consulting Buddhist literature and five Denver-area Buddhists. Also, I participated in nine meditation retreats and attended talks led by the teachers to gain experiential understanding and a sense of the teachers’ style of teaching. Interviews were held in convenient, private locations and taped, transcribed, and summarized. (There was one exception; one teacher who lives overseas was not interviewed and answered the questionnaire in writing.)A summary was sent to each subject for additions and corrections.

All subjects participated out of interest and good will. None were remunerated. It was hoped that the self—reflective process of the interviews and the compilation of information shared would benefit all participants. All signed a consent form and were assured confidentiality. Generally, there was much interest in the study, and it was not difficult to recruit subjects. Out of 15 teachers contacted, only three refused to participate (due to busy schedules.) Meditators were more difficult to find, perhaps due the rarity of meditation—related psychosis and the vulnerability associated with mental difficulties (see below). Six meditators contacted me. One was having current difficulties and felt unable to talk; another was not involved in Buddhism or serious meditation. Four were interviewed altogether. Each illustrates a different aspect of difficulties with meditation.

Demographics of Subjects

Nine of the teachers were Westerners and three were born and trained in the Far East (one of these required an English interpreter). All of the Westerners except two were trained by oriental teachers. Among the Theravadins, all had been taught by a number of Southeast Asian teachers. One especially draws upon the Mahasi Sayadaw (1971) approach with some modifications. Among the Zen teachers, three were trained in both Rinzai and Soto traditions and one was trained in Soto, but draws from Vietnamese and Korean Zen traditions as well. Among the Tibetans, one was trained in the Gelug tradition, one in the Kagyu tradition, and two in the Nyingma tradition. Despite these distinctions in training, the teachers were quite eclectic and emphasized that basically they are Buddhists. The average number of years the teachers had meditated was 26 (range 14-50, median 22). The average number of years the teachers had taught meditation was 17 (range 2-40, median 15).. All teachers taught in a number of places and could only estimate the number of students that they had had. Their estimates ranged from a few hundred to 10,000. The oriental teachers taught in monasteries and temples in the East aswell as in a variety of settings in the West.

The four meditators were college-educated Westerners. Ages ranged from 30 to 48. Two had meditated intensively and were very involved in Buddhism (one in Zen and the other in Zen and Theravada) in the 1970’s. The other two were less involved with Buddhist groups and meditated more on their own. One had some exposure to Tibetan teachers and the other was trained in TM.

To present the results, I will first focus on teacher interview data and then describe the experience of each of the meditators.

What the Teachers Said

Buddhist Terminology

A Theravada teacher said that there are many Pali words to describe phenomena that hinder realization of nirvana (ultimate reality), including nimitta, asava, mara, and upakilesa. He generally uses the term nimitta to describe phenomena involving non—ordinary states of mind that arise in meditation, such as hallucinations, delusions, and intense emotional states. The Zen teachers use the Japanese word makyo for these phenomena. One also spoke of mara, which refers to the fear, passion, and doubt that Buddha had to overcome prior to enlightenment. A Tibetan teacher said that in Tibetan, Sems ‘Khrul pa is used for mental error and sMyon pa is used for crazy or mad.

Traditional Understanding and Training

Teachers noted that there is a paucity of formal training and traditional Buddhist literature that address psychosis. They have generally had to formulate their own ideas about it and learn from experience. Some have turned to Western psychology for help. ASC are more familiar territory to Buddhists and understood as phenomena of the mind that often occur in intensive meditation. The traditions vary some in their ways of dealing with ASC. Overall, Buddhism posits that everybody is deluded to a large extent:unaware of true reality and prone to attachment and aversion. Several Theravadins said that their teachers would probably understand psychosis as occurring when there are no spaces or gaps in the mind and the person has a very deluded, abnormal identification with the phenomena coming up. Tradition may posit that there are different realms of existence and that one can go crazy when glimpsing another realm. There are also traditional stories of people going “mad with grief” and receiving help from Buddhist teaching. They said that their teachers did not say much about handling psychosis. One suggested turning to metta or loving—kindness meditation, and in Burma, burning eye drops are used to shock someone out of a psychotic state. In the East, there is also a system of beliefs about demon possession, and exorcism may be used with psychotic people.

One Theravadin noted that there are different reasons for psychosis, some related to meditation, some to karma (consequences of prior behavior), and some to external stress. Nimitta (ASC) can arise from hindrances, defilements, and excess concentration. This Theravadin’s teachers taught him how to manage meditation-related difficulties and recommended more frequent interviews with troubled students. He also learned from experience.

Several Zen teachers noted that unstable people were not allowed to practice in Japan and that their teachers did not have much experience or training in dealing with psychosis. Two mentioned that Zen master Hakuin (1689—1769) perhaps had a nervous breakdown due to strenuous practices and warned that certain practices could lead to “meditation sickness.” Three said that makyo (ASC) is believed to be caused by improper posture and lack of unification in mind and body. One believed that makyo is related to the ego’s fight to preserve its reality and involves other layers of the mind surfacing as the usual discursive mind calms down. Another teacher, who has studied the biochemical basis for psychosis, thought that factors such as prolonged pain and lack of sleep and food can generate makyo and psychosis.

The Tibetan teachers varied in their responses. They all referred to Tibetan ideas regarding an incorrect flow of wind or energy in the energy channels of the body. “Energy/mind, like a horseman on a horse, should flow in certain channels, and one can become crazy when mind is riding on energy that is misdirected.” One said that psychotic states are believed to arise from health imbalances created by things such as lack of sleep, poor diet, and stress, not meditation. Another said that meditation-related psychosis can occur in some advanced concentrative and Tantric practices. In Tantric literature, there is discussion of people going crazy with certain meditations using energy and energy channels directly. Another teacher said that his teacher believed that so-called insane people have perhaps “sprung” their habitual mind in a way that opens their awakened mind. Confusion is a basis for the awakened mind and has to be brought out fully to cut through habitual mind and its pride and get to the root of existence.

In sum, teachers cite a number of traditional views about the causes of ASC and psychosis, including improper meditation practices, defilements and ego attachments, incorrect flow of energy in the body, and factors not related to meditation, such as health imbalances and demon possession. One teacher viewed psychosis as a potential avenue to awakening.

Occurrence of Psychosis and ASC

All teachers reported that psychotic breaks are rare during meditation. Some estimated that they occur in far less than 1% of meditators. Altogether they reported personal knowledge of 20 cases where breaks occurred, and at least half of those involved relatively brief episodes. For many teachers, issues about how to work with people who are already mentally unstable were more salient than breaks resulting from initiation of meditation practices. Two oriental teachers thought that meditation—related psychosis is more common in Buddhist countries where people believe in reincarnation and rebirth and strive hard to realize enlightenment. One said that neither he nor his students were sufficiently serious at meditating to be in danger of a break. The other said that Westerners do not go as deep or practice as long as people in the East. Also, they tend to give up when they encounter difficulty. The idea that Westerners are generally beginners was also supported by the statistics of a Zen teacher who said that approximately 90% of his students (who have to be motivated, sincere seekers to become students) are at the first two stages of practice depicted by the ox—herding pictures.

