Lost in Thought, by David Kortava

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[Report]

Lost in Thought

The psychological risks of meditation

Illustrations by Jialun Deng

[Report]

Lost in Thought

The psychological risks of meditation
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On a cloudless afternoon in March 2017, Megan Vogt drove her truck toward a Delaware town between the coastal plain and the foothills of the Appalachians. She was on her way to a silent retreat at Dhamma Pubbananda, a meditation center specializing in a practice called vipassana, which its website describes as a “universal remedy for universal ills” that provides “total liberation from all defilements, all impurities, all suffering.” Those who attend Dhamma Pubbananda’s retreats pledge to observe strict rules (no reading, no dancing, no praying) and to stay for the whole ten days, as it is “both disadvantageous and inadvisable to leave . . . upon finding the discipline too difficult.” Megan knew that she’d have to forfeit her cell phone and observe a mandatory “noble silence,” so she called her mother one last time. “I love you, I love you, I love you,” she said. “I’ll talk to you in ten days.”

On the first day of the retreat, Megan, a cheerful twenty-five-year-old with blue eyes and shoulder-length hair dyed a cardinal red, woke at four o’clock in the morning to the chiming of a bell. For a cumulative ten hours and forty-five minutes, she sat cross-legged on a rug, her spine erect, and tried to focus on her breath. During breaks, she walked among the beech trees and orange lilies on the center’s thirteen acres. That evening, everyone gathered in the meditation hall and an instructor inserted a videotape into an old VCR. On the screen was an elderly man with soft, hooded eyes, sitting cross-legged on the floor. Satya Narayan Goenka, a Burmese businessman turned guru, had taken up meditation in the Fifties, hoping to alleviate his chronic migraines, and was so happy with the results that he went on to establish a global network of more than one hundred vipassana centers. Goenka died in 2013, but students on his retreats still receive much of their instruction from grainy recordings of the master himself.

“The first day is over,” Goenka said. “You have nine more left to work.” His voice was gravelly, his demeanor almost soporific. “To get the best result of your stay here, you have to work very hard,” he said. “Diligently, ardently, patiently, but persistently, continuously.” He spoke of the difficulties students would encounter in the coming days. “The body starts revolting. ‘I don’t like it.’ The mind starts revolting. ‘I don’t like it.’ So you feel very uncomfortable.” He called the untrained mind “a bundle of knots, Gordian knots”—an engine of tension and agitation. “Everyone will realize how insane one is.” He looked into the camera with an air of sympathy. “This technique will help you,” he said. “You must go to the source of your misery.”

At the time, Megan’s life was in flux—she had just gone through a breakup and decided to move to Utah, where she planned to work on an organic farm. Ten days of meditation sounded restorative, a way of turning the page to a new chapter. She found the early days of the retreat physically challenging in the ordinary sense: she had aching knees, a sore lower back, hunger pangs. But it was nothing she wasn’t used to from her time as an AmeriCorps volunteer, maintaining hiking trails out West, or the months she’d spent camping in national parks.

On the morning of the seventh day, Megan went outside to meditate alone under a tree. She had by now logged more than sixty hours of meditation. She wasn’t sure how long she sat there. “Time had slowed down,” she later wrote. The ferns and grasses were vibrating; they were made of vibrations, just as she was. Megan felt an exquisite serenity unlike any she had ever known. Tears came to her eyes. “I was so happy. I finally knew my place in the world. I was a child of the earth and I needed to share my joy.”

But hours later, Megan’s bliss dissipated. She became tired, then drained. She lay down on her bed and could not marshal the energy to get back up. The next meditation session was starting. She felt heavy, responsible for everything that was wrong in the world. Maybe I’m holy, she thought. Maybe I was put here to heal everyone. She forced herself upright and set her feet down on the floor.

