Hello <<First Name>>
If it is available to you, drop into this moment by dropping into your body - noting all the body sensations coming and going moment by moment...for a few moments. Thank you
I hope you are peaceful and at ease these days, or at least minimally frazzled. If you are stressed or distressed, notice if you meeting your challenges optimistically and positive, handling them constructively, or playing the victim role, blaming-shaming…that is, are you hoping, coping or moping?
Darkness, Darkness Be my blanket
Cover me with the endless night
Take away, oh, this pain of knowing
Fill this emptiness with light, now
Robert Plant
For the last few years I have been presenting a lecture, “The Dark Side of Mindfulness” at the United Way of Broward annual Behavioral Health Conference. A month ago, I decided to offer a community workshop on the side effects and adverse effects of mindfulness (Link Here).
While preparing for this workshop, a few things that make me think this topic is timely showed up. First, I saw a research paper, Intermittent mindfulness practice can be beneficial, and daily practice can be harmful. An in depth, mixed methods study of the "Calm app's (mostly positive) effects concluding that mindfulness-based self-help apps such as Calm have the potential to both enhance and diminish users' wellbeing." The authors recommend that mindfulness proponents be aware of negative outcomes and resist the idea that mindfulness works for everyone. The second thing I saw was the release of the annual “Mindfulness journal articles published by year: 1980-2019”. This is a graph from UCLA that comes out yearly depicting the year-by-year exponential increase in published research. Thirdly, I listened to a recent podcast, “CAN MEDITATION BE HARMFUL?” with Willoughby Britton, PH.D. of Brown University.
That mindfulness has a dark side may be news to you, but to most persons that have been practicing and especially teaching mindfulness for a while, this is known. Personally, I have had a long-time interest in the side effects and adverse effects of mindfulness and meditation. Undoubtedly this stems from my practicing Medicine, where to know and discuss the side effects of treatments with patients was essential. And medical training teaches us First Do No Harm. Not unexpectedly then, I became interested in and curious about what can go wrong with mindfulness when I first started teaching MBSR. Also, the more I practiced, the more I had unpleasant experiences that I was told were ‘normal’ and expected by my teachers and other meditators.
By now, that practicing mindfulness has benefits is well known, well-established and supported by research. But much less is known about the dark side - both the side effects and adverse effects. The article revealing that negative experiences with an app can happen is something not many of us are aware of. The graph of the year-by-year mindfulness publications reminds me that in spite of the abundant and growing amount of research, only a tiny fraction address adverse effects systematically -- something unheard of in Medical research where reporting side effects is a must to be published. And in the Britton podcast, she points out how little is known about the real and potential problems with mindfulness and meditation. She and her team at Brown University are raising awareness of this important topic. Along with others such as David Treleaven and Trish Magyari who focus on trauma and mindfulness, they are providing information and resources for recognizing and addressing the negative experiences that meditators might have.
There is no dark side of the moon really. As a matter of fact, it's all dark Pink Floyd
What can go wrong, what are these dark, negative, unpleasant experiences that can happen to mindfulness practitioners? This is too long a topic to write about here. And at the risk shamelessly plugging my workshop, this is what I will be addressing on Mar 15th (see below). Briefly, there are known and expected difficulties with meditation practices, which I call “side effects”. These meditation-related difficulties are found and have been written about in most contemplative traditions. They are well-known by experienced teachers. Examples include: ‘Dark Night of the Soul' in Christianity, ‘Kundalini Crisis’ in traditional yoga, various physical injuries in modern-power yoga and ‘Spiritual Emergence vs Spiritual Emergency.’ In mindfulness, there is the Path of Insight of vipassana meditation. The most common map of the Path of Insight describes 16 stages that meditators go thru. Stages 5-10 are grouped together as the Knowledge of Dukkha (suffering) stages and are named: 5) dissolution, 6) fear, 7) misery, 8) disgust, 9) desire for deliverance and 10) re-observation. Their names allude to their disturbing and distressing nature. Importantly, these are part of the path and they cannot be avoided if one is to achieve awakening and liberation. But they vary - some will pass thru them quickly, some slowly; some barely notice them, and for some, they are strong & obvious.
On the other hand, there are unwanted, harmful and unhealthy problems and experiences that can arise for mindfulness practitioners - what I call adverse effects. Researchers and therapists have noted negative effects of meditation > 50 years. They are predominantly exacerbations of mental health issues, such as dissociative symptoms, psychosis, depersonalization, derealization, confusion, increased false memory susceptibility, criminogenic thinking, changes in worldview, impairments in executive functioning, and disorientation. Also possible is the triggering of traumatic memories with or without exacerbation of traumatic distress and the arousing of negative emotions. These are being seen more and more in our classes these days, possibly because of the rise in mental illness in our society leading to an increase of people with mental health issues attending our classes, or perhaps we are more just aware of them. Either way, there is a paucity of information and knowledge into these potentially devastating effects. There are also a host of somatic changes affecting sleep, appetite, pain, energy, and involuntary movements. Common too are perceptual changes such as hypersensitivity to light or sound, distortions in space and time, visions or visual hallucinations. And potentially most distressing and destabilizing are changes in the sense of self affecting one's sense of ownership over thoughts/emotions/body, agency over actions, or boundaries between self and world.