Almost all teachers said that ASC are relatively common and occur in almost everyone who meditates intensively. Some Theravadins said that during a long retreat (three months), about half the students experience ASC. The teachers themselves reported a range of personal experience with ASC: Some had minor experience while others had intense and more prolonged experience. None felt close to having a psychotic break, but a few struggled with personal issues and emotional states that interfered with their ability to meditate over a substantial period of time. One teacher emphasized that practice is usually boring, and seekers of ASC should look elsewhere!

The question of when psychosis and ASC are most likely to occur brought differing responses. In some teachers’ experience, psychotic breaks occurred as early as the first day of meditation and only in beginning students. Others said that the breaks they knew about occurred during intensive meditation and at more advanced stages of practice. These seemed related to overexertion and excess concentration. One teacher knew about a few cases where the break occurred after an intensive retreat. He noted that students are generally more vulnerable and open after retreats and some become over stimulated and depressed when they reenter ordinary life. Teachers who began screening for prior psychiatric history noted that screening virtually eliminated early breaks. This suggests that people who have a major mental illness, such as schizophrenia or bipolar disorder, are the main students who encounter difficulties with initial meditation practices.

As to ASC, the Theravadins said that ASC are more likely when practice is deepening than at the very beginning. If one cannot observe and realize these states as empty, one will return to them and cannot progress. (See Namto, 1989 and Sayadaw, 1971 for more specific information. They are more frequent and strong when concentration is strong and mindfulness is relatively weak. One teacher said that they do not occur with moment-to-moment concentration (khanikasamadhi), but can occur between access concentration (upacarasamadhi) and full absorption (appanasamadhi).

Zen teachers also correlated ASC with deepening concentration and practice and viewed them as a sign of progress. Those who use the Ox-herding pictures to represent stages of practice said that ASO tend to occur most in students at the first or second stage during longer retreats. One said that if they occur at later stages, they are weaker and the student relates to them more easily as though they were any other thought. Another teacher said that ASC at earlier stages may involve memories, hallucinations, and creative ideas. ASC discontinue with further practice and do not reappear until just before awakening. Those ASC may be very positive and alluring in that they involve religious symbols and blissful feelings. Or, they may involve great doubt and fear. He also observed that experienced students tend to absorb ASC energy in a retreat, thereby lessening the frequency of occurrence and intensity of ASC. ASC tend to increase with an increase in the number of inexperienced meditators.

The Tibetan teachers varied in their responses perhaps because of differing definitions regarding psychosis and ASC. One did not cite any stages of practice, but said that meditation gradually brings greater awareness, less self-absorption, and more precise functioning in the world.

He did not know of anyone who had difficulties with ASC or psychosis during meditation, but did talk of helping students understand their mind so that they are not tormented and controlled by the unconscious mind. Another teacher said that ASC (visions for a few and more commonly unusual experiences such as telepathy) tend to occur most in preliminary (pre-access level) concentration, but that he has known of two people who may have bordered on psychosis at higher levels of concentration. Priti or the energy factor of absorption is quite common at higher levels. Another teacher said that ASC are not common and usually only occur with serious retreat meditation, which involves meditating throughout the day with only short breaks for eating and sleeping. Also, in Tantric visualization practices, one can have spiritual visions that may be either psychotic or genuine. Another teacher said that ASC can occur at any stage of practice, but in his experience, they have been most intense and bordered on psychosis during intensive (solitary) retreats involving advanced Vajrayana practices (Ngondro practices outlined above), which deliberately provoke a great deal of resistance and confusion.

In sum, meditation—related psychosis is rare while meditation-related ASC are fairly common. Psychosis can occur at any stage of practice. At initial stages, it can occur in people who have been psychotic before. In more advanced meditators, it is usually related to excess concentration and overexertion. It can also occur after a retreat because of difficulties in reentering society. ASC generally occurs in initial stages when concentration is deepening. Initial ASC may involve hallucinations, memories, and creative ideas. “Preawakening” ASC may involve more extreme states and either be very pleasurable or fearful.

Differentiation of ASC and Psychosis

Because some ASC can seem psychotic-like in content, how do teachers differentiate them from psychosis? Some teachers did not like to use “psychotic” to refer to ASC and emphasized that all phenomena experienced in meditation are just phenomena. Psychotic refers more to th type of relationship a person has with the phenomena. Generally, teachers defined psychosis as a problem of over identification with phenomena and inability to disidentify and let go. The psychotic person overvalues his/her version of reality, thinks it is truth, and can not look at it from a different perspective. Also, psychosis involves losing the ability to function and respond ir normal ways. One is disoriented, confused, and unable to control the mind to return to the correct way of practice. Two Zen teachers noted that samadhi can involve a loss of functioning that can last from minutes to hours. In that state, the person just sits, unaware of time going by. Kensho (breakthrough) can also create temporary dysfunction and be an object of over identification. One teacher added that there are non-psychotic forms of obsession too. He thought that perhaps non- psychotic people experience more sadness and moments of clarity whereas psychotic people have more rage and self-pity. A Tibetan teacher noted that with Tantric visualization practice, it is sometimes difficult to distinguish a psychotic episode from an actual spiritual vision. A key factor is the humility with which the person approaches the experience. One also needs a good teacher to be able to understand the experience.

Several teachers said that they have an intuitive sense of psychosis. They practice meditation, have experience of ASC and the process, and hopefully have a deep, clear awareness so that they can easily know a student’s state of mind. One teacher reported that when assessing students, he considers overall social and psychological functioning in line with Western diagnostic criteria for mental illness. In sum, teachers generally differentiate ASC from psychosis by assessing the meditator’s degree of identification with the phenomena and ability to function in ordinary ways.

Forewarning Symptoms.

Teachers cited a number of signs that alert them to student difficulties and the possibility of a psychotic break. In accord with their definition of psychosis, a primary sign is extreme obsessiveness, i.e., the student cannot let go of an idea, feeling, or experience. In some cases, the feeling involves overwhelming self-judgment and guilt or fear. In other cases, the student believes s/he is enlightened. Other cases involve suicidal preoccupation or psychotic—like symptoms such as thought insertion, bizarre delusions, auditory command hallucinations, and social withdrawal. Teachers noted that difficulties in following retreat structure and rules can also be risk indicators. Generally, teachers observe, talk with, and know students fairly well and can tell when someone’s behavior changes for the worse (e.g., has trouble with hygiene, poor eye contact, and aberrant speech or actions.) Difficulties are often noticed by others as well and reported to the teacher. Zen teachers in particular emphasized the behavioral aspect of functioning and said that aberrant behavior is conspicuous in the austere, formalized milieu of Zen retreats.

Several teachers said that students having difficulty often seek help and report fear of going crazy. Two Theravadins said that they treat this fear seriously, whereas when they first began teaching, they told the student to just mentally note the feeling. Another Theravadin said that nimitta (ASC) is more negative and seems more dangerous to those in danger of psychosis, He finds that these students may think about going crazy, think of people they know who are crazy, or think of bad events when they lose the object of mindfulness. Some students practice well during the day, but then have a bad dream and wake up feeling badly and cannot continue with mindfulness practice. Paranoia and hallucinations of ghosts may also arise. A Zen teacher also noted that he becomes concerned if makyo (ASC) is intense and extreme and paralyzes a person or if a person becomes extremely fearful or traumatized.