Walking into the meditation hall, Megan looked at the rows of silent meditators, their eyes closed or staring vacantly at the wall. A surge of “immense fear” coursed through her body and she found herself panicking, unable to move. “I just zoned out into space,” she wrote later. “I can’t remember where I am. Who I am. What I’m doing here.” Then a torrent of dark thoughts came rushing in: Is it the end of the world? Am I dying? Why can’t I function or move? I can hear the Buddha now. He is telling me to meditate. I can’t, I’m so confused. Is this a test? Am I supposed to yell out “I accept Jesus as my Lord and Savior?” What am I supposed to do? I am so confused.

Buddhist meditation, which began as a practice among renunciants living in monasteries, hermitages, and caves in the fifth century bc, is now a part of mainstream American culture.* Countless books, magazine articles, YouTube videos, apps, and corporate wellness programs celebrate its benefits to our cognitive, emotional, and physical well-being. The market for meditation products and services in the United States is valued at $1.2 billion. In 2017, by one conservative estimate, some 15 percent of American adults engaged in “mental exercise to reach a heightened level of spiritual awareness or mindfulness.” Arianna Huffington captured the pop-psych view of meditation and mindfulness in an interview during the promotional tour for Thrive, her 2014 self-help book: “The list of all the conditions that these practices impact for the better—depression, anxiety, heart disease, memory, aging, creativity—sounds like a label on snake oil from the nineteenth century,” she said. “Except this cure-all is real, and there are no toxic side effects.”

Unfortunately, Huffington was wrong. Although there is data supporting the positive effects of meditation, the scientific literature is murkier than some champions of the practice would like to believe, and the possibility of negative outcomes cannot be so easily dismissed. As early as 1976, Arnold Lazarus, one of the forefathers of cognitive behavioral therapy, raised concerns about transcendental meditation, the mantra-based practice then in vogue. “When used indiscriminately,” he warned, “the procedure can precipitate serious psychiatric problems such as depression, agitation, and even schizophrenic decompensation.” Lazarus had by then treated a number of “agitated, restive” patients whose symptoms seemed to worsen after meditating. He came to believe that the practice, while beneficial for many, was likely harmful to some.

One case study, from 2007, documented a twenty-four-year-old male patient who had slipped into “a short-lasting acute psychotic state” during “an unguided and intense” meditation session. He was referred to clinicians following the onset of “an acute sensation of being mentally split.” He saw vivid colors, hallucinated, and was overcome with severe anxiety. At the height of the episode, he was tormented by “delusional convictions that he had caused the end of the world” and talked of suicide. The man had experienced one previous hypomanic episode and had a history of untreated depression. The authors posited that “meditation can act as a stressor in vulnerable patients.”

Even as academic interest in meditation has mounted, with hundreds of new papers published every year, the question of adverse effects has received little attention. Most studies don’t monitor for negative reactions, relying instead on participants to report them spontaneously. But the research that does exist is not reassuring. More than fifty published studies have documented meditation-induced mental health problems, including mania, dissociation, and psychosis. In 2012, leading meditation researchers in the United Kingdom published a set of guidelines for meditation instructors, noting “risks for participants,” including depression, traumatic flashbacks, and increased suicidal ideation. Four years later, the U.S. National Institutes of Health cautioned that “meditation could cause or worsen symptoms in people with certain psychiatric problems.” Jeffrey Lieberman, the former head of the American Psychiatric Association, told me he’d seen this in his own practice. “The clinical phenomenon is real,” he said. “There’s no question about it.”

Exactly who is vulnerable to these negative effects remains a subject of debate. Some clinicians suspect that meditation can trigger such reactions only in individuals with underlying psychiatric conditions. Vinod Srihari, of the Yale School of Medicine, explained that genetics and environmental factors can come together to kindle the onset of psychosis. “For people already at risk for a psychotic disorder, to have a first break on an extended meditation retreat makes sense logically.” Lieberman posits that most cases likely involve a latent psychiatric condition that is activated by sustained or intensive meditation. These mental health crises, he believes, tend to occur in the context of a retreat, when people are meditating for hours at a time. “For most people, meditation is an either innocuous or potentially beneficial activity,” Lieberman said, “but in a small number of individuals it has the potential for psychological destabilization.”

