'I was the void': What happens when meditation goes wrong

Meditation can help and it can harm. This is what happens when it goes wrong "Everybody thinks meditation's hunky-dory … there's just this automatic assumption that it couldn't possibly come in and totally blow up your brain." Three years ago, Sue discovered pranayama, a type of meditation involving modifying the length and timing of breaths. But the self-described "spiritual seeker" in her 70s from Florida stopped after having "an acute traumatic experience … caused by meditation". Sue is not alone. Research suggests one in 10 meditators will experience an adverse effect that lasts more than a month or is associated with impairment and functioning. Loading...This is significant given the growing popularity of meditation, particularly mindfulness-based meditation. In the US, the number of people meditating has increased from 10 to 20 per cent of the population over the past two decades. In Australia, that figure is even higher, with one third of the population practising some form of meditation. There are a wide range of proven mental and physical health benefits of mindfulness and meditation. But the potential negative or adverse effects of meditation remain relatively unknown and under-researched. The evangelical meditator Willoughby Britton, an associate professor of psychiatry at Brown University and director of the Clinical and Affective Neuroscience Lab, is a pioneer and world-leading researcher into meditation-related adverse effects. But 20 years ago, Dr Britton was what she now considers an "evangelical meditator". "I spent my first 20 years of meditation research promoting the benefits, stating there were no adverse effects even though I never measured them," she admits. Dr Britton was first introduced to meditation following the death of a childhood friend. "I was really devastated and anxious and I didn't know what to do and I really didn't want to take medication." Instead, Dr Britton's father sent her a book on meditation that she describes as "my gateway drug". After quickly establishing a daily mindfulness routine, she decided to research the impact of meditation on sleep. "I was going to prove to everyone that not only was meditation good for sleep, but how it also improved depression because lingering sort of problems with sleep can lead to relapse in depression." But she was surprised by the results. Instead of improving sleep quality, the study showed participants' brainwaves got faster and they woke up more after meditation. At the time, Dr Britton chose not to publish her findings. A couple of years later while working as a resident doctor at Brown University's psychiatric hospital, she treated two patients with psychotic symptoms who had been on separate meditation retreats. "It was like some of the most extreme patients that I saw in that hospital all year." Following those encounters, Dr Britton sought advice from a trusted meditation teacher. "I said, 'Well, have you ever seen this before?' "She didn't say anything but I remember the look on her face was like, 'Oh yes, this is definitely a thing that she's seen before'. The conversation prompted Dr Britton to embark on decades of research into the field of meditation-related adverse effects. Very quickly, she says, all her "fantasies about meditation were sobered up". What are meditation-related adverse effects? In 2017, Dr Britton and her team published a 10-year study based on interviews of more than 100 Buddhist meditation practitioners describing challenges they had experienced personally or observed in meditation students. Insomnia, as Dr Britton had previously discovered, was just one of more than 50 adverse meditation-related symptoms reported. Many of the adverse symptoms people in the study reported fell into two categories: Hyperarousal, such as anxiety, fear, insomnia, involuntary movements and emotional flooding; and hypoarousal, such as a lack of emotion, motivation and sense of self. Many people described feeling dysregulated, experiencing a combination of both hypo and hyper arousal. They also reported psychosis symptoms that lasted on average between one and three years. "There was a considerable amount of impairment where some people were hospitalised, some people became suicidal, many people had to take time off work, or were fired or had to take time off school. "So it can be quite a significant impairment in functioning," Dr Britton says. Sue experienced symptoms of hypoarousal and dysregulation after using a meditation app a couple of times each week. One experience was particularly frightening. "I was all by myself in my car and I had this profound sense of myself dissolving … so it was just the void and I was the void … it was really terrifying". Sue remained in this dysregulated space for about a year and a half. While Sue experienced negative symptoms after meditating regularly over time, short exposures right through to intensive meditation practices can trigger adverse effects. Twenty years ago, Jane, a retiree in her mid-seventies who had practised Zen meditation for several years, experienced a serious and prolonged mental health episode after attending her fourth five-day retreat. Jane distinctly remembers the first night of that retreat. "My mind was just fizzing, like a sort of lemonade bottle, I knew something wasn't right," she says. "I made an appointment the next morning with the teacher, and she just looked at me and said, 'Oh, you don't need to sleep when you meditate.'" When Jane returned home after completing the course, her husband contacted their local GP who diagnosed her "as being psychotic and manic". Over the next two decades, Jane was hospitalised multiple times and treated with a range of antipsychotic medications. In hindsight, Jane believes she was likely slightly psychotic before starting the retreat, but she thinks if the teacher she sought advice from had a greater awareness of the risks, they may have recognised she was clearly unwell. Clues in plain sight While Dr Britton's research has contributed to growing awareness of meditation-related adverse effects, she is not the first person to recognise the problem. The earliest understandings of these problems date back as ancient Buddhist traditions, according to Pierce Salguero, a professor of Asian history and health humanities at Penn State University. "I came across some writings from about 1,500 years ago that were talking about meditation as a form of healing … and what I noticed was that those texts were also talking about meditation as a source of both mental and physical problems and conditions," he says. Benefits of meditation Yet there is plenty of evidence that supports the benefits of meditation, specifically mindfulness meditation. "It can help with a wide variety of mental health issues, anxiety, depression and some substance use problems," Nicholas Van Dam, director of the Contemplative Study Centre at the University of Melbourne, explains. Meditation can also help with the management of pain associated with physical health conditions such as arthritis and cancer recovery by helping train attention and shifting focus away from pain. The relaxation aspect of meditation is also beneficial. "Many times, in meditation you are engaged in a process where you're slowing down your breathing, you're potentially seeing the mind quiet," he says. So, given the benefits, how can it prove dangerous for some? "Much like a lot of other treatments … in medicine and mental health, it would be remiss not to acknowledge that what we do know about meditation is that it's potent, it's powerful," Dr Van Dam explains. He believes informed consent is "missing" in the conversation about meditation and participants should be made aware of the potential risks. The beginning of Cheetah House Dr Britton says she was overwhelmed by the public's response after her study, which is part of the Varieties of Contemplative Experience project, was published in 2017. "We had so many calls at the lab that we had to turn off our phone because it was interfering with research," she recalls. "[Callers] were like, 'You're the only ones I've ever seen who knew anything about this … everyone I've been to is like, 'meditation doesn't have side effects.''" In response, she set up Cheetah House, a not-for-profit service that offers support to meditators in distress and aims to educate meditation teachers and clinicians about the risks of meditation. A decade later, Dr Britton says the service has on average 150 appointments each month and has treated thousands of meditators in more than 20 countries. "There is a problem that is being systematically ignored, it's a pretty common problem and there's just this kind of system of denial and gaslighting," Dr Britton says. Jane agrees. "I think people who do these practices … almost feel [meditation] is the answer to everything and it just isn't," Jane says. "Sometimes it doesn't suit a certain person."