Finally, one Tibetan teacher noted that psychotic people may incorporate Buddhist doctrine into a delusional system. He added that besides extreme identification with phenomena, extreme disidentification can occur. Some students misunderstand the Buddhist doctrine of “no-self,” meditate in a way to disidentify with their experience, and thereby cultivate a withdrawn, emotionally disconnected “schizoid” state.

In sum, teachers generally cited obsessiveness with ASC, more negative and fearful ASC, aberrant behavior, and “schizoid” states as signs that psychosis may occur. Assessing Vulnerability

Teachers were asked if some people seem more prone than others to psychosis, and if so, how they would characterize them. Almost all the teachers noted that people who have had prior psychotic episodes are more prone to psychosis and need to be monitored and guided carefully if they medicate. One teacher noted that such students tend to meditate incorrectly and thereby generate more unusual experiences. Many teachers now ask about psychological and medical history when someone is applying for an extended retreat (one week in Zen; three months in Theravada). Others try to interview students they do not know before a retreat or at the very beginning to assess and instruct. Some require outside professional approval for participation in retreats when a person has a serious mental illness. Some centers have an extensive membership screening process involving questionnaires (see Appendix C for sample questions), interviews, and trial membership to assess student motivation and suitability for practice. More informal assessment (as needed) is done for day—long or weekend retreats. The use of screening questionnaires xas been especially helpful to those who do not know their students well because they have a large number of students and are itinerant teachers. A Theravadin who works with only a few students at a time does not use a questionnaire, but spends the first three days of a long retreat becoming acquainted, assessing student temperament and needs, and teaching the fundamentals of Buddhism and practice. Teachers who use questionnaires report that their screening procedures have virtually eliminated the incidence of psychosis although a few students lied about their history and encountered some difficulties. They think that the screening may foster a self-selection process.

As to people who do no have prior psychiatric history, teachers were less sure about how to assess vulnerability. One, who is also a mental health professional, wrote a guide about psychiatric states for the meditation instructors in his organization. He believes that many Western students are fragile to some extent and that instructors vary in their understanding of psychology. Some teachers thought that withdrawn students who seem fragile, lack confidence, and cannot relate very well are more prone, but one noted that he knows of several high—functioning, articulate, and humorous people who had brief episodes during intensive retreat. In line with the notion that excess effort causes imbalance, a Theravadin noted that people who are overly ambitious and zealous encounter difficulties. Their ego is too involved in progress and they have trouble being mindful. More balanced people who are neither lazy nor overzealous and who are persistent and intelligent tend to have the easiest process. Some teachers thought that people who are more psychic and intuitive and people who are more emotionally volatile, anxious, and high-strung have more intense, frequent ASC. On the other hand, lack of anxiety before an intensive retreat may signal trouble. A Zen teacher observed that people who have a clear appreciation of themselves and are grounded can observe makyo (ASC) without being repulsed or drawn in by it. He also noted that fragile people usually cannot focus well enough to reach the level of practice where makyo appear.

In sum, screening by asking about prior psychiatric history has helped eliminate difficulties in people who have had prior psychotic episodes. Teachers varied in how they assess vulnerability in students who have no psychiatric history. Overall, imbalances in effort and anxiety seem to be factors indicative of vulnerability.

Responses to Vulnerability

General style of teaching.

Most teachers said that their style of teaching varies depending on the personality and needs of a student. In other words, with some students they are gentle and moderate while with others they are demanding and rigorous. Three of the four Tibetans, on the other hand, said that they take a solely gentle, moderate approach. They emphasized that forcing anything, including meditation, creates problems. One said that he does not expect much from his students because they basically want information, not a lifelong commitment to a tradition that is intellectual and involves years of philosophical study. To him, it is sufficient that students develop a slightly more wholesome mind. If one can reduce harmful attitudes towards others and see the faults of desire, that in and of itself is something good.” Another said that meditation can be powerful and people need psychological integration and a supportive social context to deal with its effects. He emphasized that spiritual development is gradual, about the cultivation of wisdom and compassion, and not about the “appropriation of experiences into a fragile ego—structure.”

Two Theravadins said that when they began teaching, they were more zealous and demanding than they are currently. They noted that Western teachers tend to be more moderate than oriental teachers and that one of their oriental teachers became less pushy after having some bad experiences with Western students. A Zen teacher likewise noted that he has become more moderate. He was trained in the 1970’s during the “heyday” of a “macho, samurai” style of Zen in which people were beat with the encouragement stick (kyosaku) and pushed to throw themselves away and breakthrough. He said that such approach led to shaking, screaming, crying, and more intense makyo (ASC). He now believes that such approach leads to kenshos (breakthroughs) that are premature, and he uses a softer, more “feminine” approach balanced with an intense, disciplined atmosphere. The kyosaku is used at the request of the sitter to ward off sleep, arouse energy, and help concentration, and retreats are much quieter. Another Zen teacher said that he believes that a. “mist” approach penetrates more and lasts longer than a “thunderstorm” approach.

When walking in a mist, you keep walking and at one point notice that you are wet; whereas, wetness from a thunderstorm happens quickly and also dries up quickly. He said that he first practiced with an “Iron Mountain” approach of cutting off all thoughts and focusing one-pointedly. Now, practice is more “like the ocean-absorbing and purifying all.” All can be brought to practice. He said that some students need to be pushed, however, and some need to develop concentration with a one-pointed approach. He emphasized the importance of knowing and having a relationship with students. He also noted that there is more energy and intensity in retreats where students are used to sitting together and know the procedures.

In sum, teachers have generally become more moderate in their style of teaching as they have worked with Western students. Most also advocate knowing students and tailoring practice to their needs and character.

Variation in practice.

Almost all teachers said that they tell a student to discontinue meditation if s/he seems imminently psychotic. They may ask the student to leave the retreat or have the student removed or observed. Some pursued psychological evaluation and facilitated hospitalization in the past, and said they would do so again if necessary. Several noted that they consult with mental health professionals who are members of their center about psychological issues and often recommend therapy for students with difficulties. Two Asian teachers distinguished between meditation-related psychosis and general psychosis. A Tibetan said that one should consult with a meditation expert regarding the former. Generally, it is due to overexertion and pressing on when it is inappropriate, so the remedy is to stop meditating and relax. A Theravadin said that when psychosis is from the practice, he has the student focus on it as the object of mindfulness. If s/he cannot do that, he may try to get at the deeper meaning of the problem or change the object of mindfulness. When psychosis is caused by other factors, those need to be addressed. He suggested that some psychotic people have to live out their karma and cannot be helped through meditation practice.

Teachers reported a number of strategies that they use with students who are experiencing ASC. They generally reassure students that such phenomena happen, will pass, and are a sign of deepening practice. They note that others, including Buddha, have gone through such experiences. They also try to help the student to just observe the experience without denying, rejecting, or indulging it. Such approach allows it to pass. Most teachers also label the phenomena (as nimitta or makyo) and teach that it is illusory, impermanent, and not the “truth.” Some make light of ASC that students mistake for enlightenment experience. Some said that they try to be supportive if memories of trauma emerge, however.

In Theravada retreats, teachers instruct about “mindfulness in the present moment” and to “touch and let go” or “focus and forget.” In beginning stages of practice, they may have the student “mentally note” the experience; e.g., if a students sees lights, s/he notes “seeing” without getting caught up in the content. In intermediate stages, the student drops conceptualization and uses “bare attention” mindfulness.

