A Duty to Warn About Meditation Sickness?

Click here to read the first part of this series on the roles of both psychologists and religious studies scholars in the investigation and treatment of "meditation sickness."

When research psychologist Willoughby Britton first learned that meditation practices could have unwanted and even distressing effects, she was surprised to find little mention of them in the latest scientific studies purporting to demonstrate their clinical efficacy. Adverse meditation experiences have, in fact, been discussed in psychological literature in the past. But this only further piqued the curiosity of the psychologist Miguel Farias who has written that, if communities of transpersonal psychotherapists, for example, had previously observed such meditation effects, “how could [they] be completely absent in the recent research?”.

In a wide-reaching academic journal article, Willoughby Britton and a cohort of other leading researchers hypothesized that it is the fervor of a “pervasive mindfulness hype” that has led many to “overloo[k] the very real potential for several different types of harm.” Experimental psychologists can sometimes be caricatured as cloistered away up in the ivory tower of Academia. The reality is that, since the birth of psychology as an academic discipline, many psychologists have been highly invested in the societal impact of their research; there has always been push back against a pure ethic of amassing “knowledge for knowledge’s sake.”

The researchers who sounded an alarm about the overenthusiastic promotion of therapeutic mindfulness practices wrote in this tradition of public scholarship and, beyond addressing their colleagues, hoped to also impact the larger popular discourse surrounding meditation practices. And it likely felt especially consequential to warn the otherwise unsuspecting public of potential unwanted effects. This public often takes up meditation practice anticipating only decreased stress and a greater sense of peace. They could then feel like the rug has been pulled out from under them when they, for example, find themselves overly “awakened” and unable to fall asleep.

These psychologists may, in fact, have seen themselves as bound by something of a “duty to warn” such meditators. “Duty to warn” has become a colloquialism, but originally was a reference to psychotherapists’ ethical obligation to break confidentiality when they receive information that there are individuals at risk of imminent harm. Meanwhile, Britton has also directly evoked another set of principles in biomedical ethics, that of the prescription to “first do no harm.” In this regard, whatever therapeutic benefits meditation practices may hold, understanding their potential risks should be prioritized. Britton’s team has adopted the phrase to name a set of trainings they’ve developed to educate both psychologists and meditation teachers about their findings. And through Cheetah House, an organization that provides resources and support for meditators-in-distress, Britton has further extended herself into advocacy and support for those who are struggling. In all of this, then, for a psychologist like Britton, collecting more data about how meditation practices could cause potential harm is far from a purely academic exercise.

Religious Studies Scholars Enter

To assess the effects of meditation, however, contemporary psychologists have largely found a paucity of existing scientific research literature. Certain Buddhist writings, meanwhile, contain deeply developed meta-psychologies and catalogues of cognitive states that are often illuminated through contemplative exploration. Could the intricate descriptions of meditative nyams-myong one finds in Tibetan Buddhist philosophical texts offer clues for psychologists like Britton and Farias in their study of these present-day phenomena? Much of the U.S. psychological studies of challenging meditative experiences conducted by researchers in the past took the form of case studies. Could the accounts of the 17th-18th century Rinzai Zen master Hakuin Ekaku about his treatment for zenbyō (meditation sickness) in texts like the Oradegama or Yasenkanna be approached as case studies as well?

One might think it unusual to find an explication of the aforementioned Tibetan concept of nyams in a scientific academic research article in the peer-reviewed journal PLOS One, but arguably the most important study produced by Britton’s Brown University lab includes just that. Bearing the same name that the lab currently holds itself, the paper, “The Varieties of Contemplative Experience,” opens with a survey of such technical terminology, of historical and philosophical Buddhist understandings of experiential states that could seem comparable to those of today’s so-called meditators-in-distress. Moreover, the first author of this paper was actually not a psychologist, but the religious studies scholar Jared Lindahl. Lindahl has first-authored a number of pieces on behalf of the lab and much of this material has been published in academic religious studies journals and books.

Crossing the Border Between the Religious and the Medical?

