A version of this article has been published in the Journal of the Academic Study of Religion 31.2 (2018).
In contemporary Western society, meditation techniques that were previously taught within the context of Eastern religious traditions are now increasingly being practiced in secular settings. While the boundary between the secular and the religious is blurred, popular meditation techniques such as Transcendental Meditation, Vipassana and mindfulness are generally promoted as being derived from Eastern religions, but inherently non-religious, aligned with Western psychology, and suitable for a general audience. Over approximately forty years, thousands of research studies suggest that there are many psychological and physiological benefits associated with these forms of meditation; however, a small but growing literature indicates there could also be adverse effects. In Eastern religious traditions, difficulties associated with meditation are acknowledged, and are usually understood to be milestones on the path to enlightenment, the result of improper practice, or due to individual differences. However, in a Western secular context, negative effects associated with meditation have largely been overlooked. This article argues that this is in part due to the fact that in contemporary Western society the goal of meditation has shifted from enlightenment to symptom relief and personal transformation, leading to the assumption that meditation is harmless and ‘good for everyone.’
Mainstream Meditation in the West: A Brief History
The practice of meditation is found in most, if not all, of the world’s major religious traditions. Meditation is found in Christianity (in the form of contemplation), Hinduism (from which Transcendental Meditation is derived), Buddhism (from which mindfulness and vipassana meditation originated), Judaism and Islam. In some Eastern religions, such as the various schools of Buddhism, the practice of meditation has continued unbroken over centuries. In the West, however, the living tradition of meditation largely disappeared with the destruction of classical civilisation (although the Eastern Orthodox churches have a rich and varied contemplative tradition), and interest in meditation only began to gain mainstream traction in the West when Eastern meditative practices were reintroduced by Asian meditation teachers (Shear 2006: xv). During the nineteenth century in particular, Eastern religious philosophy and meditation practices started to have a significant influence on Western ideas regarding spirituality and mental healing. The nineteenth century saw notable visits to the West by Eastern spiritual leaders, such as Swami Vivekananda (1863-1902), the Zen roshi Soen Shaku (1860-1919), and Paramahansa Yogananda (1893-1952), all of whom founded societies and institutions for the distribution of their meditation techniques and philosophical teachings. In particular, scholars have argued that the Parliament of the World’s Religions, held in Chicago in 1893, was the landmark event that increased Western awareness of meditation, as this was the first time that Westerners on Western soil received Eastern spiritual teachings directly from Asian teachers (Murphy and Donovan 1999: 4).
Despite this initial interest, meditation remained a relatively fringe activity in the West until the late 1960s and early 1970s. During this period there was a wave of interest in Eastern spiritual practices fuelled by the counter-cultural climate, the birth of the humanistic and transpersonal schools of psychology, and the arrival of Eastern religious teachers from Asia. In particular, Maharishi Mahesh Yogi (1918-2008), the founder of Transcendental Meditation (TM), had a substantial impact on the popular reception of meditation in the West (Goldberg 2010). Maharishi successfully promoted TM in both the mainstream media and in scientific circles, and in the 1970s there was a large amount of research conducted on the TM technique, with studies indicating that this form of meditation has numerous positive health outcomes across a variety of physiological and psychological domains (Shapiro and Walsh 2009 ).
The late 1970s was also a critical period for the mainstreaming of vipassana and mindfulness meditation. During this period a number of Westerners trained in Asia in the vipassana meditation method, and brought the teachings home in the form of workshops and retreats for Western lay practitioners. Many of these Western teachers had both formal scientific training in disciplines such as psychology and medicine, and an extensive personal experience of meditation. Hence, this period saw the rise of a new type of Western meditation teacher; one who was trained in science but sympathetic to Eastern religions, and also personally engaged in meditation practices. In Mindful America, Jeff Wilson (2014: 78) argues that the “universally acknowledged turning point” for the mainstreaming of mindfulness, and in particular its relationship with psychology and medicine, is 1979, when scientist Jon Kabat-Zinn founded the Stress Reduction and Relaxation Program (SR & RP). Now referred to as mindfulness-based stress reduction (MBSR), Kabat-Zinn’s program (which is based primarily on vipassana courses but also has influences from Mahayana Buddhism, Zen, Vedanta and select Neo-Hindu gurus) has been credited with instigating the current Western meditation boom, and in particular meditation’s flourishing relationship with psychology (Wilson 2014: 78). Following on from the success of MBSR, mindfulness meditation has become extraordinarily popular, and meditation is now currently one of the world’s most widely practiced and researched psychological disciplines.
A large part of the appeal of these popular mainstream forms of meditation (TM, vipassana and mindfulness) is that they are usually presented as being secular, or unassociated with any formal religion. While in contemporary religious studies, the term ‘religion’ is viewed as problematic and vague, a distinction is commonly made between what is ‘religious’ and what is ‘secular.’ Secularism is differentially defined depending upon the context within which it is discussed (for example, secularism as a philosophy versus secularism as a political stance). However, it is broadly identified as a separation from, and movement away from, religion. There is statistical evidence of secularisation in almost all European countries since the end of World War II, a trend which has developed alongside modernisation (Habermas 2006: 2). While there is an active debate regarding whether secularisation has been happening or whether there has been a return of religion, or a turn towards ‘postsecular’ themes, nevertheless, in the modern West, secularism is a widely accepted paradigm and mainstream meditation is presented primarily as a secular activity (Lauricella 2014: 1748-1762). As a result, a growing number of people practice what is commonly described as secular meditation.