But an alternate view has been around for decades and has recently been gaining traction. Some clinicians believe that meditation can cause psychological problems in people without underlying conditions, and that even forty minutes of meditation per day can pose risks. In 1975, The Journal of Nervous and Mental Disease published the case study of a thirty-eight-year-old woman, Mrs. M., who had no history of trauma or psychotic episodes but had begun to experience “altered reality testing and behavior” soon after taking up transcendental meditation. She was meditating for twenty minutes, twice a day. The authors, psychiatrists at the University of California, Davis, wrote that

an altered state of consciousness within days after beginning TM, and the occurrence of the “waking fantasies” shortly thereafter, leave little doubt of some causal relationship between the use of TM and the subsequent psychosis-like experience.

They concluded, “We would expect the occurrence of powerfully compelling fantasies in some portion of normal individuals utilizing depressive procedures of any form,” including meditation.

Precisely what happened after Megan’s unraveling in the meditation hall is unclear. By one account, she went outside and tried to tear down a fence. By another, she broke into uncontrollable laughter. What is certain is that one of the teachers, a middle-aged woman named Yanny Hin, realized that something was wrong. Hin found a volunteer in the kitchen, Jodi Beck, and asked her whether she’d mind attending to Megan. Beck tried having a conversation with Megan but couldn’t follow her train of thought—something about God “getting back at her” for something she’d done. Megan kept asking, “Is Jesus punishing me?” Beck told me. “She didn’t understand what was happening to her.”

As she ranted, Megan mentioned that she had stopped taking her medication. She had been on the lowest therapeutic dose of Zoloft for mild anxiety since her early twenties. Before admitting Megan to the retreat, the center’s administrators required that her doctor complete a form certifying that she was in good health. One of the questions read: “If the patient has difficulty during the course would you be available to him/her?” Megan’s provider checked yes. Hin instructed Beck to administer Megan’s pills for the remainder of the retreat, but the center did not attempt to contact Megan’s doctor.

Megan spent much of the next three days in her room, trying to concentrate on sensations in her body. Beck sat by her side. “She always had the option to leave,” Beck said. “She wanted to stay. She doubled down. She was trying so hard.” According to Beck, Megan told Hin that she felt like she was going crazy. Hin instructed Megan to focus on her breath. During one meeting, Megan had trouble sitting up, so Hin had her lie down. When Megan clenched her fists, Hin told her to focus on the feeling in her hands. “Yanny had no sense of this being anything that she couldn’t teach her way out of,” Beck told me. When Megan got agitated, “the instruction was always the same: close your eyes, go back to meditating.” (Yanny Hin declined to be interviewed for this story.)

On the last evening, more than sixty hours after the conspicuous onset of Megan’s mental health crisis, Beck managed to get in touch with Megan’s family. “Her problems were getting worse and worse,” Beck told me. “She looked like a ghost of herself. She hadn’t slept in days. She had stopped showering.” Beck, who moonlights as a bartender, told me she recognized when someone could not get behind the wheel of a car. “She was not equipped to leave without help.”

When Megan’s parents and her younger sister, Jordan, arrived the next day, Beck asked for them to visit Megan one at a time, so as not to overwhelm her. Her mother, Kris, went in first. “That’s not confused, that’s psychotic,” she said. “That’s not my daughter.” Jordan went in next. Megan was hunched over at the foot of the bed, staring at the ground. She looked pale. Jordan sat down on the opposite end.

“Hey, Meg.”

A moment passed in silence.

“You’re not really here,” Megan said finally.

“It’s me,” Jordan said, holding out her hand. “You can touch me, I’m here.”

