Mental health and Intensive Meditation Retreats

Geoff Dawson is a Dharma Successor of Charlotte Joko Beck. He is the teacher of the Ordinary Mind Zen School - Sydney. He began the school in 1998 and received Dharma Transmission in 2003. 

Who are retreats appropriate for?

Geoff has been studying and practising Zen Buddhism since 1975 and was one of the founders of Zen in Australia. He has also presented at many seminars and conferences in Australia on Buddhism and Psychotherapy. Geoff Dawson is also a registered psychologist. He works in full time private practice at North Sydney and  the Blue Mountains. Geoff provides adult psychotherapy, couples therapy, family therapy and clinical supervision that is integrated into a Buddhist perspective.

Will Hall’s 2007 article (“Freedom to Sit”) posted elsewhere on this blog (see: "Psychosis and Buddhist Retreats"), acknowledges that from time to time a retreat participant will go into an emotional crisis or need additional attention and care which may be disruptive to other participants and potentially, on rare occasion, lead to hospitalization. 

Will observes that 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. Whilst recognising the need to screen applicants, Will is critical of attempts to predict someone’s ability to complete a stressful retreat by asking them "intrusive" questions about treatments, hospitalization history, or whether they have been labelled with a severe mental illness. He argues that such questions invade privacy and are based on stereotypes about what people can and cannot do. Such assumptions, he argues, can lead to discrimination.

In a 2011 article, Geoff Dawson also addresses the issue of retreat participants potentially going into an emotional crisis or needing additional attention and care. But Geoff takes a slightly different approach: “I don't know how compatible it is with Will's article” he said, and reflecting upon Will’s article, Geoff acknowledges that he understands and respects the need not to discriminate; however he also says: “I find I need as a Zen teacher and psychologist to ask "intrusive" questions to make a clinical judgement as to whether someone is ready to undertake a retreat and whether it would be harmful to them”.

The theme in Geoff’s article is about the importance of "gradual exposure" to meditation practice. “I am non-discriminatory in the sense that I wont let people with or without a psychiatric history do a retreat without some significant prior experience to meditation” he said, but his position seems to differ from Will’s when he says: “I don’t see it simply as a matter of letting people make up their own minds when given the information about the intensity of the retreat”.
Geoff also says “if someone who was previously psychotic could demonstrate to me through gradual exposure to intensity that they could handle it that would fine too”.

Perhaps Geoff's approach will bring us closer to a middle way between, on the one hand, discriminating against people simply because of stereotypes, and on the other, accepting people into retreats which may be harmful to them simply because that is what they choose. 

The following article by Geoff Dawson, was first published April 2011 in InPsych,The Bulletin of the Australian Psychological Society:

Over many years working as a psychologist and as a Zen Buddhist meditation teacher, I have often had people come to see me professionally because they have experienced ongoing mental and emotional distress as a result of attending an intensive meditation retreat.

These experiences have mainly been panic attacks and depressive episodes but have also included some manic and psychotic episodes. Many of these episodes have persisted and have met the criteria for an ongoing mental disorder.

As a consequence of these incidents I feel strongly that mental health professionals and meditation teachers need to be aware of the potential adverse effects of intensive meditation retreats, who they are and are not suitable for, and what safety procedures can be put into place to minimise the possibility of mentally distressing experiences.

Unfortunately, there is very little guidance available in this area, so this article offers advice on these matters from my own personal experience as both a psychologist and teacher of meditation.

As a Zen Buddhist meditation teacher, I am obviously a supporter of meditation retreats. People who can handle this rigorous training report having positive integrating experiences – greater resilience, less ruminating in their everyday life, insight into their narcissistic attitudes and behaviours, deeper feelings of self-acceptance, emotional stability and compassion towards others, and spiritual insight into the impermanent and interconnected nature of life.

However there is a vast difference in the practice of meditation for half an hour a day compared to the experience of a retreat involving six to ten hours a day for days on end, all conducted in silence and with no socialising or eye contact. Even resilient and experienced meditation practitioners can find retreats mentally and physically challenging.

While meditation intensives may be challenging and difficult, I am also opposed to living in a risk-averse culture and creating a climate of hysteria as to their potential dangers. People undertake many risky activities, such as mountain climbing, abseiling – and even getting married, or investing on the stock exchange. Many people have experienced profound difficulties as a result of the stock market collapsing or becoming divorced, but we would not consider that these institutions should be stigmatised. Neither should all meditation centres become the subject of a witch-hunt because of the unfortunate experiences of a few.

Many meditation teachers specify that people should not do retreats if they have a current psychiatric disorder. This obviously includes the more pathological disorders such as psychoses, severe mood disorders, severe anxiety disorders and identity disorders, but this should not be restricted to just the most severe types.

It is recommended that people with little or no meditation experience should not go straight into a meditation intensive if they have:

• A substance addiction, or have just detoxified without first undergoing a follow-up treatment program

• A significant personality disorder

• Any anxiety or mood disorder.

However, the reality is that there are many people who have undiagnosed psychiatric disorders who apply to undergo intensive meditation training. Frequently, troubled souls are drawn to the quick fix that the profound peacefulness of a meditation retreat can provide, so care needs to be taken in selection. Appropriate selection for a meditation retreat can be managed through a graded introduction to meditation which provides the opportunity for the teacher to assess the suitability of individual participants.

