Psychosis and Buddhist Retreats

Back in around 2001, after speaking about my own history of psychosis with a Zen  Monk, I recall being advised not to go on a week long Sesshin (Zen retreat), but instead to attend the monastery at another time when meditation sessions are less intense. In hindsight I can see the good intention behind this advice, but I recall the feeling that I must be more vulnerable in some way, and even wondered if I may not be able to train as deeply as others who don't have a history of psychosis. I felt sad and annoyed at this, but accepted the advice, albeit slightly begrudgingly.  

Since that time I have been on a number of week long retreats without psychosis as an outcome, but I can see how a retreat may not be helpful and may indeed be potentially harmful if one is currently experiencing psychotic symptoms. It would possibly just open things up too much and it could all get pretty overwhelming pretty quickly. I certainly wouldn't recommend it in these circumstances. 

More recently I spoke to a Zen Master about this question, she seemed to emphasise the importance of training in everyday life and seemed to suggest that training deeply in Zen does not necessarily mean building up a portfolio of retreats one has attended. So going to retreats is not really something essential to genuine Zen training for everyone anyway - especially when it might cause more harm than good - indeed, that would just be silly. 

Will Hall is a mental diversity counselor and consultant with a private therapy practice based in Portland Oregon. He holds a Masters Degree in Process Work and has done teaching and consulting work on mental health, trauma, domestic violence, conflict resolution and organizational development in more than 8 countries.

Will has been widely featured in the media for his advocacy efforts to reform mental health care. His work and learning arose from his own experiences of recovery from madness, and today he is passionate about new visions of mind and the possibilities of what it means to be human.

For Will, who was given a diagnosis of schizophrenia, his experiences labelled as “mental illness” by psychiatry, were an invitation to a richer and more spiritual understanding of life. Will found that the methods and outlook of the Buddha deepen his understanding of himself and the “madness” he went through. He has also found that Buddhist practice focused his mind and awakened his body.

Yet, Will argues that without realizing what they are doing, some Buddhist retreat centres may be stigmatizing and discriminating against people, like ourselves, who have experienced psychosis. 

The following article was first published in the summer of 2007 in Turning Wheel: A Journal of Socially Engaged Buddhism, a publication of the Buddhist Peace Fellowship, it is reproduced here with Will's permission:  

Freedom To Sit: 

Welcoming People Labeled with Psychiatric Disabilities at Buddhist Retreats

by Will Hall

In 1992 I was committed to psychiatric hospitals, suffering from voices, fear, isolation, and visions that led to a diagnosis of schizoaffective disorder schizophrenia. Since then, these same experiences guided me to the deeper questions of self and reality addressed by the dharma, and meditation practice has become an essential part of my life. The methods and outlook of the Buddha not only deepen my understanding of who I am and the “madness” I go through, but also, by focusing my mind and awakening my body, help to soothe and overcome the forces that threaten at times to destroy me.

When I am flooded with terrifying images and voices, stillness and listening clear a pathway for choice and control. Sensory awareness helps me regain a sense of safety in the world. Overwhelming fears become more manageable with observation, and dreamlike coincidences, telepathy, and omens lose their dangerous and seductive fascination when understood as expressions of the timeless unity of mind. Most importantly of all, when I am visited by seemingly demonic forces, I greet them as an opportunity: an opportunity to look more deeply at the trauma inside myself. Western medicine labeled my experiences mental illness, but for me they are an invitation to a richer and more spiritual understanding of life.

Meditation retreats are important to my practice, a place to reduce the clamor of daily life and increase the opportunity for discovery. But some of these retreats have policies that would exclude people like me. With the intention of protecting my own safety and the safety of their centers, retreats around the world regularly deny attendance to anyone labeled with severe mental illnesses such as schizophrenia or bipolar, and ask detailed and intrusive questions about psychiatric history, diagnosis, medication, and current medical care. Without realizing what they are doing, these retreat centers are stigmatizing and discriminating.

A friend called me recently from Northern California, in tears that his hospitalization as a teenager meant being banned from a retreat, when he knew that others, with far less experience and dedication in their practices, were welcomed. I have spoken to many meditators with mental illness labels who share similar feelings from these policies: shame and violation. Retreats claim to be acting for our own good, but this is no comfort: the painful history of society’s treatment of people labeled “mentally ill” shows that the worst of abuses can be done in the name of a person’s own good.

Meditation center policies do have honorable motives. Retreats often involve great psychological and physical stress, and can stir up powerful emotions and experiences. Sitting for hours, living in silence, and breaking familiar routines of food, sleep, and work can be overwhelming. From time to time a retreat participant will go into an emotional crisis or need additional attention and care, which is disruptive to other participants and can, on rare occasion, lead to hospitalization. There are fears of insurance liability as well. Retreats therefore try to screen applicants for their suitability to the rigors of the retreat and their ability to complete the program successfully, hoping to prevent any problems.