The distinction between secular and religious meditation is, of course, partially an arbitrary one. The only way to distinguish between secular meditation versus religious meditation is to focus on the end goal of the practice (that is, whether it is a religious goal or a non-religious goal), and on claims to secularity (that is, what different scholars, teachers and religious practitioners have claimed about both meditation practices and their end goals). For example, contemporary meditation practitioners such as Kabat-Zinn, who apply meditation in a purely clinical way, view meditation practice (in this case mindfulness meditation) as secular simply because it is employed towards clinical goals (such as the alleviation of chronic pain). Likewise, the Transcendental Meditation technique created by Maharishi Mahesh Yogi claims to be secular because its goals are this-worldly, physiological and health-related, and no adherence to a belief system is required in order for it to be effective.
It is important to note that meditation is widely considered by some leading figures in the field as a deeply spiritual practice (e.g. Arat 2017; Hale 2018; Sharf 2015) and there has been much debate regarding whether meditation can ever be successfully separated from its religious context and made ‘truly secular.’ While an in-depth analysis of this issue is beyond the scope of this article, for present purposes, it is useful to distinguish between secular meditation and religious meditation to the extent that it helps to identify a particular discourse, while also keeping in mind that the boundary between the secular and the religious is both arbitrary and porous. This article will, for the most part, narrow its focus to three types of secular meditation: Transcendental Meditation (TM), mindfulness, and vipassana. These are the meditation practices that have been studied the most in Western clinical and research settings, and for which the most data exists. They are also the practices that are most commonly presented as secular. Other forms of meditation that are practised within the context of an organised religious tradition (for example, a school of Buddhism) will be referred to as ‘traditional meditation’ or ‘religious meditation.’
Negative effects related to meditation have been described across a variety of religious traditions, and in Western psychology. Terms such as ‘Dark Night of the Soul,’ ‘Kundalini Crisis’ and ‘Spiritual Emergence’ have all been used to refer to periods of difficulty associated with contemplative practice (e.g. Grof and Grof 1989). In Eastern religions, traditional commentaries, stages-of-the-path literature and biographical narratives also acknowledge difficulties associated with meditation practice. For example, Eric Greene (2017: 373) writes that Buddhist meditation has been seen as both a high risk and high reward practice:
Given its frequent presentation in the modern West as a panacea for psychological or even physical ailments, it might be surprising to find that Buddhist meditation has often been seen as potentially dangerous. The otherwise highly praised Buddhist meditations on the impurity of the body can, according to a famous canonical story, lead to suicide; elsewhere we learn that meditation on the breath-a common introductory meditation practice-can, if performed improperly, disturb the body’s “winds” and lead to death. The Buddha himself is said to have been attacked by demons-in the form of the hosts of Mara-on the eve of his awakening, precisely on account of his advanced levels of meditative attainment.
Examples of meditation difficulties are found in Theravada Buddhism, Zen Buddhism, Tibetan Buddhism and in the neo-Hindu/Yogic traditions. Further, while the great majority of modern research into meditation has tended to emphasise beneficial outcomes, a close examination of the scientific literature reveals a small number of studies that mention meditation adverse effects. Early reports by renowned psychologists Arnold Lazarus and Albert Ellis expressed concerns regarding possible negative side effects of therapeutic meditation including depression, agitation and suicidal ideation (Lazarus 1976). Ellis cautioned that the practice could be harmful for certain groups of individuals, particularly those with obsessive-compulsive and ruminative tendencies (Ellis 2009 ). A survey of meditation adverse effects reported in the scientific literature includes: dissociative symptoms (Deikman 1963; Deikman 1966); psychosis-like experiences (French, Schmid and Ingalls 1975); out-of-body experiences (Kennedy 1976); depersonalisation and derealisation (Castillo 1990); confusion and disorientation (Shapiro 1992); increases in perceived stress and depression (Dobkin, Irving and Amar 2012); increased false memory susceptibility (Wilson et al. 2015); links to criminogenic thinking (Tangney et al. 2017); and exacerbation of traumatic distress (Treleavan 2018). In addition to these examples, there exist numerous anecdotal reports of meditators in both clinical and non-clinical populations experiencing psychological disturbances that appear to be related to meditation (Britton 2011a; 2011b).
However, despite these reports, researchers have only very recently begun to investigate meditation adverse effects in a rigorous way (Lustyk et al. 2009; Lindahl et al. 2017). Additionally, popular media reports on meditation have been overwhelmingly positive, with almost no mentions of adverse effects prior to 2014. For example, a recent study by Sharon Lauricella analysed 764 mainstream print media articles about meditation that were published between 1979 and 2014. The author employed frame theory analysis to understand how meditation is presented in print media and how the perception of meditation is interpreted by readers. From the sample of articles analysed, only six reported negative aspects of meditation, and none of the articles reported on adverse physical or psychological effects (Lauricella 2014: 1753).
