After seeing multiple headlines about the dangers of meditation, Randy Rosenthal decided to investigate it for himself. Here’s what he found.
“How has Vipassana changed your life?”
This is a standard question on the student intake form for a Vipassana course in the S. N. Goenka tradition. For years, after taking my first ten-day retreat in 2003, I used to write a paragraph-long answer describing all the positive ways Vipassana had affected me. Over time, something shifted and now I simply state, “I’m more sensitive.” And I don’t necessarily mean that in a good way.
Vipassana is the systematic scanning of the sensations of the body, part by part, and the observation of the rapid arising and passing away of those sensations. Essentially, one pays attention to how external stimuli come into contact with the six sense doors and the sensations that arise from the contact between the two. As a result, I’ve found that I’ve become very sensitive to noise. Hammering and sawing noise from construction, for example, agitates me much more than it does others. People I’m with usually don’t even register such noise—or, if they do, they don’t mind it. But I often have to generate equanimity, compassion, or patience to calm my irritation. And it’s not only noise. Someone’s synthetic cologne can ruin a meal in a restaurant. Moreover, I’m strongly affected by unsettling energies from malicious, severely intoxicated, or mentally disturbed people. In other words, my susceptibility to dukkha—to stress—seems to have increased due to my meditation practice, not decreased.
That’s why I was so intrigued by David Kortawa’s article on the psychological risks of meditation, “Lost in Thought,” in the April 2021 issue of Harper’s magazine. I was struck by one section in particular: a 2014 study from Carnegie Mellon in which two groups of participants were subjected to deliberately hostile interviews. One group was coached in meditation for three days prior to the study, and the other group wasn’t. Interestingly, the participants who had meditated reported less stress during the interview, but their levels of the stress-hormone cortisol were higher than the control group. As Kortawa writes, “They had become more sensitive, not less, to stressful stimuli.” I figured that’s what happened to me. The article is about much worse things than becoming easily irritated, however. Its focal point is the tragic death of Megan Vogt, a twenty-five-year-old woman who committed suicide a few weeks after experiencing psychosis during a ten-day Vipassana course in 2017.
Although articles like Kortawa’s have become increasingly common in recent years, scientific reports that present a counternarrative to the one most of us have embraced since first hearing about meditation—that meditation is a universally beneficial cure-all for all ills of mind and body—have been in circulation for more than forty years. Brown University researchers Willoughby Britton and her husband, Jared Lindahl, are at the current forefront of this counternarrative, and while neither is a medical doctor (Britton has a BA in neuroscience and a PhD in clinical psychology, and Lindahl has a PhD in religious studies), their work has been tremendously influential. In their coauthored article “The Varieties of Contemplative Experience,” published in 2017 by the journal PLOS One, they detail numerous reported cases of “anxiety and panic, traumatic flashbacks, visual and auditory hallucinations, loss of conceptual meaning structures, non-referential fear, affective flattening, involuntary movements, and distressing changes in feelings of self.” Labeling these cases “meditation-related difficulties,” they postulate that meditation is a stressor or trigger for latent or known mental disorders. For any serious meditator or meditation teacher, these reports should be troubling.
I’ve been aware of Britton’s work since 2018, but it wasn’t until reading “Lost in Thought” that I felt the need to write about this issue from the perspective of a practitioner. Accordingly, I reached out to several prominent meditation teachers so that they, too, can contribute to the conversation.
One thing that struck me about Kortawa’s article is his minimization of the relatively strict screening process that helps determine whether someone is prepared for a ten-day Vipassana course. Applications include questions about one’s emotional and mental health history. Potential students are also alerted to the fact that they’ll be in silence, without a phone, books, writing material, or any other entertainment, and that the schedule requires sitting for about twelve hours a day, which is physically painful and exhausting.
I wanted to know more about the development of this screening process, so I spoke with Vipassana teacher John Beary, who began meditating with S. N. Goenka in India in 1973 and now oversees the Vipassana centers in the western United States.