“I’m creating you. You’re just a projection.”

Megan recoiled from her family and resisted getting into the car. “I have to die here,” she cried. Eventually, Hin persuaded Megan to leave with her mother and sister. Her father, Steve, followed in Megan’s truck. As they drove off, Megan’s wish to die took on a violent urgency. She clutched at her neck. She stuffed her mouth with a blanket. She attempted to climb into the front seat and get at the glove box, where she knew her mother kept a switchblade. As the car accelerated on the interstate, Megan pried open the door. Jordan held on to her and pulled it shut.

Kris called Steve and told him she was going straight to the University of Maryland’s Harford Memorial Hospital, which has a psychiatric unit. Megan screamed at her mother, “Stop talking to the devil!” Jordan took off a necklace that Megan had made for her out of redwood bark and pine nut shells. She put the necklace in Megan’s hand, “just trying to get her to feel that there was a physical reality.”

In the emergency room, Megan repeated, over and over, “I did something terrible, I did something terrible.”

“Baby, what did you do?” her mother pleaded. “We can work through this.”

“I killed the universe.”

According to hospital records, Megan appeared “disheveled and unkempt” and seemed to be “responding to internal stimuli.” Her initial physical examination was “limited, as patient is very disorganized and afraid. Doesn’t want anyone to touch her.” As medical staff were taking her vitals, Megan pulled out her IV and shoved the attending physician. Doctors then forcibly administered an intramuscular injection of Geodon, a powerful antipsychotic. Beyond her psychological distress, whatever was ailing her was also causing a physical reaction: her stomach churned, and she was both cold and perspiring. She was tested for drugs and infections that could induce psychosis; everything came back negative.

Her first night in the hospital, Megan was started on a new drug regimen: the antipsychotic Zyprexa, along with Ativan, a benzodiazepine used to treat anxiety. Two days later, Kris, Steve, and Jordan came for visiting hours. Megan told them she couldn’t remember how she had gotten there, and that her memory of the retreat was a haze, but she was otherwise lucid and in a bright, almost lighthearted mood. “I can’t believe I’m in a nuthouse,” she said, laughing. “People are going to think I’m crazy.” After they left, a doctor wrote in Megan’s chart that she “feels much better after seeing them,” but also that she could hear music playing.

After a week, Megan’s waves of psychosis leveled off. She was sleeping better and eating regularly. She said she could think more clearly and told her doctors that she was “sorry for everything.” The medical staff encouraged her to talk or write about her experience. They left her with paper and a pen. “I lost it on the seventh day,” Megan wrote. “I was on the right path. I had relinquished all things. But then I realized I had to relinquish my body too, and that is what sent me into a panic.” She believed her breakdown resulted from having “overworked my brain for three days not sleeping.”

Megan was not given a formal diagnosis but was told that she might be showing symptoms of bipolar disorder. Her Zoloft prescription was discontinued, as her doctors believed it could have been contributing to her mood swings. Megan showed no withdrawal symptoms, and was given a supply of Zyprexa and Ativan. She was advised to see a psychiatrist within the week and to seek immediate medical attention if she experienced “racing thoughts, increased rate of speech, mood lability or decreased need for sleep.” With that, Megan was released to her family in “medically stable condition without any safety concerns.”

Jordan scoured the internet for some clue as to what was happening to her sister. She found the Facebook page of an online support group called Cheetah House, based at Brown University, that provided guidance to people experiencing mental health problems precipitated by meditation. Its website featured articles from academic journals and firsthand accounts of meditation-induced medical emergencies. “I’m not exaggerating when I say that Cheetah House literally saved my life,” wrote one “ex-meditator-in-crisis.” Jordan sent a message to the group. “My sister entered into a meditation-induced psychotic state this week and I am searching for help,” she wrote. “She is completely disoriented and convinced that she needs to kill herself.” Jordan asked for her message to be relayed to the group’s facilitator, a clinical psychologist and neuroscientist at Brown named Willoughby Britton, who has become one of the foremost advocates of the view that meditation can be harmful even for people without underlying psychiatric disorders.