It is clear from the above literature review that there are adverse effects associated with meditation, and that these adverse effects have been largely overlooked by the academic literature on meditation, and until very recently, largely unheard of in the mainstream media. This raises serious concerns regarding the possible risks associated with the use of meditation in both secular clinical and non-clinical populations. This issue is particularly relevant given the current popularity of secular meditation practices in a large variety of non-traditional settings including therapy, education, and the workplace. Further, many people now self-refer to meditation (for example, via the internet) and seek meditation in highly variable settings outside of clinical programs, for example in the form of performance improvement services such as coaching, or apps. Given the current popularity and proliferation of secular meditation-related products and services, it is important to understand why meditation adverse effects have been overlooked and under-reported. This article argues that this is in part due to the fact that in contemporary Western society the goal of meditation has shifted from enlightenment to symptom relief and personal transformation, leading to the assumption that meditation is harmless and ‘good for everyone.’
From Enlightenment to Symptom Relief and Personal Transformation: Meditation as a Secular Western Therapeutic Intervention
The attempt to extract the common characteristics of ‘meditation’ from a variety of religious traditions in order to come up with a generic definition is a uniquely modern Western phenomenon (Murphy and Donovan 1999: 2). In religious traditions the term meditation does not refer to one distinct technique; rather it is an umbrella term that refers to a variety of practices that are intended to cultivate a particular state of being, and that promote self-transformation along a religiously defined path. Despite the huge variety of different religious meditation techniques and traditions, all point towards a common goal; that is, if an individual practices meditation with dedication, for a prolonged period of time, it should eventually lead to a state of enlightenment; this is the primary goal of religious meditation. For example, schools of Hinduism and Buddhism view meditation as a practice that has both short term (state) and long term (trait) transformational goals. However, unlike in Western secular applications, the short term state changes (e.g. calming of the mind) produced by Hindu and Buddhist meditation are cultivated as part of a much larger transformational aim; the realisation of enlightenment, or a fully transformed consciousness. These traditions consider the everyday state of consciousness and the conventional sense of a ‘self’ to be inaccurate, limited, and the cause of human suffering. This suffering can be overcome by following a prescribed religious path that includes many components (including ethics, ritual and renunciation), and of which meditation is a key ingredient.
In contrast, modern Western secular meditation (in particular, mindfulness) is focused primarily on symptom relief and transformation of the private psychological self. This is largely because the popular conceptualisation of meditation in the West has been heavily influenced by its affiliation with various streams of psychology. The idea that meditation has therapeutic potential can be traced back to 1934 when eminent psychiatrist and psychoanalyst Carl Jung posited that Zen Buddhism and psychotherapy shared a common goal (that is, the alleviation of human suffering via psychological means), and that the Buddhist teacher and psychoanalyst fulfilled a similar role in facilitating an individual’s healing (Fields 1992: 205). Since then there have been numerous attempts to link meditation with psychology, including the ideas that mystical experiences associated with meditation are therapeutic, and that meditation can enhance or even replace psychotherapy (E.g. Smith 2009 : 55-61). Historically, almost every school of psychological thought has been used to support these claims, and working definitions of meditation have evolved alongside developments in psychology.
A key theme that emerges from the historical interaction between meditation and psychology is the view of meditation as a type of panacea; an exalted technique with a therapeutic potential that transcends conventional Western psychotherapy. This view can be traced back to the early dialogue between psychoanalysis and Buddhism, and in particular to psychologist Erich Fromm (1900 – 1980), who reformulated psychoanalytic theory to propose a more positive definition of health as ‘well-being,’ rather than just the absence of illness. While Freud’s psychoanalysis was concerned with only one aspect of the unconscious – that dealing with psychopathology – Fromm argued for a humanistic psychoanalysis that went beyond symptom relief and included the full recovery of the unconscious. Informed by his correspondence with of renowned Zen scholar Daisetz T. Suzuki (1870-1966) and his analysis of Zen Buddhism, Fromm believed that meditation could be used as a tool to aid psychotherapy in not just the elimination of neuroses, but the “more radical aim of a complete transformation of the person” (Fromm, Suzuki and de Martino 1993 : 137). This perspective provided the basis of a Western conceptualisation of meditation that has proved to be enduring: the optimistic view of meditation as an exalted technique that has the power to provide healing beyond traditional forms of psychotherapy.
Another reoccurring theme that has contributed to overly positive Western perceptions of meditation is the idea that there is something inherently healing about present moment ‘awareness;’ a key state cultivated by meditation, and in particular mindfulness meditation. For example, Shauna Shapiro and colleagues note that “attention has been suggested in the field of psychology as critical to the healing process” (Shapiro et al. 2006: 376). This is a theme that can be traced back to noted psychiatrist and Buddhist sympathiser Fritz Perls (1893-1970), the founder of Gestalt therapy, who claimed that “awareness – by and of itself – is curative” (cited in Walsh and Shapiro, 2006: 231). Perls designed experiments in self-awareness which were designed to bring to consciousness the thoughts and bodily activities which were considered to be creating ‘unconscious blocks,’ resulting in psychopathology (Dryden and Still 2006: 12). Similarly, renowned psychologist Carl Rogers (1902-1987) defined psychologically healthy, fully functioning people as “allowing awareness to flow freely in and through their experiences” (cited in Walsh and Shapiro 2006: 231). Humanistic psychotherapists like Perls and Rogers saw personal transformation instead of symptom relief as the end result of successful therapy, and this was brought about through awareness and acceptance. Dryden and Still (2006: 14) posit that many humanistic psychotherapists were “familiar with and probably influenced by Buddhist ideas, though this is rarely made explicit in their theory or practice.”