Over Zoom, Beary told me that back in the 1970s, there were no questions about mental health on a course application; Goenka taught whoever came to learn. But after a while, he noticed that some people had difficulty during the courses. There was one incident, in particular, when a man from Holland had a dramatic psychotic episode. Afterward, Beary told Goenka, “If this were at a center in the West, it could have sunk the center.” As a result, he and fellow meditators developed a more thorough screening process. Today, questions about emotional trauma, mental health, and past use of medication aim to determine whether someone is prepared to undergo what Beary called a “significant churning of their mind” caused by the meditation technique. For every applicant admitted to a course, several others are deemed unlikely to benefit, unlikely to complete it, or otherwise unsuitable. Some admitted students also decide to opt out after receiving a more detailed description of the course and its arduous discipline.
Because the application depends on the honor system, though, some people choose not to disclose their mental health histories, thereby slipping through the screening process. That being the case, Beary emphasized that assistant teachers are well trained to identify potential issues and assess daily whether a student should continue. Their training prepares them to identify symptoms in participants who should stop meditating. Sleeplessness or fasting are often red flags, for example. Age can be a contributing factor, as most people who experience psychotic episodes are in their late teens and early twenties.
Because the average age of first-time Vipassana meditators today is around forty-five, Beary said there’s actually been a significant reduction in dangerous experiences over the years. “We used to be on a first-name basis with the EMTs near the center in Shelburne Falls,” he added. Vogt’s suicide, like all alarming incidents, caused him and other senior teachers to revisit the screening process, but they determined there was nothing they could do to improve it. At the end of our call, Beary said he’s never been more confident that Vipassana causes much more good than harm.
I also spoke with Dr. Paul R. Fleischman, a psychiatrist as well as a Vipassana teacher in the Goenka tradition, who doesn’t believe the research from Britton and Lindahl stands up to scrutiny. From his perspective, there is no such diagnosis as “meditation-induced anxiety.” First-year college students often experience stress, depression, and anxiety, he said, but no one would diagnose a “college-induced” psychological disorder. Fleischman had classmates during medical school and his psychiatry residency who experienced psychotic episodes, yet no one claimed studying psychiatry was the cause of those episodes. Similarly, he argued, even if a negative experience first occurs during meditation, it does not mean meditation was the cause.
“Meditation may be stressful for certain people, but they are not experiencing psychological phenomena that are unique to or uniquely caused by meditation. They are experiencing psychological phenomena that are present to human beings under many circumstances,” he clarified.
Correlation, Fleischman stressed, does not imply causation. Because these difficulties—“anxiety and panic, traumatic flashbacks, visual and auditory hallucinations, loss of conceptual meaning structures, non-referential fear, affective flattening, involuntary movements, and distressing changes in feelings of self”—can and do occur anywhere and at any time, he does not believe it’s warranted to call such issues meditation-induced mental health problems merely because of where they arose.
“Meditation cannot solve most severe psychiatric problems,” Fleischman concluded, “but it also shouldn’t be held accountable when the problems surface inside the meditation hall.”
Unlike Dr. Fleischman, Buddhist scholar Bhikkhu Analayo doesn’t dismiss Britton and Lindahl’s research as flawed, methodologically. Over a Zoom call, he told me it should be taken seriously.
“It is true—intensive insight meditation for somebody who’s unprepared can have negative consequences,” acknowledged Analayo, who is well known for his work on the Satipatthana Sutta, or the Discourse of Establishing Mindfulness, on which the techniques of Vipassana, insight, and mindfulness meditations are based.
Yet Analayo also thinks negative claims about meditation are sometimes exaggerated, and he’s concerned that some of these claims are being taken seriously by psychologists who don’t have a sufficient understanding of Buddhism and meditation practice to put them into context. He sees the negativity surrounding meditation as a reaction to the hype around mindfulness; at first, the positive benefits were extolled, so now there’s a backlash of people who “overstate their criticism.”