Some Zen teachers tell students that incorrect posture and breathing creates makyo (ASC) and instruct them to correct their posture and return to natural breathing. One teacher said that he checks if the makyo is created by prolonged pain or lack of sleep or food, and if so, he will correct those problems. Another said that he has repentance ceremonies for those who are caught in tremendous feelings of remorse and guilt. Another noted that with increased experience and confidence, he relies more on spontaneous, intuitive responses. For example, he may touch or speak to someone who appears to be leaving his/her body or is frozen in some way.

One Tibetan teacher emphasized taking care of health imbalances, such as those due to lack of sleep, poor diet, and stress. He has students start with a short practice and gradually increase time as they gain insight, so has not encountered difficulties with ASC. Another Tibetan teacher said that advanced practices are meant to provoke confusion, and confusion is a sign of correct practice. He tries to help people find a balance between withstanding discomfort and knowing their limits so that they do not damage themselves.

If ASC become extreme arid the student seems paralyzed, other measures are taken. Most teachers advocate mindfulness and put less emphasis on concentration. Theravadins try to get the student to return to body- mindfulness. One Theravadin said that he uses Taungpulu Sayadaw’s technique of concentrating on 32 parts of the body with students who are too egotistically involved. When ASC are due to excess concentration, he has the student observe what is presently happening and what was immediately preceding that. This increases mindfulness, and they can work on what was preventing mindfulness from arising. Some Zen teachers switch students from koan practice, which is highly concentrative and tends to suppress unconscious material, to shikantaza practice or a gentle breath practice, which allows material to emerge more naturally. Generally, teachers tell students to lighten up, which for some means to just watch the mind without judgment and effort to practice. Teachers also may have more frequent interviews with the student, decrease the student’s sitting time, and involve the student in “grounding” activities, such as work, “108 bows” practice, and physical exercise. Some Theravadins have found acupuncture helpful; there have been students who were able to complete retreat after a few treatments. They sometimes also recommend eating meat and pasta. Zen teachers ask their monitors (senior student helpers) to attend to troubled students more diligently and carefully. One center gives advice about possible post-retreat problems to students who have had particularly intense experiences and calls them a few days after a retreat. One Tibetan teacher says that after an early tragic case where he was “polite” about bizarre behavior, he has become confrontive in pointing cut “craziness.” This is done in the context of an ongoing, caring relationship. A Theravadin teacher likewise may challenge a students “Who’s crazy? You or me? Why don’t I have problems if you think I’m wrong?”

In sum, teachers generally advocate discontinuing meditation when a student becomes psychotic. ASC are treated in a variety of ways. Initially, teachers try to help the student realize that ASC are just phenomena and not to be denied or indulged. If someone has difficulty letting ASC go, a variety of other measures are taken, including increasing mindfulness and physical awareness and activity and decreasing exertion. Some teachers confront the “craziness” of the student.

Working with the mentally ill.

All of the teachers except two have worked with people who have an identified major mental illness and who participate in their centers in some fashion. While these people experience difficulties with meditation and often do not continue practice, a small percent remain involved. Some drop in and out of participation while a few become more integrally involved. Several teachers speculated that they do so in part because of their search for relief from suffering and wish for a caring, safe community. The structure of Buddhist community life and practice seems to help some.

Generally, it seems that teachers have become more psychologically sophisticated and aware of the difficulties mentally ill people encounter with meditation, and they try to carefully monitor their meditation practice. Usually, they prescribe initial mindful breathing and shikantaza-like practices. Also, they do not allow participation in retreats that extend beyond two days. Some have consulted with mental health professionals and family members and made sure the person was taking prescribed medication. One Zen teacher described a bad experience of becoming moreof a social worker than a teacher, however. One of his students who was highly involved in their center decompensated. The teacher sought professional advice, had the student pursue treatment, and drastically reduced his involvement. The student committed suicide, and the teacher regrets that he did not heed the student’s observation that meditating helped him keep track of reality. One Theravadin said that he was able to help stabilize two disturbed artists in month-long retreats because they could cooperate with him. A Theravadin and a Tibetan also mentioned the use of metta or loving-kindness meditation. The Theravadin said that he mentally sends troubled people metta. The Tibetan taught a bipolar woman initial mindfulness of breath practices for relaxation and stability and initial metta meditation to cultivate feelings of kindness towards herself. She reported that the practice was beneficial and she had no manic episodes after adopting it.

In sum, teachers have found ways to work with the mentally unstable by utilizing gentle, initial meditation practices and carefully monitoring those. Some find metta meditation helpful.

Summary of Teacher Responses

Teachers vary some in their understanding of and responses to psychosis and ASC that emerge in meditation, and the variation occurs among and between the different traditions. But, there are also major similarities. When a student becomes psychotic, i.e, extremely identified with meditative phenomena and unable to function in ordinary ways, teachers generally have the student discontinue meditation. Some turn to mental health professionals and Western psychology for help in this arena. Teachers varied in their responses as to when psychosis occurs in the meditative process. This variance can be explained by differentiating true meditation-related psychosis (which occurs at advanced stages and is often related to excess effort) and psychosis that occurs in people prone to psychosis. The latter psychosis can occur in early stages and is related to the meditator’s inability to use meditation to stabilize the mind when primary process phenomena become more salient.

As to ASC, most teachers recognized the link between concentration and ASC and the need for a balanced approach to practice. All teachers teach students that ASC are just phenomena and not something to be rejected or indulged. Theravadins generally focus on increasing mindfulness as an antidote to excess concentration. Some Zen teachers likewise switch students from intense concentrative practices to more gentle mindfulness kinds of practices. They also emphasize correct posture and breathing. Three Tibetans advocated moderation and a gradual development of meditative skill while one noted the value of evoking confusion at advanced stages of practice. He tries to help students go beyond their normal safety without hurting themselves. Generally, when ASC become extremely problematic, teachers advocate discontinuing meditation.

Many teachers have developed screening procedures so that they can be aware of people who are prone to psychosis. These procedures involve asking about psychiatric history. People who are vulnerable to difficulties, but have not had prior psychosis are more difficult to assess. Teachers varied in their views as to personality types that might be more likely to encounter problems with meditation. Generally, imbalances in effort and anxiety were risk indicators.

Meditator Experience (Four Vignettes)

The following vignettes sketch the experience of four meditators who encountered difficulties with their practice of meditation. None of these meditators actually experienced a psychotic episode while at a Buddhist retreat, but rather in other settings or uses of meditation. Each illustrates a type of personality, experience, and difficulty that may resemble those of many students who become involved in Buddhist meditation and go on to have problems with meditation. It is unknown if these meditators are prototypical, however, due to the small number of subjects and lack of random sampling procedures. The vignettes depict real experiences and history, but identifying information has been changed to protect confidentiality.