It is recommended that retreat participants are first started on regular daily meditation and meditation once a week in a group, then introduced to one or two day retreats, and gradually moved to a longer retreat. (This is similar to teaching beginners abseiling by going over a small cliff face first before attempting a deep gorge.) With a graded approach, even those with previous acute disorders can frequently adapt and gain benefit from retreats.

It is also important for meditators to develop a trusting relationship with their teacher, prior to the retreat where possible, just in the same way a client develops a trusting relationship with a therapist. This also provides support and security for a new student when first undertaking a retreat instead of ‘going in cold’. During this time of getting to know a student, the teacher can make an assessment of general fragility or resilience and the appropriateness of the person undertaking intensive meditation.

Some meditation teachers also make it a requirement that if the student is undergoing counselling or psychotherapy that the recommendation of his or her mental health professional is sought before undertaking a retreat, and a student is not accepted if the mental health professional advises against it.

How meditation intensives are conducted

In the Zen tradition and in some other Buddhist traditions, there are ongoing interviews with a teacher during the course of the day in a meditation intensive. These interviews are usually of a short duration of up to 15 minutes and may occur once to three times a day. Students check in with a teacher on various aspects of their meditation practice, and the teacher may also check on the mental wellbeing of students and offer support and guidance through the retreat.

However, in some meditation retreats the standard advice is to encourage students to continue the retreat no matter what level of difficulty they are experiencing. I believe discernment is necessary as to whether to encourage a student through a difficult experience or not. Sometimes a student can benefit by getting out of the intense atmosphere of a retreat and then returning after a break. Defences and resistance need to be respected and worked with, rather than stripped away.

Follow-up care

My own experience in working with many meditation retreat ‘casualties’ confirms that they benefit from debriefing, normalising and making sense of their experience. This can involve providing reassurance that they are not 'going mad', or taking them through the experience again to desensitise them to the distress, or simply hearing their story and empathising in a non-judgemental manner.

Sometimes retreats bring to the surface old memories of neglect or abuse, which may require ongoing counselling or therapy. Meditators can often benefit from some ongoing mindfulness-based therapy, an approach that they obviously understand and connect with.

Most people after a good retreat feel peaceful, tired, clear-headed and sober, rather than emotionally high. Occasionally some meditators have what may be described as a bleak experience in contrast to a peak experience, where their everyday life seems somewhat meaningless for a while. With support this feeling usually dissipates.

It is important to look out for students who are socially withdrawn who may not readily seek out support, and make a point of actively engaging them. Many meditation teachers structure a meal and a light socialising activity after a retreat to gradually allow students to re-orientate to their social world again.

It needs to be emphasised by meditation teachers at the end of a retreat that they are available for follow up, or to encourage participants to follow up with a mental health professional if they have distressing experiences which continue after the retreat is over.

Where does responsibility lie for meditation ‘casualties’?

People who experience a psychotic episode after attending a meditation retreat are sometimes advised that they must have had a pre-existing condition that the retreat uncovered. I am rather sceptical of this view. It may be true some of the time, but not automatically true of all people who have adverse experiences after a retreat.

An article which reported on a literature search for case studies of psychotic states induced by meditation provides some guidance on these matters (Kuijpers et al., 2007). The authors state that about half the case studies researched had a previous history of a psychiatric disorder. Most of the conditions were transient and would fit the DSM-IV diagnosis of a brief psychotic disorder.

The conclusion drawn is that there is no certainty that all cases of meditation-induced psychosis are pre-existing conditions, but rather conditions that in many incidences are caused primarily by the stress of intensive meditation in vulnerable individuals.

Meditation centres need to look more closely at taking responsibility for who is accepted into retreats. If someone went to a solarium and developed a melanoma does that mean that the solarium bears no responsibility? In many cases there may be a genetic pre-disposition, but exposure to excessive radiation, which could have otherwise been avoided, arguably caused the melanoma.

Meditation centres need to be subject to the same scrutiny as other organisations on the question of whether they are putting profit before the welfare of people for whom they provide a service. Many meditation centres are organisations based on values of altruism rather than profit, but this does not mean that they are free from making ill-informed decisions. Good judgement can also be clouded by blind faith and evangelism and the attitude ‘that one size fits all'.

Conclusion

If psychopathology is organised into three broad categories – psychoses, personality disorders and neuroses – it is my view that only people who are well over the acute stages of a disorder, or are in the neurotic range or better, should undertake intensive meditation retreats.

Preferably all participants should have daily meditation experience before undergoing an intensive.

When a gradual approach to the experience of meditation retreats is adopted, supportive processes put in place during retreats and follow-up care provided, there is no guarantee that participants will not have adverse experiences but such practices certainly help prevent and minimise the development of mental disorders.

Most meditation teachers I am familiar with who follow similar guidelines to those outlined in this article do not report high rates of mental distress among participants during or after meditation retreats. By contrast, meditation centres that do not adhere to these recommended practices appear to have a much higher rate of psychological casualties.

In selecting participants for meditation retreats, resilience is the essential factor. Some mental health colleagues and friends who have had minimal meditation experience have found a meditation intensive retreat to be an integrating and fulfilling experience. But these are people who through their own natural resilience and life experience were able to enjoy the solitude and the sustained focus on present moment experience, and were able to integrate their experience into their everyday lives. 

Geoff Dawson

Reference

Kuijpers, H.J., van der Heijden, F.M., Tuinier S., & Verhoeven, W.M. (2007). Meditation-induced psychosis. Psychopathology, 40, 461-464. 

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...