The idea that meditation can facilitate awareness in order to access human potentials that go beyond the levels currently recognised by conventional Western psychology (what Abraham Maslow (1971) called “the farther reaches of human nature”) is an idea that developed further within transpersonal psychology. For example, theoretical psychologist Ken Wilber created a developmental model that spans the full spectrum of human growth from infancy to enlightenment. Within this model, the earlier levels refer to the developmental territory studied by conventional psychology, and the higher ‘transpersonal’ levels of consciousness refer to developmental stages that can only be accessed via spiritual practices such as meditation (Wilber 1996: 75-77). A similar idea was developed by psychologist and meditation teacher Jack Engler, who argued that psychology and Buddhism map discrete states of a single developmental sequence, which starts with lower stages of conventional development (the domain of psychotherapy) and leads to more subtle stages of contemplative development (the domain of Buddhism) (Engler 1984). Engler has since revised his theory regarding a linear developmental model, but still believes that Buddhist theory and meditation practice address a type and range of functioning and well-being that go beyond traditional Western clinical practice (Engler 2003). This view that meditation is a technique that reaches beyond conventional psychotherapy can be found throughout the transpersonal psychology literature (e.g. Epstein 1995: 130; Goleman 1971: 4).
While both transpersonal psychology and psychoanalysis have been criticized for lacking conceptual, evidentiary and scientific rigor, contemporary Western psychology is now exploring the relationship between meditation and human potential through the current dominant paradigm of cognitive psychology. For example, Walsh and Shapiro (2006) discuss the potential of meditation to enhance sophisticated psychological capacities such as emotional intelligence, equanimity, moral maturity and lucidity during both waking and sleeping states. Other recent studies have examined the effects of mindfulness meditation on empathy (Berry et al. 2018), compassion (Fulton 2018), prosocial behaviour (Luberto et al 2018) and well-being (Brown et al. 2007).
Hence, one of the factors that has contributed to meditation adverse effects being overlooked in psychological and clinical settings is quite straightforward: meditation is seen as a highly successful therapeutic intervention, and successful therapeutic interventions are supposed to help, not harm. A close examination of the psychological and scientific literature reveals that where meditation adverse effects have occurred, two strategies have been used in order to “explain away” these effects. The first is that in psychotherapy, any difficulties that occur during meditation have generally been attributed to ‘normal’ psychotherapeutic processes such as catharsis or “working through” issues (Parsons 2009: 205; Bogart 1991: 397). This is seen particularly in early TM studies, where negative effects associated with meditation were simply attributed to “unstressing,” a term used by the Students International Meditation Society (SIMS, the parent organisation of TM), to describe an initial, transient process whereby the problem areas in the meditator’s life are solved or “normalised” (Otis 2009 ). Similarly, Walsh and Shapiro (2006: 234), when discussing complications that can arise as the result of meditation practice, write that from a Western psychological perspective:
growth at any stage can be challenging, but many challenges may be potentially therapeutic, and clinicians have therefore described them as, for example, ‘crises of renewal’, ‘positive disintegration’, ‘creative illness’, and ‘spiritual emergencies.’
While Western psychological views of growth and transformation entail change that, regardless of whether initiated by meditation, will be experienced as difficult by many people, it is important to note that the ‘adverse effects’ this article is referring to are quite literal. The term adverse effects is not, in this particular context, simply a metaphor for the emotional discomfort involved with personal growth. It would be quite unusual, for example, to expect auditory hallucinations, involuntary movements, or psychosis to result from psychotherapy, yet these effects have all reportedly been associated with meditation (Britton 2011a; 2011b; Farias and Wikholm 2015: 150-151). Further, meditation adverse effects that are long lasting and functionally impairing are unlikely to be the result of a normal process of psychological growth. Despite this, it seems that a common explanation for meditation adverse effects is that they are simply the result of psychological discomfort arising from the therapeutic process.
Secondly, in Western psychotherapeutic contexts, difficulties associated with meditation may also be misattributed to the individual meditator. Willoughby Britton notes that when it comes to meditation adverse effects there have been various instances of “victim blaming” and a tendency to assume that any problems encountered with meditation are the meditator’s fault (Britton and Lindahl 2017). This is a perspective that can also be found in the psychological literature. For example, religious studies scholar Jeffrey Kripal (2007: 138) writes that in the 1960s and 1970s, people who showed interest in various altered states of consciousness – such as those resulting from meditation – were routinely diagnosed by the Freudian-influenced medical establishment as displaying signs of mental disorder. Even relatively recently, psychologist John Suler has argued that people who are drawn to meditation display a range of psychological problems: “from a fear of autonomy and refusal to assume adult responsibility to issues concerning incapacity for intimacy and passivity/dependency needs” (cited in Parsons 2009: 201). Other scholars have argued that in some situations meditation may be used as a form of ‘spiritual bypassing;’ a technique used by individuals to avoid dealing with unresolved emotional issues or unfinished developmental and psychosocial tasks (Masters 2010) and that people with identity and self-esteem problems are particularly attracted to meditation practice (Engler 1984). Simply blaming adverse effects on the meditator is both an intellectually lazy and unhelpful practice, as it is likely that most meditation adverse effects involve a complex interaction between the practice of meditation and the individual meditator. However, in therapeutic contexts, where meditation is used to treat a variety of conditions that affect mood and cognition, it can be challenging to identify what difficulties are due to pre-existing or latent psychopathology and what might be caused by the meditation technique itself.