Cracking the Shell: Quest of Unravelling

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

Mara began working odd jobs, such as house-cleaning, and participating in all activities offered by a Zen Center. She attended morning and evening sittings, all-night sittings, and seven-day retreats. The center she attended was large, and she was “just another person” and a beginner, which meant that she did not have any duties or positions. The center had hierarchical layers of students with senior students having major roles in training. Those who had “broken through” wore a rakusu (rectangle of cloth held by strips of cloth around the neck.) The center was Rinzai in approach, and the attitude was that the harder one worked, the longer and more one—pointedly one focused in meditation (for beginners, this usually involved the koan “Mu”), the more likely one would experience kensho (breakthrough). There was an “all or nothing” attitude and people were encouraged to go to the extreme. The teacher, who had been trained in Japan, was generally distant and formal. Mara admired him greatly from afar. They did not know each other well. She only met with him in “dokusan” (interviews held during retreats where the teacher guides and tests the student’s progress). During dokusan, he questioned her penetration of Mu.

Mara does not remember whether students were screened in terms of their ability to handle meditation (this was in the mid-1970’s). She said that not everybody was allowed to attend retreats: One had to be a good and devoted sitter. She never felt that there was a risk in sitting strenuously and sat at least two hours a day when not in retreat. She said that she never had any problems with meditating until the retreat that preceded her psychotic episode. That retreat occurred after she had seriously meditated for a year and a half. It was a seven-day retreat and followed another seven—day retreat that had ended a week before.

The retreat was intense. Mara meditated day and night with breaks for meals, chanting, work, and rest during the day and breaks for juice at night. She said that she was able to sit full—lotus, which was amazing and perhaps supported by the high energy level in the zendo (meditation hall). She did not experience pain and was fiercely intent on going deeper and breaking through. She said that she had intense makyo (ASC), but did not fear going crazy. The makyo involved mostly positive imagery except near the end, when there were demon-like faces. She also experienced going down a shaft in her mind and opening doors to different realities. And at the end, she experienced an overwhelming sense of holiness and felt she had tapped into universal mind. She was able to let the makyo go, and by the end of the retreat, was sure she had broken through as she could answer most of the teacher’s questions in dokusan and he hugged her and seemed to appreciate her experience.

Following the retreat, she told others that she had broken through, and word got back to the teacher. He told her that she had not broken through. She thought he just wanted her to go deeper. During the week following the retreat, she experienced being like a bird in an egg, tapping to get out, and suddenly she heard tapping from the other side. She felt that God was revealing Himself and tapping to free her, and she was ready to “throw herself into the fire of consciousness to break through to His love.” She realized that this seemed more theistic than Buddhist and was excited that there was something out there working on her too. That was when she consciously decided to let her mind go, allowing it to go “crazy.” After that point, everything seemed symbolic with cosmological dimensions, and she found her mind racing, trying to figure everything out. She thought and thought in her quest and wandered around looking for her teacher, who she believed was God. Finally, she was hospitalized and received huge doses of antipsychotic medication.

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

Mara’s experience in the mental health system was taxing. It seemed that few understood her experience and most were condescending and perhaps needed to see her as sick and themselves as healthy. She felt that her mind was unravelling, all the major fears, desires and “skeletons from the past” emerging into consciousness. She was helped most by a Buddhist psychiatrist who acknowledged that her experience was valuable, valued the spiritual dimension, and grounded her with medication and questions about mundane things when she became carried away with ideas.

Mara received a diagnosis of schizophrenia. She is unsure about this diagnosis. She assumes that she has some genetic, biochemical proclivity for psychosis and says that her lack of control over the unravelling seemed like schizophrenia. But there was also the spiritual quest part and a release from past karma. She said that once the unravelling was complete, she felt more stable and at peace than ever before. She was able to discontinue antipsychotic medication.

Currently, Mara meditates for an hour a day. The meditation involves following the breath, thinking about things (not in the prior searching way), and listening to her inner life. She lives alone and tries to live simply and mindfully. She says that more intense meditation would probably be harmful. Her spirituality is closer to Christianity at this point, in part because of her experience of God tapping at her shell. She says that her spiritual vision is unique, personal, and somewhat mystical, and che does not share it with others.

Terror Alone: Snapping and Song Yet Unsung

Ada grew up in a “workaholic” home--too busy and striving to pay attention to the feelings of a little girl. Sweets were the soothers. Happy and good were the ways to be. A family story has it ,that as an infant, she was left to cry for hours. She remembers three times of terror as a young child when she did not know where she was while in a familiar place. Ecstatic experiences with intense, concentrated writing of poetry as a teenager offered her an avenue to a different type of consciousness.

Ada’s involvement in meditation began in 1967 with TM, which helped calm and balance her after a traumatic breakup with the “love of her life,” Paul. Nine months later she entered a year and a half practice of Vedanta, a form of Hindu mysticism, which involved meditating on a spiritual passage. Ada “upped the ante” after reading books (Watts, 1957 and Kapleau, 1965/1989) on Zen and became excited about depictions of enlightenment experience. She had brief exposure to two famous Japanese Zen masters in 1969 and began practicing in earnest after meeting another master in 1970. He became her “real teacher.” He was “dear and warm,” and she felt quite close to him. Also, Paul was back in her life and also excited about Zen. They sat and studied regularly with other meditators. Ada was quite involved in their group and helped organize retreats when their teacher visited from Japan. It was a “high” time in her life.

Ada was attracted to Rinzai Zen--its “intensity, high drama, and do or die effort.” It felt good to “bust her butt” and survive the pain of extended sitting. She does not remember the kind of practice her teacher taught, but she pushed herself to become enlightened. When he visited for the last time, she took his words to “just sit’ to heart. She had asked him what to do and was at a turning point in her career, i.e., she had to decide whether to become a professional singer and train in opera. Paul had also broken up with her. It seemed that if she became enlightened, her problems would be solved.

Ada quit singing to meditate full-time. When not in retreat, she began sitting at least four hours a day and otherwise noticing thoughts, letting them go, and coming back to the moment. She attended at least one extended retreat a month with various Buddhist teachers. She felt peaceful and loving, more like herself than ever before. She experienced veils falling from her eyes and “everything just as it is.” Yet, she still was unsure about what to do with her life. Others’ talk seemed trivial, and she could not relate as before, so she cut off relationships. She also discontinued therapy with a Buddhist psychologist after four months because it was not helping. In retrospect, she thinks that her practice was an evasion of painful feelings, which were going to make themselves known at some point.

After six months of such practice, Ada attended a ten-day Theravada retreat led by a well-known oriental teacher. This retreat involved concentration and mindfulness practices, which were mostly done while alone in one’s room. The teacher checked on each person in the morning and gave group talks. Ada experienced intense makyo (ASC) during the retreat: crackling electricity going up and down her spine and profound relaxation with early memories of hearing music and a drawer opening and seeing the peephole of a door. Near the end of the retreat, she woke to an “absolute state.” She knew that it was kensho because she could not have imagines anything like it. First was cosmic pulsation with everything flowing towards a single point and erupting through it back into the cosmos. Then appeared a sheet-like image with elements of reality floating. As she looked at them, she realized they were all her and that there was nothing in the universe except her. Rather than joy, she felt profound fear and loneliness. No one was there to help her. The next morning, her teacher responded, “Now you know that you’re afraid of being alone.” She wished for affirmation of her experience and advice.

After the retreat and during the month prior to her “breakdown,” she had another unbearable experience of loneliness. She also took LSD (for the third time in her life) and had a “terrifying trip” of disintegrating into bones. She willed herself out of that by telling herself she could refuse to accept it. She also was deeply “grabbed” by Janov’s “Primal Scream,” which gave her the idea that if she reached and released her primal energy, she would be free. Then something “snapped,” and she felt tremendous grief and a few days later, rage and terror. Only months later did she tie this snapping with her grief about losing Paul.