Britton had started out as an avid meditator, but as a graduate student in the mid-Aughts she made an unexpected discovery. As part of her PhD research at the University of Arizona, Britton conducted a study to determine the effects of regular meditation on sleep quality. The consensus at the time was that meditation helped people sleep better, but most of the existing studies relied on self-reports. Britton was one of the first researchers in her subfield to bring subjects into the laboratory overnight, measuring their brain waves, eye movements, and muscle tension. Britton collected two hundred nights of data. As in other studies, her twelve subjects said they had been sleeping better since taking up meditation five days a week. And the data seemed to support that for the group that was meditating less than thirty minutes per day. But any more than a half hour and the trend started moving in the other direction. Compared with an eight-person control group, the subjects who meditated for more than thirty minutes per day experienced shallower sleep and woke up more often during the night. The more participants reported meditating, the worse their sleep became.

Britton’s sample size was small, but other researchers have also documented this apparent paradox—positive self-reports combined with negative outcomes. A 2014 study from Carnegie Mellon University subjected two groups of participants to an interview with openly hostile evaluators. One group had been coached in meditation for three days beforehand and the other group had not. Participants who had meditated reported feeling less stress immediately after the interview, but their levels of cortisol—the fight-or-flight hormone—were significantly higher than those of the control group. They had become more sensitive, not less, to stressful stimuli, but believing and expecting that meditation reduced stress, they gave self-reports that contradicted the data.

Until the sleep study, Britton had been, in her own words, an evangelist for meditation. “I just sat on the data,” she told me. “I really didn’t want to see it, because it was sort of the wrong answer.” Britton filed away the results and delayed publishing them. On a vipassana meditation retreat in 2006, she told one of her instructors about her research. “The teacher kind of chastised me, like, ‘Why are you therapists always trying to make meditation a relaxation technique? That’s not what it’s there for. Everyone knows that if you go and meditate, and you meditate enough . . . you stop sleeping.’ ” Britton’s resistance to her own findings gradually gave way to curiosity. In 2010, she finally published the results of her sleep study.

Britton and her team began visiting retreats, talking to the people who ran them, and asking about the difficulties they’d seen. “Every meditation center we went to had at least a dozen horror stories,” she said. Psychotic breaks and cognitive impairments were common; they were often temporary but sometimes lasted years. “Practicing letting go of concepts,” one meditator told Britton, “was sabotaging my mind’s ability to lay down new memories and reinforce old memories of simple things, like what words mean, what colors mean.” Meditators also reported diminished emotions, both negative and positive. “I had two young children,” another meditator said. “I couldn’t feel anything about them. I went through all the routines, you know: the bedtime routine, getting them ready and kissing them and all of that stuff, but there was no emotional connection. It was like I was dead.”

Britton realized that she had experienced some of the symptoms that her interview subjects were describing. “It took me three years of trauma training to realize, oh, that’s dissociation. And I hadn’t realized it because if you can sit for long periods of time and not feel any pain and not have any thoughts, most meditation teachers are going to say that you’re doing great,” she said. “But this was different. I felt like I was living in a parallel dimension from the rest of the world, not connected at all.” She recalled one experience she’d had while still in graduate school. “I was meditating outside, and I felt something shift. I was having a really hard time, and then everything just clicked.” Suddenly everything seemed fine. “Now I know that’s a red flag, when someone goes from having intense negative emotions to instantly feeling fine, as if someone just flipped a switch.”