One of the first theories that attempted to explain the effectiveness of meditation in clinical settings was that meditation helps produce a state of relaxation. Certain physiological changes have been consistently reported during meditation studies, including reduced heart rate, decreased oxygen consumption and carbon dioxide elimination, decreased blood pressure, increased skin resistance and increased regularity and amplitude of alpha brain waves (e.g. Shapiro and Walsh 2009). As these physiological signs are typical responses that occur during relaxation, early researchers hypothesised that meditation produces a ‘wakeful hypometabolic state’ of relaxation, and in 1975 cardiologist Herbert Benson coined the term ‘relaxation response’ to describe the physiological and psychological effects that occur during meditation (Benson 1975). The attainment of a relaxation response during meditation has been replicated by many subsequent studies, and as a result, meditation practices are often reduced to and equated with (particularly in the popular media) other relaxation techniques such as hypnosis, progressive relaxation, guided imagery and biofeedback.
Today, the relaxation view of meditation has been recognised by scholars as overly reductionist and incomplete, however, the association between meditation and relaxation has prevailed. Scholars have argued that this is because defining meditation as a relaxation technique allows it to fit more easily into secular therapeutic paradigms. For example, Gordon Boals posited that the relaxation view of meditation initially gained popularity because it demystified meditation and divorced it from its Eastern religious roots, “thereby countering the apparent secrecy and cultishness that have risen around most meditation procedures” (Boals 1978: 149). When reconceptualised as relaxation, meditation became more familiar, acceptable and accessible to the scientific community.
However, one of the problems that arises when meditation is equated with relaxation is that it leads to unrealistically positive expectations regarding meditation outcomes. For example, a common popular misperception about meditation is that it always leads to the attainment of blissful states or the transcendence of one’s day-to-day reality (Lustyk et al. 2009: 26). Perceptions such as this contribute to the view of meditation as a panacea and may possibly result in the under-reporting of meditation adverse effects by practitioners. When meditation is presented as a harmless relaxation technique this creates a situation that meditators may be reluctant to question or challenge, and meditators may be afraid to speak up regarding difficulties with practice. Farias and Wikholm (2016) describe the case of a meditator who:
tried out a mindfulness course because he was having some trouble falling asleep. While doing the course he became aware of negative thoughts, which wouldn’t disappear no matter how much he accepted and tried to ‘let them go.’ After eight weeks his anxiety levels had increased from something barely noticeable to an everyday problem which he found hard to manage. ‘Is it my fault?’ he wanted to know — and this is a common question for those who don’t feel the wellbeing, relaxation, happiness kick one might expect to get when meditating. Let’s not add stigmatisation to the list of adverse effects. It is no one’s fault when meditation goes wrong.
Hence, meditators who do not experience relaxation, or worse, experience adverse effects, may attribute these experiences to their own perceived inadequacies as practitioners and be reluctant to speak up. Contributing to this effect is the fact that even in Western secular contexts it is common for meditators to practice in silence in order to enhance the deepening of concentration and awareness (Compson, 2014). Limiting social interaction and encouraging uninterrupted practice may create conditions that contribute to meditators’ reticence to speak about adverse effects with teachers. For example, it is possible that the common instruction in therapeutic mindfulness practice to ‘just sit with it’ may create an implicit pressure on the meditator to endure any adverse effects in silence, leading to an under-reporting of adverse effects.
The relaxation view of meditation has also greatly influenced the way in which scientific studies report the effects of meditation. Scholars have argued that studies of meditation may emphasise or deemphasise certain effects in order to fit within acceptable modern paradigms, such as that of Western therapeutic culture (Britton et al. 2013). So far, studies of meditation have emphasised its relaxation effects, however, the evidence that meditation can lead to a state of relaxation is based primarily on studies of only two types of meditation: TM, and mindfulness techniques derived from the Theravada stream of Buddhism. Interestingly, a number of studies exist that show that other forms of meditation, such as those from the Vajrayana and Hindu Tantric traditions, produce a state of arousal, not relaxation (Amihai and Kozhevnikov 2014). For example, a study by Ido Amihai and Maria Kozhevnikov (2014) suggests that different types of meditation are based on different neurophysiological mechanisms, which give rise to either a relaxation or arousal response. An interdisciplinary review by Britton et al. (2013) also lends support to meditation’s arousing effects, providing further evidence that the common characterisation of meditation as a relaxation technique is incomplete. The evidence from this review suggests that not only do different types of meditation techniques lead to either relaxation or arousal, but that paradoxical arousal effects may occur even with meditation techniques that were traditionally thought to be relaxing. Specifically, some types of Buddhist meditation (e.g. vipassana) can actually result in increased wakefulness and lower sleep propensity depending on the dose and the expertise of the practitioner. As meditation adverse effects are by definition arousing and not relaxing, research studies that focus only on the relaxing effects of meditation risk ignoring other categories of phenomenological experience that may include adverse effects.