The next few years were like “heavy labor with no rest” and “being in a tunnel without light.” Ada could not talk about her pain and lostness and felt that people would lock her up if they knew how crazy she was. She reentered therapy with her prior therapist and tried everything else available as well: encounter and therapy groups, energy and body work, and Arica training (which involves meditation, yoga, body work, and psychological processing). The therapies never quite enabled her to reach and release the core of her difficulties. She also tried meditation and attended some retreats, but found that her energies were too high (feeling of levitating, etc.) to feel safe with meditation. She also did not know how to transition back into the world. She met with one-Zen teacher who was also a psychoanalyst, but was not able to heed therapeutic advice because she was too “freaked out.” This teacher affirmed her kensho experience and “ripe” concentration practice, but advised that she needed more balance-work, singing, and a light meditation practice. She did not continue to see this teacher due to a lack of emotional connection with her. Throughout this difficult period, there was one sign of hope: a dream of holding a tennis racket, which looked like an Ankh, Egyptian sign of life.

Twenty years later and after more attempts at therapy, Ada still struggles with her experience and her life. She believes that she has a borderline personality disorder. She agrees with Jack Engler’s (1986) idea that you cannot go beyond yourself until you have a self. She does not meditate much for fear of what might come up, but has worked some with a Vipassana teacher who meditated with her, demystified “enlightenment,” and gave feedback about her meditation. The technique of noticing what is prominent in the body and being with it helped with pain a few times and offered hope. Ada says that when she first practiced, teachers were not psychologically sophisticated and did not ask about students’ lives or process emotional issues. She believes that she could have benefited from a moderate, gentle practice and advice to work, sing, and learn how to relate better. “I needed someone to investigate my big hurry, terrible race towards enlightenment and to say that I was trying to run from something.” She believes that teachers are probably more sophisticated these days and teach differently.

Lost in Thought: 24 Hour Practice

Rose’s family history is positive for mental illness: two siblings suffered psychosis or suicidal impulses, and her father, a physician and medical researcher, is riddled with phobias and compulsions. Rose’s first psychotic episode occurred when she was 19, her second when she was 20. She says they were triggered by relationship stress involving family and two gestalt therapists who used her to work out their marital problems. The third occurred at age 37 and the fourth at age 39. These episodes related to not knowing her limits and becoming overextended and “lost” without realizing it. The last involved meditation, a “24-hour practice” as Rose calls it.

Rose first read a Buddhist book in her mid—20’s. She likes philosophy and thinking about mind and spirituality and is interested in other cultures, so she found Buddhism intellectually stimulating. Also, she felt frustrated with her psychosis and disliked the deadening effects of medication. She could see that TM helped a friend become less flighty and more able to be alone, and hoped that meditation would help her gain control of her mind and be more content with herself. She did not begin meditating until her mid— 30’s, however. At that time, stress over having a boyfriend in prison and exposure to Trungpa Rinpoche’s (1969) “Meditation in Action” prompted her to seek instruction. She was told to follow her breath while sitting comfortably and to label any thoughts that arose as “thinking” and return to her breath.

Rose had two consecutive meditation instructors. She did not feel comfortable with either. One was too strict and pushy about a particular type of training. She felt too intensely about the other and worried that she was insensitive to him. In general, she feels hemmed in and controlled by others’ instructions. She ended up meditating on her own with the little practice she had been given. She practiced at most three hours a week and generally did not meditate every day or at the same time.

Rose met a teacher who she really liked five years after starting meditation. This teacher was Tibetan and seemed to know what he was doing. He was not pushy about the practice. He was careful about the effect of his words and would stop if someone said he was going too far. He also tolerated doubt and skepticism; he wanted people to think for themselves. She went to a weekend retreat that he led and was interviewed by him once after the retreat. Her only strange experience was before the interview. She felt driven to get up nerve to have an interview and experienced seeing a series of faces as she looked in a mirror. She had an “ordinary, down-to-earth conversation” with the teacher and did not mention the faces, however.

Rose says that she did not tell any of her teachers about her prior psychotic episodes, and she felt stressed by her memory of them. The teachers may have known about them through her therapist, but they did not mention them. Her goal to overcome psychosis through meditation was never clarified.

The Tibetan teacher emphasized a “24-hour” practice of mindfulness as well as sitting meditation. This appealed to Rose and she adopted a kind of practice where she would sit for hours and let her mind wander while half noticing her breath and other things. She discontinued her antipsychotic medication on her own a few months after the retreat.. Later, she was working less, and so had less structure and contact with people. Also, due to a foot injury, she lost her usual way of stabilizing her mind: running. (She finds that physical exercise relaxes her and slows her mind so that thoughts come more gradually and are more to the point.) She also became very upset about the L.A. riots. Around the same time, she saw another face in the mirror and bega: having intense spiritual fantasies involving reincarnation and Christian symbols. Fantasies became more important than details of everyday life, and psychologically sophisticated and did not ask about students’ lives or process emotional issues. She believes that she could have benefited from a moderate, gentle practice and advice to work, sing, and learn how to relate better. “I needed someone to investigate my big hurry, terrible race towards enlightenment and to say that I was trying to run from something.” She believes that teachers are probably more sophisticated these days and teach differently.

She lacked her usual awareness and fear that she was going too far. Her break occurred about six months after the retreat.

Rose was hospitalized and resumed medication, Her diagnosis has been paranoid schizophrenia. She finds the diagnosis hurtful and limiting. It labels her as being different and “all washed up” and does not help her get close to people. It a’so puts pressure on her to become well and “enlightened..” “Psychosis does not mean you’re better or worse than others; it’s just what has happenod o a person in her life.”

Rose is now using a Yoga relaxation tape for her practice. It involves relaxing different parts of the body and helps her go to sleep. She thinks about seeing the Tibetan teacher again, but does not feel ready to answer questions about why she wants to meditate and see him. Her spirituality is private. She is trying to regain her sense of wonder. She is trying to come to an acceptance of what happened to her and to get away from the compulsion to feel like everybody else.

ASC Seeker: Roller—Coaster Ride

Chad’s childhood was not sublime. His mother was alcoholic, moody, and sexually abusive, and his father suffered from depression and eventually suicide after six years of hospitalizations, electroshock therapy, and various medications.

Chad began abusing substances and cutting on himself at age 17. He started with marijuana and alcohol, and went on to hallucinogenic mushrooms and LSD (he did the latter two 15-20 times while in college.) He says that he was always seeking expanded states of consciousness and felt extremely inadequate socially and sexually. The self-mutilation was a way to access hateful, aggressive parts of himself, control rape fantasies, bleed off the intensity of suicidal feelings, and stay present in his body.

At age 18, Chad was trained in TM, which offered escape from ordinary reality. Meditation was a “practical, self—accessed route to intense, far-reaching states of peace, lightness, and timelessness.” He also tried to use it as a substitute for substance abuse and self-mutilation. Later, writing, yoga, weight-lifting, and rock-climbing offered alternative ‘addictions’. He described himself as “always looking for a way out of myself, burning up the options, looking for alternatives to quell the inner void.”