In 2017, Britton and her team published their findings in PLOS One, a prominent scientific journal. The report presented a taxonomy of “meditation-related difficulties,” including anxiety and panic, traumatic flashbacks, visual and auditory hallucinations, loss of conceptual meaning structures, non-referential fear, affective flattening, involuntary movements, and distressing changes in feelings of self. Some of the study participants were new to meditation, but nearly half had at least ten thousand hours of practice. The majority of the sample—forty-three out of sixty meditators representing Theravada, Zen, and Tibetan traditions—had experienced moderate to severe impairment in their day-to-day functioning. Ten had required inpatient hospitalization. “Hearing those stories, one after the other, I was like, wow, there’s a lot of suffering here,” Britton said. “That study changed everyone who worked on it. I just couldn’t be the evangelist that I had been.”

Some of the individuals in the study had preexisting psychiatric conditions, but most did not. For Britton, the takeaway was that adverse effects routinely occur even under optimal conditions, with healthy people meditating correctly under supervision. “It’s so easy to assign a latent vulnerability after the fact,” Britton said, “but we are seeing people who really had no indicators.”

While Jordan waited for a response from Britton, Megan sought her own answers from the instructors at Dhamma Pubbananda. “Something very profound happened to me during the course,” she emailed the center staff.

I have memory loss; there is about a week gone during and after the retreat that I cannot remember/is very fuzzy. I am now trying to get back to my normal life, but I am having some trouble focusing; my mind keeps going back to the retreat and trying to figure out what happened.

Megan wondered whether there were lessons from Buddhism that could “shed light on my situation.” She asked whether Yanny Hin might be available for a phone call, and apologized for any disturbance she may have caused. A volunteer named Arun, whom Megan had never met, wrote back that day: “Hi Megan, Forwarded your email to Hin. Take care of yourself. With Metta.”

The Buddhist ascetics who took up meditation in the fifth century bc did not view it as a form of stress relief. “These contemplative practices were invented for monastics who had renounced possessions, social position, wealth, family, comfort, and work,” writes David McMahan, a professor of religious studies at Franklin and Marshall College, in a 2017 book, Meditation, Buddhism, and Science. Monks and nuns sought to transcend the world and its cycles of rebirth and awaken in nirvana, an unfathomable state of equanimity beyond space and time, or at least avoid being reincarnated as a mountain goat or a hungry spirit in the hell realm underground. In the Pali suttas, the earliest Buddhist texts, the Buddha discusses meditation almost exclusively with audiences of followers ready to reject all earthly belongings. “Generally meditation is presented as something monastics aspiring to full awakening do,” McMahan writes, “an activity that is part of a way of being in the world that is ultimately aimed at exiting the world, rather than a means to a happier, more fulfilling life within it.”

In other words, mindfulness was not invoked to savor the beauty of nature or to be a more present, thoughtful spouse. According to the Pali suttas, the point of meditation was to cultivate disgust and disenchantment with the everyday world and one’s attachments to people and things. Aspiring Buddhas were “asked to contemplate the body from head to toe, inside and out,” McMahan writes, “not for relaxation and even less for body acceptance, but to bring to full realization its utter repulsiveness, coursing as it is with blood, phlegm, and pus.” If meditation conferred any practical benefit, it was in helping ascetics “accept the discomfort of a hard bed and a growling stomach or in preventing them from being beguiled by physical beauty.”

Reports of disturbing experiences during meditation appear in a number of early Buddhist writings. In the Theravada tradition, from which S. N. Goenka’s system derives, meditators are said to experience “corruptions of insight” that, from the vantage of modern clinical psychology, resemble psychosomatic ailments, including manic bliss states, gastrointestinal issues, and visual hallucinations. Monks in the Zen tradition may encounter “diabolical phenomena,” which are characterized by involuntary movements and frightening mental imagery. Chinese and Japanese Zen masters are said to succumb to a “meditation sickness” in which the afflicted become disoriented and have trouble regulating their body temperatures and energy levels. Buddhist monastics in Tibet may develop “wind illness,” the symptoms of which include confusion and agitation; according to a twelfth-century Buddhist medical treatise, the disorder is caused by the “three poisons of attachment, hatred, and closed-mindedness.”