Attempts to integrate meditation into Western psychotherapy have focused on the therapeutic benefits of meditation as a technique to help a person address psychopathology and develop a healthy sense of self. Secular meditation-based therapies are therefore concerned with individuals and their adjustment to their social context; a context which scholar Geoffrey Samuel describes as “deeply invested by the Western sense of the separate individual” (Samuel 2015: 494). Yet, contemporary therapeutic meditation practices such as mindfulness and TM derive from modernist versions of Buddhism and Hinduism; religious traditions which emphasise the deconstruction of the individual self, or the realisation of non-self. In Hinduism this is referred to as self-realization (atma-jnana) and is equated with knowledge of the true self beyond identification with material phenomena. Similarly, Buddhism denies the existence of the sense of self (atman) as a stable and continuous entity. Samuel (2015: 494) writes: “For Buddhists, the human sense of oneself as a coherent, stable individual is ultimately artificial and mistaken … This is not an optional extra for Buddhists; it is a central assertion of the tradition.” Thus, in these religious traditions, meditation is seen as a technique that can aid in the realisation that the conventional sense of self is an illusion.
This presents an interesting challenge for Western therapeutic meditation with its current individualistic orientation. While the Western meditation literature describes a helpful shift in perspective that arises from basic mindfulness practice, the idea of non-self as defined by Buddhism fits poorly into the contemporary Western therapeutic context, which focuses on the fulfilment of the individual’s personal desires and the gratification of the psychological self. A problem arises because in Western therapeutic approaches, meditation is seen simply as a technique whereby “one’s old notion of self can better get what it wants” (Rosch 1999: 222). However, as a contemplative practice, the goal of meditation is not self-gratification or self-fulfilment, but rather the deconstruction of the individual self. While psychotherapy seeks to modify the self, the original goal of meditation in a religious context is to experience a consciousness beyond the cognitive structures and constructs of the conventional self.
That Western psychotherapy and the Eastern religions from which contemporary forms of meditation originate have fundamentally different ideas regarding the self is a fact that has been largely ignored in the scientific literature on meditation. It is possible this is because there is an implicit assumption that both psychotherapy and the contemplative traditions share a common goal – the alleviation of human suffering – and that notions of non-self are seen as irrelevant in contemporary secular pursuits of this goal. While this may be true to an extent, the definition of ‘suffering’ differs significantly according to context. In psychological terms, suffering is equated with psychopathology, or problems associated with the individual self. In Buddhist and Hindu traditions, suffering is caused by the illusion of the individual self. For example, in Buddhist philosophy, any relief from suffering that is provided by an attempt to adapt to external conditions – arguably the goal of most forms of psychotherapy – would be temporary; true alleviation of suffering would only come from realising the illusory nature of the self. As C.W. Huntington Jr. (2018) writes:
Both Buddhism and psychotherapy are directed toward the problem of human suffering, but nibbana—the goal of Theravada Buddhist practice—and the therapeutic goal of “mental health” are grounded in two distinct understandings of the nature and scope of human suffering. While psychotherapy aims at the alleviation of symptoms experienced as extrinsic or peripheral to the patient’s underlying core sense of self, Buddhism addresses a form of suffering (dukkha) considered intrinsic to the experience of the personal self as an independent agent defined by its capacity to analyze and think, to judge, choose, act and be acted upon. Buddhist teachings associate these two forms of suffering with two distinct but interrelated truths about the self and its world: the first is ‘conventional’ truth (sammuti-sacca), which governs day-to-day, practical affairs, where appearances are all that matters; and the second is ‘ultimate’ or ‘absolute’ truth (paramattha-sacca), which reveals the illusory nature of these same appearances.
The practice of psychotherapy is, accordingly, dedicated to a method of healing that leaves the conventional structure of self-as-agent intact as the focal point of attention, whereas Buddhist spiritual practice engages in a sustained, methodical dismantling of our customary preoccupation with self-centered experience.
This key difference in definitions of suffering may be another factor contributing to meditation adverse effects being overlooked in secular therapeutic contexts. That is, secular therapeutic forms of meditation may induce effects that go beyond symptom relief; specifically, changes to the meditator’s sense of a stable individual self. That is, to use the words of Huntington Jr., secular therapeutic meditation may not always leave the “self-as-agent” intact. A review of the psychological literature shows support for this idea, and also indicates that such experiences of insight into the impermanent nature of the self during meditation may be extremely challenging. For example, in his pioneering phenomenological study of insight meditation practitioners, Jack Kornfield (1979: 54) describes the challenging aspect of non-self experiences in vipassana meditation:
Deep practice also involves mindfulness of death-like experiences, reported as feeling a dying of the body, death of illusions, of self-images, of ideals, of past and future, and the idea of one self as permanent or solid at all. One of the experiences most commonly described as powerful or transformative is the insight into the moment-to-moment changing nature of the self. Students report experiencing themselves as simply a flowing process of sense perceptions and reactions, with no sense of a fixed self or person existing apart from this process at all.
Similarly, Jack Engler (2003: 92-93) writes:
Discovering that there is no ontological core to consciousness or self that is independent and enduring and no stable ‘objects’ of perception … no ‘I’ or ‘thing’ enduring across the gap between one construction and arising of the next – this is a profound shock. It is experienced as a free fall into a looking-glass world where, as the Mad Hatter tells Alice, ‘Things are not as they seem!’ It so turns our normal sense of self and reality on its head that, as Niels Bohr once remarked about quantum physics … if you don’t get dizzy thinking about it, you haven’t understood it.