Other than TM training, living at a yoga ashram, and picking up ideas from reading and local people, Chad learned to meditate on his own. He began with the usual TM mantra and schedule (20 minutes, twice a day). Later, when more into self-mutilating episodes, he meditated one to two hours a day and used a mindfulness of breath practice as a way to control his impulses. He also added visualizations to his repertoire.

Chad feels adept at reaching ASC through meditation. He says that he has experienced releases of kundalini (psychospiritual energy; see Sannella, 1976/1992), activated chakras (centers of energy in the body as depicted in Yogic philosophy), past lives, and levels of absorption where sensory input is substantially decreased. He would feel that a breakthrough was imminent while meditating, but then “crash and burn” when he tried to carry on with the rest of his life.

After reading the “Diagnostic and Statistical Manual of Mental Disorders,” Chad diagnosed himself as having a bipolar disorder (manic depression) and post-traumatic stress disorder. Currently, he is in “Alaya” therapy, which involves mindfulness of breath and body. He is working at experiencing his emotions directly and increasing awareness of anxiety and impulses. as they manifest in his body, so that he can do something healthy rather than go through a cycle of destructive behavior., He meditates 40 minutes, twice a day using a breath practice. He also talks with friends and has seen channelers for “aura cleansing.” He is trying to stay in the ‘here and now” and feels more grounded than ever before though life is a constant battle and roller coaster ride.

Discussion of Vignettes

The experiences of Mara and Ada illustrate problems that may emerge when one is zealous and focused solely on gaining enlightenment. It appears that the “Rinzai” milieu and enlightenment zeitgeist of the 1970’s influenced Mara’s and Ada’s perspectives and seemed to offer a solution to life’s problems. Also, teachers at that time were probably less psychologically sophisticated than they are today, and it appears that those who taught Mara and Ada did not understand their motivation to meditate in terms of personal history and personality wounds and organization.

Their dedication to practice and borderline to neurotic level of functioning enabled Mara and Ada to reach more advanced levels of concentration where “preawakening” makyo occurs. They both had powerful makyo experiences, and it appears that their personality structures could not integrate and let go of these. In -Buddhist thought, perhaps a person’s Hdefilements in terms of desire/attachment and fear/aversion manifest most strongly at these levels of practice. Mara’s desires to be special, understood, accepted, and adequate (narcissistic concerns) may have fueled her zeal and been major stumbling blocks in letting go of her sense of breakthrough. On the other hand, perhaps it was her ‘karma” to open the doors of her mind and let the unconscious become conscious (she seemed to have some observing ego in the process). In Ada’s case, preverbal borderline issues involving abandonment were activated, and she did not have the ego strength and defenses to metabolize the associated feelings.

Other explanations for the “breakdowns” involve biochemical imbalance, or in Tibetan thought, a pranic (energy) imbalance. Perhaps the intensity of their practices altered their brain chemistry to make them more sensitive to the influx of unconscious material. Ada’s LSD trip may have contributed as well. Or, perhaps their zeal and improper practices caused “rlung” imbalances as outlined in the Buddhist literature reviewed above.

Both “breakdowns” occurred after intensive retreats and both Mara and Ada were “too far gone” to utilize teacher help. Both also did not have any close relationships, a social network to which they could turn. These factors point to the importance of follow-up after intensive retreat experience and a trusting, somewhat intimate student-teacher relationship. Mara perhaps had an idealizing type of narcissistic transference to her teacher, who may have fostered such transferences in his distant, “Zen master” stance with students. Ada’s borderline tendencies may have resulted in idealizing/devaluing transferences that made intimate, ongoing relationships difficult. Her needs for affirmation and care were strong, so that she may have felt that no one could provide the right balance of understanding, acceptance, and guidance. Mara’s and Ada’s lack of social network suggest that teachers should encourage relational skills and the development of good relationships in students who cut themselves off from others.

Both Mara and Ada are currently wary about undertaking intensive practice. It appears that Mara benefits from the calming and organizing effects of a gentle breath and mindfulness practice. A mindfulness practice of noticing and being with body sensations offers Ada a means to explore and modulate emotions.

Rose’s experiences illustrate the problems of meditators who have had prior psychotic episodes. She pursued meditation as a way to control psychosis and gain freedom from medication and being “different.” Meditation was also feared as a possible inducer of psychosis. Her sensitivity, lack of trust in relationships (perhaps due to family history), and the lack of teacher awareness and responsiveness prevented discussion of this motivation and fear. Such lack of relationship is probably common in many people with major mental illness due to the nature of the illness and the stigma such illness involves. Mentally ill people could probably benefit from open discussion about their illness and from an increase in psychological knowledge on the part of teachers. Also, teachers can possibly enhance relationship by playing a supportive, warm role and offering clear, concrete guidance.

Chad’s experiences illustrate issues that may occur in addictive, traumatized people. Neditation as a “positive addiction” was sought as a mood and esteem elevator and as an escape from effects of trauma and depression, including patterns of acting t.pon destructive impulses. It paradoxically helped open and contain unconscious material related to trauma and sexual- aggressive impulses. It also became a way to try to master a bipolar cycle of inflation and deflation and contributed to that cycle. Similar to Rose, Chad’s family history may have impacted his ability to trust others and thereby prevented him from forming an ongoing relationship with a teacher.

Rose and Chad’s current meditative practices and Rose’s prior use of running suggest that practices involving physical awareness and activity can have a grounding, organizing effect in people with psychotic tendencies.


The teachers in this study have obviously struggled with the psychological difficulties of Western students and have already begun to synthesize Eastern and Western approaches to the mind. Overall, teachers have become more moderate and gentle in their approach to practice and more attuned to the need for psychological processing during the meditation process. They have also developed more efficient and sophisticated ways to assess meditators to prevent unstable meditators from becoming further destablized during practice. Finally, they exhibited a real concern and interest in working with people with major mental illness. For some, this concern means referring these people to mental health professionals and not assuming that they can help. For others, it means consulting with mental health professionals as they work with these students.

A number of conclusions can be drawn about psychosis and ASC during meditation. Psychosis is rare but can easily occur in people who have had prior psychotic episodes. Their personality organization and tendency to biochemical imbalance hinders development of concentration and mindfulness skills and promotes the likelihood of psychosis. Initial practice has a derepressive effect, and such individuals lack the defensive structure or modulatory capacities to deal adaptively with the “primary process” material that emerges. They may also lack relational skills and trust, so may have difficulty utilizing teacher help.

Psychotic episodes can also occur in people who have a borderline level of personality organization. These people can advance in meditation skill, but as deeper levels of concentration are achieved, they may begin to have difficulties witp ASC. Issues and deficits of wounded “self” and object- relationship structures can fuel their quest for enlightenment and make them overexert in their practice. Narcissistic grandiosity can be tapped with blissful “pseudo-nirvana’ experiences and kensho, and borderline terror of aloneness can be tapped with the passing away of experience and glimpses of “no-self” and interdependence. Although “breakdown” may not be immediate, their ASC experiences reverberate throughout their being and alter their sense of themselves and the world. Someone with narcissistic pathology may have trouble letting go of experience that validates an underlying sense of grandiosity. Someone with borderline pathology may have trouble modulating and integrating the powerful preverbal emotions that arise. Both may use a splitting defense (idealizing/devaluing) that hinders a realistic view of self and others and an ability to rely on a teacher for help.