He noted that when he taught in Asia, the great majority of those who “went off” during a retreat were Westerners. The reason for that, he believes, is because those raised in Buddhist cultures more gradually moved into this type of serious meditation practice and could place their meditation exper-ience within a broader Buddhist context. Westerners, on the other hand, often have no interest in preliminary practices, and many come with a lot of traumatic baggage. These dynamics play out in a zero-to-sixty style ten-day course in which Westerners work intensely to get as much from it as they can. Analayo thinks the silent setting can exacerbate the strenuousness, as Westerners are, perhaps for the first time, in a situation “where all forms of communication are forbidden and hence practitioners are stripped of central modalities with which we all construct our sense of identity: communicating with others.” For those raised with a Buddhist worldview, there are enough other familiar trappings to help soften that sense of deprivation. But for a Westerner, “this type of setting can easily lead to a disorientation that, in turn, can trigger traumatic experience from the past to come up.”
Therefore, Analayo doesn’t think the intensive, silent, ten-day retreat model is necessarily the best way to introduce Westerners to insight meditation. When he runs his own courses, he combines periods of silent practice with study and group discussion. This provides time for his students to mindfully socialize alongside intensive meditation, so no one feels the anxiety of being isolated and not knowing anybody. He suggests that Vipassana organizations could offer introductory three-day courses of anapana (observation of the breath), still ending with the teaching of metta bhavana (loving-kindness meditation), as a prerequisite for a full ten-day course—at least for those new to meditation. He believes it could also be beneficial to have a formal moment of socialization before the course begins. “This takes some time,” Analayo admits, “but it pays off in having every individual meditator feel recognized and part of a greater community” and provides “a felt sense of cohesion and collaboration that will also forestall any alienation or loss of orientation that can go out of hand.”
While Vipassana is ostensibly secular and open to people of any or no religious beliefs, like its insight meditation siblings in the Mahasi Sayadaw tradition, it’s drenched in the Burmese culture from which it originated. During a course, Goenka chants in Pali throughout the day, relates stories from the Buddha’s life in his evening discourses, and generally advocates a Theravada Buddhist worldview, with the acceptance of rebirth and the existence of devas and other invisible beings. (In contrast, most contemporary mindfulness practices—including all those meditation apps—have completely stripped away the Buddhist context.) Though virtue and generosity are emphasized during a retreat, the focus is meditation itself, and, following Analayo’s thinking, the practice of these other Buddhist aspects might be too little too late for those who need more preparation.
Thanissaro Bhikkhu, abbot of the Metta Forest Monastery near San Diego, agrees. “Meditation is safe if you do it right—but to do it right, you have to be properly prepared,” he explained to me over email. “Most of the problems that trigger these episodes have to do with the release of strong energies in the body or with misinterpretation of visions or other realizations that come up in the course of trying to calm the mind.” In the Forest Tradition, for instance, if strong energies come up in the body, one is counseled to think of them going down the arms and out the palms of the hands, or down the legs and out the soles of the feet. One is then counseled to focus on a subtler level of energy in the body until the grosser energies dissipate. “The problem comes when meditation is stripped of its context—or forced into an alien context—and the correctives are forgotten,” Thanissaro said.
This is why he doesn’t recommend throwing people into a retreat setting and having them meditate for many hours at a stretch without prior knowledge of Buddhist psychology, doctrine, or practice.
After reading Thanissaro’s email, I thought back to Megan Vogt. According to Kortawa’s article, after experiencing strong vibrations and serenity on day seven of her course, Vogt told herself she was “responsible for everything that was wrong with the world,” thought that maybe she “was holy,” and that she “was put here to heal everyone.” But then she panicked, and after her ecstatic experience turned to terror, she believed Jesus was punishing her. Eventually, she convinced herself that she “was trapped in hell and needed to die to escape.” I wonder how things would have been different if she had come to the Vipassana course with a different background, or if she had a better knowledge of Buddhism. Maybe she’d still be alive.