A recent study by Lomas et al. (2015) also reported on the difficulties that meditators can encounter with non-self experiences. When describing one participant’s experience, the authors write: “the deconstruction of the self (which is the goal of the practice) was experienced as a frightening dissolution of identity, rather than as a sense of liberation (which the practice is arguably designed to invoke) (Lomas et al. 2015: 855).” Other participants in the study described their non-self experiences as disorienting, frightening, alienating and disturbing. Sean Pritchard’s (2016: 66) qualitative study of vipassana meditators supports these findings, with one participant describing an insight into non-self as a “death experience.” Further, Andrea Grabovac (2015) argues that some participants in secular mindfulness-based interventions appear to progress through the Theravadan Buddhist stages of insight, even during a relatively short period of time, such as an eight week program. This progress involves experiences that can be extremely psychologically challenging (including experiences of non-self), and that may become clinically significant. Hence, it seems that even when secularised and applied in Western therapeutic contexts, meditation may cause the concept of a stable, permanent psychological self to be challenged, and this may result in adverse effects.
It is clear that while Western psychotherapy and meditation share some similar goals and functions in the enhancement of individual well-being, there are also major philosophical differences that must be acknowledged. Some scholars have gone so far as to argue that the Buddhist and Hindu goal of meditation (the realisation that the individual self is illusory) is fundamentally irreconcilable with the Western therapeutic goal of facilitating the development of a cohesive psychological self (Bradwejn, Dowdall and Iny 1985). Others have argued that a more balanced approach may be to maintain a clear distinction between Western psychotherapeutic aims and the goals of Eastern meditation, and to admit the differences between the stated aims of each technique (Bacher 1981). While the idea of completely excluding meditation from psychotherapy seems unnecessary and extreme, the literature suggests that it would also be impossible to make a clear distinction between ‘Western psychotherapy’ and ‘Eastern meditation’ in modern contexts, because they have co-arisen and been developed in a mutually informing way. Hence, it is up to secular clinicians and meditation teachers to recognise that non-self experiences may occur, even with secular meditation, and that these experiences are distinct from psychopathology.
A final factor to consider is that the scientific study of meditation has occurred primarily in clinical trials and self-report surveys that have focused on quantitative, bio-neurological investigations into the effects of meditation. While clinical trials are the most reliable method for acquiring accurate information about the effects of meditation, their design does not specifically seek to test for side effects or adverse effects. Currently there is no standard method for identifying adverse effects in clinical trials, and the vast majority (>75%) of meditation studies do not actively assess adverse effects, but rely on patients to spontaneously self-report any negative experiences that occur (Lindahl et al. 2017). However, research into the nature of self-report has demonstrated that participants in clinical trials are unlikely to spontaneously volunteer information about negative experiences due to the influence of social desirability effects and demand characteristics. Therefore it is probable that the prevalence of adverse effects in clinical trials, including meditation studies, is greatly underreported. Indeed, Lindahl et al. (2017) posit that passive monitoring of adverse effects in clinical trials may underestimate their prevalence by more than 20-fold.
Additionally, as quantitative studies de-emphasise the subjective experience of participants, very little research exists on the ‘lived experience’ of meditators, resulting in a skewed and incomplete perspective that focuses mainly on the positive effects of meditation. The small number of qualitative research studies on meditation that do exist indicate that there is a comprehensive phenomenology of meditation experiences that commonly includes negative effects. For example, Jack Kornfield’s (1979) mixed methods study of meditators during a three-month vipassana retreat reported several adverse effects including intense negative emotions, involuntary movements, abnormal somatic sensations, and altered state experiences. More recently, a qualitative study by Tim Lomas and colleagues found that one quarter of participants encountered substantial difficulties with meditation including troubling thoughts and feelings which were hard to manage, exacerbation of depression and anxiety, and in two cases, psychosis requiring hospitalisation (Lomas et al. 2015: 848-860). Additionally, Sean Pritchard (2016) examined the qualitative experience of advanced vipassana meditators and found that disturbing emotions such as anger, fear, anxiety and shame often occurred during certain stages of meditation practice, along with challenging shifts in perception of self. Finally, Leigh Burrows (2016: 285), in describing her small qualitative (n = 13) pilot study of young adult mindfulness meditators, writes:
the finding that many of the 13 participants had negative or unusual experiences raises a more fundamental issue—why is it that such an unusually high number of participants experienced negative emotions in this study and not in the vast majority of randomized controlled trials? Obviously, better controlled research is clearly needed to tease out whether the findings in this preliminary, uncontrolled study are unique to this study or generalizable to other mindfulness-based interventions.
These qualitative studies suggest that meditation adverse effects may in fact be a common and normal part of meditation practice that is being overlooked in clinical studies.