Only to the degree that people are unsettled is there any hope for them Ralph Waldo Emerson
There are many reasons for this lack of awareness of the negative effects, beginning with the fact that in today’s rapidly growing mindfulness movement and marketplace adverse effects are bad for business! Also, as the goal of meditation in the West has shifted from enlightenment-awakening to symptom relief and personal transformation, there has been a misperception that meditation always leads to blissful states or transcendence of day-to-day reality. Popular media reports on meditation are overwhelmingly positive with almost no mention of adverse effects prior to 2014. This gives the impression that meditation is a panacea...if done "correctly." Then when practitioners are not feeling happy or not achieving pleasant states or are having negative experiences, they feel that they are doing something wrong - it's their own fault. When the difficulties are misattributed to the meditator, the problem is compounded by feelings of shame that can cause a reluctance to question or challenge the teacher or practice. Or worse, there is (unintentional) victim-blaming by the teacher.
As I note above, there are no standard methods for identifying side effects and adverse effects in research and clinical trials. The vast majority of meditation studies do not prospectively measure adverse effects. Instead, they rely on patients to spontaneously self-report negative experiences. But meditators may be afraid to speak up regarding difficulties with practice, and so these unwanted, harmful effects go unreported.
Adding to all of this, there is a significant lack of awareness of the expected unpleasant meditative experiences that are part of the path by therapists and psychologists and a consequential lack of knowledge of mental illness by meditation teachers. This leads to a tendency to pathologize expected meditation experiences by clinicians and to romanticize/spiritualize psychopathology by meditation teachers.
Fortunatley, most of the adverse effects happen to those on long silent meditation retreats. But Britton’s group and others are starting to collect data on participants in MBSR and similar mindfulness programs. In these cases, the adverse effects are usually uncommon and mild. Still, I have seen things go wrong in my MBSR classes. Without a systematic and informed approach, it has been challenging to address the needs of the practitioner when they arise.
To go in the dark with a light is to know the light.
To know the dark, go dark. Go without sight,
and find that the dark, too, blooms and sings,
and is traveled by dark feet and dark wings Wendell Berry
Remember though, in mindfulness we are trying to be with all our experiences, including the negative and unpleasant ones. Indeed, as supported by research, practicing mindfulness skillfully and compassionately can be beneficial for disorders such as PTSD, anxiety and panic, grieving, depression, stress, chronic pain, and other mental illnesses. But this is most effectively done by being with and exploring these negative, unpleasant and sometimes painful expereinces - a going into the darkness to fully heal.
Knowing your own darkness is the best method for dealing with the darknesses of other people. Carl Jung
So, what to do when a negative, unpleasant event happens to you or to a student of yours if you are guiding-teaching others? Here again, there is not enough space and time to discuss this aptly. I can say that this topic is relatively new and developing, so it would be prudent to make yourself aware of what can happen. And to know there are others that are interested and experienced in these matters that can serve as a resource/referral.
For now, I agree with Britton’s view that we should adopt a person-centered approach. This requires the care, attention and skillful know-how of experienced meditation teachers and clinicians that can work together when necessary to address the needs of the person in a respectful and empowering way, not just about their meditation experiences and mental health, but also what has ultimate value for the person. Additionaly, always keep in mind the context of the practice and culture of the meditator, as well as the totality of their health, both illness and wellness. We should make sure that what constitutes well-being is not simply assumed or imposed by the teacher or clinician.
Finally, if you have experience with, comments, feedback, or questions about any of this, please feel free to contact me. I do not consider myself an expert, just authentically interested as someone who came to mindfulness for my own mental health and addiction issues and that has gone through many cycles of the Dark Nights stages of mindfulness, as well as dealt with adverse effects in my classes. But particularly, if you are experiencing an adverse or negative effect from practicing mindfulness, please, please, reach out for help - you are not alone.
Take good care, practice well, stay connected…
You darkness from which I come,
I love you more than all the fires that fence out the world,
for the fire makes a circle for everyone
so that no one sees you anymore.
But darkness holds it all:
the shape and the flame, the animal and myself,
how it holds them, all powers, all sight
and it is possible:
its great strength is breaking into my body.
I have faith in the night Rainer Maria Rilke
For more information on this topic, see Cheetah House, Britton’s website with lots of resources. Also, I have summarized the benefits and adverse effects on my website. And David Treleaven and Trish Magyari have useful resources as well.