For a Mahayana perspective, I spoke with Zen teacher and clinical psychologist Grace Schireson, who thinks meditation-induced psychotic issues occur due to the combination of factors that come with a meditation retreat: the silence, the long hours, the lack of sleep, the regimented food. “All these things are meant to disturb,” she said.
Schireson is particularly concerned about the Goenka tradition because students are introduced to meditation through the ten-day course. Conversely, she encourages her beginner students to first try a few periods of meditation at a Zen center, followed by a half-day or a one-day course. Only once they’ve become accustomed to meditation does she recommend they attempt a longer retreat. That way, they know what they’re getting themselves into, and they “don’t just get thrown out into the ocean without a raft,” which she thinks is the purpose of a ten-day course. “No raft, no nothing—now swim. And keep swimming.”
Striving for emptiness is a way that can exacerbate depression. …It’s very hard to predict who will have difficulties. —Grace Schireson
For a contemporary mind, she noted, even the disconnection from cell phones during a retreat can be traumatic. Schireson admitted, candidly, “I consider my phone to be part of my mental hardware.” She acknowledged this merging of self and technology isn’t always wholesome and said it’s a good practice not to allow phones in the zendo. A meditator should be able to put the phone away, but gradually—first for one meditation period, then a few hours, then a day, and finally for a multi-day retreat. Going cold turkey for ten days and just being with the self, she says, will likely cause a shock.
Yet, even with this safer approach, Schireson has still seen students have psychological episodes during Zen retreats. The problems occur, she says, mainly with students who have a history of rejection, of being sensitive to slights, or those with a history of depression or schizophrenia. For such people, working with an empty mind is not good. From speaking with many students who view her as both a meditation teacher and psychologist, Schireson has learned “that striving for emptiness is a way that can exacerbate depression.” Rather, she suggests someone find a chant or prayer that is uplifting, such as reciting the Metta Sutta, and practice that.
With her background in psychology, Schireson initially believed she would be able to help ground people who experience difficulties, but she’s found she often can’t. Now, as soon as she starts to see “aberrant behavior,” someone making odd movements or generally “not doing what we taught them to do,” she tells the student that they should go home and rest.
Barry Magid, another Zen teacher and psychoanalyst, has treated many meditators in his psychoanalytic practice. He believes the most serious danger is not the sporadic psychotic or manic breakdowns that can happen during intensive retreats, but disassociation. By this, he means “spiritual bypass,” which he described in an email as “a feature of traditional practice, whereby detachment from emotion, from vulnerability, from interpersonal needs and dependency are actually thought of as the goals of practice.” By denying one’s own personal needs, a meditator can be “adept at entering deep state of calm or inner silence, but find themselves burnt out, depressed, and in unsatisfying, often masochistic relationships.”
Whatever the issues or manifestations that arise, Schireson ultimately believes that safety comes down to teachers getting more training in counseling, as they do at the Shokagu Zen Institute. That kind of training helps teachers more easily identify students having problems; it also helps them not to become entangled in unhealthy relationships themselves. After all, a meditation teacher should be able to recognize the difference between letting go of attachments, which doesn’t require therapy, and chronic depression, which does. And yet, Schireson wouldn’t want to simply screen people out: “It’s very hard,” she says, “to predict who will have difficulties.” That is, someone who seems like an ideal meditator on paper could have a very difficult, if not psychotic, experience, and someone with an application full of red flags could have a smooth, very beneficial course. Meditation “might not be good for people,” Schireson concluded cheerfully, “but let’s find out!”
Personally, whenever I question whether I should keep meditating or not, or think about the larger issue about meditation being potentially dangerous, I return to the advice of the Buddha in verse 282 of the Dhammapada (translation by Daw Mya Tin):
Indeed, wisdom is born of meditation;
without meditation, wisdom is lost.
Knowing this twofold path
of gain and loss of wisdom,
one should conduct oneself
so that wisdom may increase.