I understand the need for meditation retreats, like any difficult program such as wilderness survival or sports training, to screen applicants. But you can’t predict someone’s ability to complete a stressful retreat by asking them intrusive questions about treatments, hospitalization history, or whether they’ve been labeled with a severe mental illness. Such questions invade privacy and are based on stereotypes about what people can and cannot do, stereotypes the disability rights movement is working to end. Being deaf, in a wheelchair, or blind doesn’t necessarily mean you can’t complete a meditation retreat, and neither does having a psychiatric history, diagnosis, or treatment. To believe people must be less capable just because of a disability, any disability, is to make assumptions that lead to discrimination.

U.S. law has already reached the same conclusion. Passed in 1990, the Americans with Disabilities Act is a comprehensive civil rights measure that protects from discrimination people who are, have been, or are perceived to be disabled. The ADA is historic legislation that has spawned revisions of international law and is looked to worldwide as a guide to fair treatment of people with disabilities, including people labeled with mental illnesses. I don’t endorse the idea of “disabilities,” and prefer instead to see them as “diverse-abilities,” but the ADA does set a basic standard for protecting people’s rights. 

Under the ADA, employers, businesses, schools, and other institutions are not allowed to ask about the specific disabilities of prospective participants, employees, or students. This includes questions such as whether the person is deaf, in a chair, has been in a psychiatric hospital, or is on medication. Asking whether they can complete a specific task is allowed, but asking for personal information about any disability itself is considered discriminatory.

Meditation retreats usually fall under the ADA exemption allowed for religious organizations, even though they offer public services. That is to say, religious organizations are free to deny deaf interpreters, have no wheelchair ramps, or ban service dogs without fear of civil liability and being sued. (A religious organization would in certain specific instances still be bound to the ADA, such as if it was using a federally funded facility such as a public school for its public programs or was receiving federal funds, and in its hiring practices.)

Any meditation retreat that asks about the psychiatric histories of participants is therefore not technically in violation of the letter of the ADA, but it is certainly in violation of the spirit.

Given that retreat centers do have a legitimate need to screen people for their ability to participate, the question becomes, Can retreats accomplish this and remain within the spirit of the ADA? Can retreats screen applicants without being intrusive or relying on assumptions about what people with psychiatric diagnoses are capable of?

The answer is definitely yes. There are many Buddhist retreat centers around the world, from all traditions and varieties, that are already doing this. They don’t ask intrusive questions or exclude people based on their diagnostic label or psychiatric histories. These retreats either describe the challenges of their programs and let participants decide for themselves, or they have found neutral, non-discriminatory questions to ask applicants, questions that, in compliance with the ADA, focus on what a person can do without making assumptions about who they are. Such questions can be even be very detailed. Examples might be, “Have you successfully spent extended time meditating before? Have you endured extended periods of silence and stillness in the past? What is your susceptibility to stress? Are you emotionally fragile and vulnerable at this time in your life? Can you do without your daily routine? Are there any vital personal needs that you will be unable to meet during this retreat? Do you think you will be unable to complete this retreat for any physical, emotional, or psychological reasons? Do you have any questions about your capacities that you would like to discuss in further detail?”

Many people who have had harrowing experiences going off the deep end of madness, landing in psychiatric hospitals and labeled bipolar, schizophrenic, or borderline, have nonetheless gone on to become perfectly capable of completing rigorous meditation retreats. And many people with no psychiatric history at all have found themselves unable to complete the same challenging retreats. We are not necessarily more fragile, vulnerable, or unstable than others just because of our mental health experiences. Given the growth of mental illness labeling thanks to pharmaceutical company marketing, and given the inaccuracy of psychiatry as a science in general, for many people a psychiatric label might mean nothing more than that one doctor decided to give one diagnosis or prescribe a particular drug where another might have disagreed.

Those of us who have been through a breakdown or a “psychotic episode” (which many traditions understand in positive and spiritual terms, instead of the pathologies of Western medicine) may sometimes be more open to benefit from meditation, and more equipped to deal with strong feelings and emotions when they arise. People often recover from past crisis and emerge stronger than ever. When I began to meditate regularly, my emotional wellbeing improved so much that dedication and insights came quickly. If sitting for many days unravels familiar patterns of mind, and I start to encounter terrifying traumatic memories, distortions of time and space, voices, or psychic phenomena, I know how to deal with these states, because I have met them many times before outside of retreats. Many of us have discovered that our so-called “illness” is actually intimately connected with spiritual awakening, and can even be our initiation into practice. Meditation, including on retreat, is a valuable recovery and healing tool, and what is called “madness” can itself be part of a spiritual path.

Buddhist teachings are intended for all. The ADA and the disability rights movement are working to ensure that people who are different from the mainstream are not segregated and excluded based on assumptions, misunderstandings, and stereotypes. If we are on the side of social justice and compassion in the world, we should be on the side of social justice and compassion in our own communities.

I know first hand how important dharma practice is and the vital role that retreats and sanghas have played for my spirit and my health. I am also diagnosed with schizophrenia, and I know how painful, shaming, and humiliating some retreat policies can be. In the face of admissions discrimination, I have, like many people who go to retreats, kept my psychiatric details hidden. But participants like me shouldn’t be put in the position of hiding who we are. Fortunately many retreats are truly welcoming to those of us with psychiatric labels. I look forward to the day when all retreats are.



Note: You may also be interested in Manasa Ayurveda - a traditional Buddhist Ayurvedic approach to mental health and wellbeing, now being introduced in the West...