This could seem like surprising cases of disciplinary border-crossing as psychologists, Buddhist practitioners, and religious studies scholars work in concert to gain more understanding of these issues. My book Prescribing the Dharma examined such apparent border-crossing in the diverse ways that psychotherapists have approached Buddhist traditions. I stress that these interactions are shaped by shifting definitions of what is and is not religious exactly and these communities’ relative degrees of investment in maintaining a clear separation between the two. For example, drawing on very specific definitions of "religion" and "science," some perceive Britton or Farias to be participating in the subsuming of the one within the other, as reducing the religious to an object of study for biomedical research. Others, meanwhile, instead see a decentering of the scientific biomedical as religious texts and ideas seemingly infiltrate Britton’s lab. My central findings in Prescribing the Dharma were that all of these sorts of interpretations are fundamentally unstable because they rely on socially and culturally constructed concepts of the religious and not-religious that themselves remain in constant flux – even as they are hugely impactful in the lives of everyday communities.

In fact, some psychotherapists interested in meditation practices have told me that it is irrelevant to them whether their work is considered to be religious, that, rather, they are fundamentally driven by an ethic of care for those in need of healing. If aiding suffering people requires violating a strict separation between what is commonly understood to be religious and not-religious, Buddhist and biomedical, then so be it. It is, indeed, on this basis that even cognitive-behavioral therapists, otherwise highly invested in maintaining status as scientific practitioners, sought to, as I have called it, “translate” meditation practices into clinical treatment interventions with result being methodologies like Mindfulness-Based Cognitive Therapy.

Informed Consent

When it comes to the potential risks or adverse effects of meditation practices, then, the relevant ethical prescription may be more rightly considered “informed consent.” I’ve previously written in considerable detail here at Therapy and Buddhist Traditions about the topic of “informed consent” on a highly related matter. But, before teaching meditation practices to those coming to see them for care, or before referring out to a meditation teacher to do so, psychotherapists would be ethically bound to provide information about the possibility of unwanted distressing effects (in the same way that all clinicians do about psychotherapy in general).

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One difficulty, however, is that many clinicians may themselves have no awareness of the potential risks involved with meditation practice and so be unable to inform others. One imagines there could be numerous MBSR trainers who are similarly unaware. There may be a real need to raise consciousness then among the very communities of psychotherapists and mindfulness trainers that are imparting it to others so that they actually know to seek informed consent in this regard. Meanwhile, as I mentioned in the first part of this series, Buddhist practitioners and meditation teachers in predominantly-White meditation-based communities in the U.S. have also recently weighed in to more publicly comment on challenging meditation experiences. But perhaps this implicitly acknowledges that they otherwise have largely passed on this knowledge in oral tradition within teaching lineages and between individual teachers and students.

Translation and Cultural Translation

This brings us full circle back to religious studies scholarship because, leaving aside oral tradition, older texts originating within Asian Buddhist communities do include written accounts of “meditation sickness.” It is simply that they are not written in English. And, furthermore, they are based in historical and cultural assumptions that may be highly distinct from those of the above-described contemporary U.S. communities. Buddhist studies scholars like Melissa Curley, Pierce Salguero, and Sara Lewis have the skills and training to provide translations of these texts as well as what they might call “cultural translation” of their origins. In other words, they have the ability to explain the historical and cultural context in which certain meditation practices were developed.

Some, however, might hesitate to do so. As I wrote in a previous post here “academic religious studies scholars are. . . typically more comfortable nestled away in their offices poring over ancient texts or semi-structured interviews.” They too have inherited normative commitments to a posture of neutrality, objectivity and detached observation of the subjects they study. Others, on the other hand, may also feel compelled by a “duty to warn,” to alert the public of the potential risks of meditation practices and to even elucidate how communities in the past have sought relief from conditions like meditation sickness. This public is often not faceless. Leaving aside my clinical practice, students regularly tell me in my religious studies classes here at Vanderbilt University that they are taking up meditation practice, often guided only by the smart phone app to which the school now provides a free subscription.

In future posts to this series, I will further examine the implications of religious studies scholars’ participation in an effort to raise awareness about unwanted challenging meditation effects. A Buddhist studies scholar like Juhn Ahn, for example, has contributed a helpful chapter of traditional academic research on this topic that sits alongside another produced by Britton’s lab in a volume, The Oxford Handbook of Meditation, that was co-edited by the aforementioned psychologist Miguel Farias. Contributing to a larger movement in the humanities towards public scholarship, they seek to strike a balance: to offer resources they may be uniquely equipped to provide, without exceeding their “scope of practice.”