It is worth noting that meditation-related adverse effects have also been reported in clinical and medical case reports, including descriptions of meditation-induced psychosis (Kuijpers et al. 2007), depersonalization (Kennedy 1976), de-repression of trauma (Treleaven 2010), and mania (Yorston 2001). However, as case reports are concerned with single instances they are often regarded as unscientific and less worthy of consideration. While case reports are of course not as scientifically rigorous as randomised control trials, they are still a key mode of transmitting knowledge and have played a significant role in the evolution of academic psychology and psychotherapy in the area of religious and spiritual issues (e.g. Lukoff et al. 1999). Scholars have argued that case reports have an important epistemological function, as over time they accumulate into a body of knowledge which then guides clinical practice and suggests where research should turn to next. For example, Hunter (1986: 623) writes: “they [case studies] are frequently the as-yet-unorganised evidence at the forefront of clinical medicine.” Therefore it would appear that case reports on meditation, while sparse in quantity and less scientifically rigorous than clinical trials, do lend support to the idea that meditation adverse effects exist and are worthy of further investigation.
A final point worth considering is that an overly positive view of meditation may have developed within Western psychology because a large number of influential psychologists and researchers were, and continue to be, meditation practitioners themselves; what Parsons (2009: 199) terms “cultural insiders” and David McMahan (2008: 28-30) refers to as “Buddhist sympathisers.” Certainly, many authors who have written significant studies of Buddhist meditation and psychology (for example, Jack Engler, Mark Epstein, Paul Cooper, Jeffrey Rubin, Jeremy Safran, Jack Kornfield, Joseph Goldstein and Jon Kabat-Zinn, to name a few) represent a baby-boomer generation who were attracted to Eastern religions, went on meditation retreats, worked closely with gurus and then integrated meditation practices into their own therapeutic work. In Mindful America, Wilson (2014: 33) notes that most early MBSR instructors were Buddhists, or directly involved in formal Buddhist meditation practice. Similarly, Walsh and Shapiro (2006: 230) note that many of the early TM studies were published by “enthusiastic advocates using self-selected subjects.”
Unfortunately, throughout the history of science, some researchers have selectively interpreted or ignored data that fails to confirm a favoured research hypothesis. This is commonly described as a confirmation bias, and “connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a hypothesis in hand” (Nickerson, 1998: 175). While rigorous experimental design and the peer review system aim to minimise this type of bias, there is evidence that it still exists in the peer review process (Emerson et al. 2010) and in academic psychology (Hergovich et al. 2010). There is also evidence to suggest that the confirmation bias may be especially harmful to objective evaluations of nonconforming results, and that data that conflict with the researcher’s expectations may be rejected as unreliable, producing the ‘file drawer problem’ (Rosenthal 1979). In the case of meditation studies, such bias may lead to the under-reporting of adverse effects. While standards of meditation research have now improved considerably since the early TM studies, questions still remain regarding the objectivity of researchers who are also ardent supporters of the meditation practices they study. In particular, it is important to consider whether conflicts of interest or expectancy effects might be contributing to an overly positive view of meditation that overlooks potential adverse effects.
This article has examined how psychologists have viewed meditation, not as a way to achieve enlightenment, but as a form of psychotherapy, and how this has contributed to adverse effects being overlooked. During the historical relationship between meditation and Western psychology some key themes have emerged and these help to explain why adverse effects have been ignored. Firstly, viewing meditation as a type of panacea means that adverse effects may be misattributed to the therapeutic process or to the individual meditator. Similarly, reducing meditation to ‘relaxation’ leads to both a narrow focus in meditation research and overly positive expectations regarding meditation outcomes. The view of meditation as a panacea and a relaxation technique may also lead to the underreporting of adverse effects by meditators whose experiences do not match the perceived ideal outcomes, and there is anecdotal evidence to suggest that meditators who don’t experience relaxation, or who experience adverse effects, may blame themselves and be afraid to speak up.
Additionally, in psychological settings meditation is seen as a technique of symptom relief and self-transformation; it is used as a tool to heal and improve the individual psychological self. However in Eastern traditions, meditation is used to deconstruct the concept of the individual psychological self and realise non-self or True Self, which is a self that is beyond identification with the material world. Interestingly, there is evidence to suggest that non-self insights occur in secular meditation settings, however, Western psychology does not currently have a framework in which to adequately explain these experiences, and hence they may be conflated with dissociative psychopathology, such as derealisation and depersonalisation.
Finally, meditation adverse effects may be overlooked because meditation research has focused mainly on short-term quantitative studies that ignore the ‘lived experience’ of meditators. Indeed, the few qualitative meditation studies that exist demonstrate a rich and varied phenomenology of meditation experiences, including adverse effects. There is also the possibility that an overly positive view of meditation may have developed within Western psychology because a large number of influential psychologists and psychotherapists were, and continue to be, meditation practitioners themselves. While rigorous experimental design and the peer review system aim to minimise confirmation bias, there is evidence that it still exists in academic psychology, hence it is important to consider whether conflicts of interest or expectancy effects might be contributing to an overly positive view of meditation that overlooks potential adverse effects.
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 It should be noted that ‘state’ and ‘trait’ are psychological concepts deriving from scientific psychology, especially psychometric research on personality and intelligence. However more recently modern meditation teachers who are influenced by Western neuroscience and psychology have adopted these terms in order to differentiate between short-term and long-term changes that result from meditation. For example, Y. Tang, B.K. Hölzel and M.I. Posner, “Traits and States in Mindfulness Meditation.” Nature Reviews. Neuroscience 17, no. 1 (2016): 59.