True meditation-related psychosis is extremely rare and may be found more in countries where people are steeped in Buddhism and ardent and advanced in practice. Tibetans offer the most explanation for this psychosis in their discussion of body energy arid channels and factors that foster imbalance or improper flow of energy. Because overexertion in meditation is one of the major factors cited, one could hypothesize a link between psychosis and underlying narcissistic issues and vulnerabilities found at a borderline level of personality organization. In other words, narcissistic issues fuel the overexertion and borderline level organization hinder one’s ability to deal with the intense emotions activated at advanced levels of practice.

ASC are common meditative phenomena, but they do not occur in everybody. Their lack of occurrence may be due to a lack of advancement in meditative skills or to an unusual skill at maintaining proper posture and mindfulness. Teachers could not conclusively identify personality types that have problems with ASC, but they said that ASC are more intense and frequent in practices involving intense concentration and they signal a deepening of concentration as the usual discursive mind settles and “primary process” increases in saliency.

Problematic ASC can occur in initial and later stages of practice. Those at later stages tend to be more religious and powerful than at earlier stages, and they can resemble experiences of psychosis in content and emotion (religious, grandiose, and persecutory delusions and manic-depressive kinds of moods). Perhaps these “psychotic-like” phenomena are the bases for psychosis and mystical-experience. Whether someone becomes psychotic depends on “ego strength” or the ability to observe and integrate the experience in adaptable ways. Generally, a meditator at later stages of practice has developed enough concentration and mindfulness (or ‘ego strength) to counterbalance their effect. Teachers can also help with problematic ASC and have developed a variety of strategies to help people “let go” of ASC or in some cases (e.g., experience of Yidams in Tibetan tantric practice), not to let go but to understand and master the energy.


Although psychosis can be transformative for some people, generally it causes much suffering and disruption in functioning. Therefore, it behooves teachers to screen for and assess vulnerability and to monitor practices of meditators who are prone to psychosis. Screening is especially important when intensive meditation is involved, and it can be done relatively easily with a questionnaire that asks about psychiatric history. Assessing students as to borderline level of organization is more difficult than assessing psychotic level. Understanding some about a student’s history and relationships and using that as a context for understanding motivation regarding meditation may be helpful, especially with students who isolate and overexert. For example, has the student had a traumatic history in terms of abuse and neglect? Is the student driven by a great need to feel accepted and adequate? Also, in assessing the saliency of narcissistic-borderline issues, it may help to understand the kind of transference a student brings to the student-teacher relationship.

Approaches and practices that may be useful differ at the different levels of personality organization. At the psychotic level, a sensitive, supportive, understanding, concrete, clear, and direct approach is advisable. Such approach and linking specific psychological issues with the selection of a meditation practice may decrease anxiety and improve the chances of a good working relationship People prone to psychosis may need extra instruction and monitoring of their meditation. Gentle body, breath and mindfulness practices done for short periods of time seem to be the practices of choice. One may also opt to promote medication compliance (see Epstein, 1993). Increasing community understanding and acceptance of mental illness may also be helpful as a way to engage and support those vulnerable to mental breakdowns and estrangement.

At a borderline level of organization (which may be fairly common in Western students), it is important to promote development of a healthy “ego” and sense of self, one that is not so vulnerable to cycles of inflation and deflation and fragmentation.

In cerms of meditation, initial breath practices may be useful as a calming skill for those who have difficulty modulating emotions. Shikantaza practice may aid in development of an “observing ego” and integration of personality aspects and memories. Some vipassana techniques, such as noticing salient body sensations and emotions, may also be useful. Moreover metta meditation can perhaps aid some individuals in developing a kinder attitude towards themselves. When it seems that material arising in meditation becomes too intense, physical activity or a break from meditation may be indicatec.. Outside of retreat, acupuncture and psychotherapy may be helpful when a student becomes too imbalanced.

In terms of student-teacher relationship, teachers need be aware of transference phenomena. Transference exists in everybody and students naturally bring hopes and disappointments from their experiences in prior primary relationships to their relationship with a teacher. Everybody also has narcissistic issues, and most students are likely to idealize a teacher to some degree. This idealization can be a growthful process if students integrate some of the qualities that they project onto a teacher. (See Epstein, 1986, as to how meditation and Buddhism can address narcissism.) Extreme idealizing/devaluing transference, which involves a primitive splitting defense, can be very difficult and disruptive in a relationship. Teachers need to be wary of becoming caught up in their own narcissistic needs to be perfect, omnipotent, and omniscient. Because people at a borderline level tend to trigger strong emotional reactions in others, it is important to be aware of emotional reactivity and emotions and behaviors that seem different from one’s usual self. These can be clues as to what the student is experiencing and suffering and avenues for understanding.

Ego/self building can also be encouraged in terms of training that involves community (sangha) and morality (shila). The idea of developing and balancing all areas of life can be promoted in terms of the Eightfold Path (right understanding, intention, speech, action, livelihood, effort, mindfulness, and concentration) and Three Treasures (Buddha, Dharma, and Sangha). When students have difficulty with relationships, one could have them focus on practice in morality and community life. When they have difficulty with work and establishing a productive livelihood, they could be given a “work practice.” At the neurotic level of organization, students may experience emergence of psychotic and borderline level material and memories of past trauma in intense practice. If they cannot observe and let go and if processing the material with the teacher becomes too intense, psychotherapy may be indicated.

In sum, this study investigated problematic ASC and psychosis that occur in meditation. Theravada, Zen, and Tibetan Buddhist teachers and meditators were interviewed about their experiences and perspectives. Results suggest that meditation-related psychosis is rare, and it usually occurs with concentrative practices and overexertion. Psychosis that is not directly caused by meditation may occur in initial stages of practice in students who have had prior psychosis and who have difficulty following correct meditation practices. Students with a borderline level of personality organization may be able to develop meditation skills and advance in practice. They may encounter difficulties at more advanced stages of practice, however, because underlying narcissistic and borderline issues can be activated by the powerful ASC at those stages.

Teachers have developed a variety of ways to help students vulnerable to psychosis and problematic ASC. One is to do initial screening for prior psychiatric history so that people prone to psychosis can be more carefully monitored. Another is to prescribe initial concentrative-mindfulness types of practices with an emphasis on moderation and gradual development of skill. When a student becomes overwhelmed by ASC during meditation, teachers generally try to help the student observe and let go of the ASC. If that does not work, they may ask the student to discontinue meditation.

Psychological literature and the experience of Buddhists suggest that particular forms of meditation can be useful in helping students who are prone to psychosis and problematic ASC. In general, these practices involve using initial concentrative and mindfulness practices to decrease emotional reactivity and to increase the ability to observe one’s mind. Also, an attitude of kindness and acceptance toward oneself can be fostered. Finally, practice involving development of morality and community can be useful in addition to meditation because many meditators who have difficulties with meditation also have relationship and self-esteem problems.


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  1. Thank-you.

    This is an answer of answers. Glad to see a peer-reviewed scholarly article. Have to bookmark it, really deep

  2. Thankyou. Informative and beneficial to my practice. Something i have sought to have some insight into for years. Regards. mark

  3. Thanks for letting us know, and we are glad that it was beneficial to your practice.

  4. absolutely wonderful article and deeply refreshing to see something positive amidsts all the negative stuff here