The adoption of meditation by the Buddhist laity in Southeast Asia began during the 1880s. In British-occupied Burma, the state ceased to provide funding to monasteries, and Christian missionaries did their best to convert lay Buddhists. Against this backdrop, a young monk named Nanadhaja—determined to save meditation, and Buddhism more broadly, from erosion—took to teaching vipassana meditation outside the monasteries. For the next seventy years, the esoteric practice slowly spread among the Buddhist laity. S. N. Goenka was among the first to teach meditation to non-Buddhists, stripping the practice of its religious lineaments and rituals. Gone was the cosmology of hell realms and hungry ghosts and karma and rebirth. Gone was the promise of miraculous healing and mind-reading and flying that meditation was believed to enable. Gone, too, was the open acknowledgment of the sundry mental and physical tribulations that might surface in the course of a serious meditation practice. Most difficulties triggered by meditation were seen as temporary, even an indication of progress, and meditators were encouraged to keep going.

Back at home, Megan continued to meditate, often for hours at a stretch, oscillating between lethargy and panic. Kris took medical leave to attend to her daughter full-time. She contacted a number of psychiatrists who she thought might be able to help. She drove Megan to her scheduled appointments, but Megan wouldn’t get out of the car; she kept a total of four appointments in two months. Every morning Kris checked to make sure Megan had taken her Zyprexa. “The pills weren’t doing anything,” Kris told me. “They just made her sleepy.” The prescription eventually ran out, and Megan refused to see a doctor to refill it.

Megan had always kept a tidy journal, but now her writing became compulsive. She scribbled her most personal thoughts on whatever happened to be around. Kris and Jordan would find Megan’s notes on receipts, bank statements, and other random scraps of paper scattered throughout the house:

The world will go on without you. It’s been around for six billion years. Stop being so selfish.

I’m afraid my energy is going to hurt everyone else.

I can’t stay inside of the lines, I can’t stay inside of the lines.

On the morning of June 6, 2017, Megan told her parents that she was going for a walk in the park. Her eyes were bloodshot and she looked as though she hadn’t slept. She had spent the previous night in a tree house that Steve had built for the girls when they were little. Before falling asleep, Steve had made sure his guns were accounted for and locked up. That morning, as soon as Megan drove away, he got a bad feeling. “We gotta go looking for her,” Steve told Kris. They drove to the park, a small wooded area along the Mason-Dixon Trail near their house, but Megan’s truck wasn’t there. They decided that Steve would wait for Megan at home while Kris continued to search on her own. After dropping Steve off at the house, Kris drove north along River Road until the Norman Wood Bridge came into view, standing one hundred and twenty feet above the rocky banks of the Susquehanna. Kris saw a scrum of police cars with their lights flashing, and Megan’s truck, parked just ahead. “I just knew,” she said. In her truck, Megan had left a note for her family: “I couldn’t keep running from what was supposed to have happened. If you get a chance to die—take it.”

Today, the luminaries of mainstream Buddhism widely promote meditation to laypeople, and refuse to acknowledge that it carries any risks. In 2012, at a conference on mindfulness at the Mayo Clinic, Britton presented her early findings on the potential adverse effects of meditation to the Dalai Lama. “The science of meditation has pretty much exclusively focused on the positive effects of meditation,” Britton said. “But if we want to understand the entire trajectory of the contemplative path and everything that that entails, we need to be more evenhanded and more balanced in our investigations, and begin to investigate the full range of experiences, including the ones that would be considered negative, difficult, challenging, or maybe even problematic.”

In a recording of the proceedings, the Dalai Lama can be seen nodding gravely, smiling genially, and, on several occasions, interjecting to crack a joke, such as suggesting that he himself might one day end up with such impairments. At one point, he said, “These people, I think they just hear things and then develop some sort of excitement.” He said that these meditators needed to read more books, analyze what they’d read, develop firm convictions, and only then try to meditate. If they followed this course, he didn’t think there was any danger. The Dalai Lama cheerfully concluded that “these negative sides are their own mistake—the positive things, that’s the real truth.” He encouraged Britton to do more research.

Britton’s more radical conclusions are also met with skepticism in some corners of mainstream psychiatry. I asked Lieberman, who is now the chair of psychiatry at Columbia University, if it could be possible, under the right conditions, for otherwise healthy individuals to be harmed by meditation. He said he didn’t think so—that it required a preexisting vulnerability. “It may be that some individuals are susceptible and others much less,” he said, “but I don’t think meditation by itself can cause this.”

I put the same question to Matcheri Keshavan, a neuroscientist and psychiatrist at Harvard Medical School. He thought it was possible. There are reliable ways to induce psychosis and other disturbances in a healthy subject—via drugs, sleep deprivation, and prolonged confinement or isolation. “If you deprive the brain of normal inputs—through sensory or social deprivation—that can produce psychosis,” he said. “And you can think of prolonged meditation as a form of deprivation.” The brain is accustomed to a certain amount of activity. When you’re sitting motionless with your eyes closed for ten or more hours a day, he said, neurons can start firing on their own, unprompted by external stimulation, “and this might lead to unusual phenomena, which we call psychosis.”

Britton’s research was bolstered last August when the journal Acta Psychiatrica Scandinavica published a systematic review of adverse events in meditation practices and meditation-based therapies. Sixty-five percent of the studies included in the review found adverse effects, the most common of which were anxiety, depression, and cognitive impairment. “We found that the occurrence of adverse effects during or after meditation is not uncommon,” the authors concluded, “and may occur in individuals with no previous history of mental health problems.” I asked Britton what she hoped people would take away from these findings. “Comprehensive safety training should be part of all meditation teacher trainings,” she said. “If you’re going to go out there and teach this and make money off it, you better take responsibility. I shouldn’t be taking care of your casualties.”

Britton didn’t see Jordan’s message about her sister’s condition until it was too late, but she has since reached out to the family. Kris and Steve feel strongly that Megan would still be here, and still be herself, had she not gone on that retreat. “I do not believe that Megan was any different from you or me or anybody in America who struggles through life,” Kris told me. “Anybody locked in their mind with silence and no communication could go to those dark places.” As far as she could tell, Megan was a happy, resilient person until the retreat. “I don’t believe you have to have an issue to have occur what happened to Megan,” she said.

In my conversations with Jordan, she found it difficult to speak chronologically about what happened to her sister. “Megan showed us so many different parts of herself over those two months,” she said. “Even when she was sick, there were moments where it felt like we were sharing in the healing, not just us taking care of her.” On the last night of Megan’s life, Jordan had climbed up the creaky wooden ladder and joined her sister in the tree house; she’d brought her some herbal tea. Megan told Jordan about a memory from the retreat that had returned to her. On the final day, she said, she found herself in the presence of a bright white light, which she knew to be God, but she became scared and turned away. She said that in that moment she had to choose between heaven and hell, and that she made a mistake, and now she was trapped in hell and needed to die to escape. Jordan tried to find the words that could penetrate the fog of delirium that enveloped her sister. “Heaven and hell are not permanent ideas,” Jordan said to her. “You can choose, this very moment, that you’re not trapped in there.”

Jordan isn’t sure whether meditation caused her sister’s psychotic break or just triggered the inevitable. “I don’t think it’s out of the question that she might have had a disorder,” she said. “But it’s also possible that this wouldn’t have happened if she hadn’t gone on that retreat.” Jordan’s irresolution stemmed, in part, from her wish to honor Megan’s own understanding of what she was going through. “Megan never blamed the meditation and she never saw it as a medical problem,” Jordan said. “For her, it was a spiritual crisis.”

 lives in New York City.


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