Thursday, August 12, 2010

More on Mental Health, Meditation, and Risk Management

The Wild Bunch
The Wild Bunch, Nice, 2010

I had an interesting conversation with Teemu Kangas in the comments thread of my musings on spiritual practice and mental health. He also linked to a study on extreme mental states in meditation practitioners, and to a blog by meditators with serious mental health issues. So I got to thinking about this a bit more.

This is a risk management problem.

Intensive meditation practices do have risks. From the bit of reading that I've done, these risks do not appear to be too extreme – incidence of psychosis among meditators appears to be lower than among the general population, and while many if not most people practicing intensive meditation do experience "nonordinary states of consciousness,"1 most handle these states perfectly well. But the risks are there; people have suffered very serious breakdowns as a result of intensive meditation.

Everything we do involves risks. Some of the things we do involve bigger risks than others. When I hop on my bike to ride to the office, I knowingly assume the risk of falling or crashing into another cyclist, pedestrian, or even a car. I feel comfortable taking this risk, because I have a pretty good idea of what's involved – over the years, I've crashed plenty of times and suffered (and, on two occasions, inflicted) a variety of trivial to minor injuries, and I've seen the statistics about cyclists needing hospitalization or dying as a result of cycling injuries. I'm also aware of the benefits – better physical condition, better sense of mental and physical well-being, the pleasure of the ride, the convenience of being able to cover medium distances in the city quickly without the inconvenience and cost of a car, a taxi, or public transportation. I feel that I know what I'm doing, and the next time I crash, I hope I'll consider that just the downside of this particular choice.

It's also possible to mitigate these risks. I can considerably cut down my risk of death or permanent brain damage by the simple expedient of wearing a helmet while cycling. I can do my best to cycle responsibly, follow the rules of the road, look where I'm going, and not go too fast. However, I still recognize that despite doing all this, I am likely to crash yet again, one of these days. You can't completely eliminate the risk of crashing from cycling, unless you stick to an exercise bike in the bowels of a gym somewhere.

I think the biggest problem with risk management in meditation practices is a lack of awareness about the risks. Most of us newbies really have a pretty poor idea of what we're dealing with. How likely is it that we'll crash at some point, and how serious are the results of that crash likely to be?

Meditation is a bit more complicated than cycling from a risk management point of view, because I think the magnitude of the risks involved are more individual. An actuary could calculate your cycling risks pretty accurately from a fairly small amount of data – your age, sex, location, the amount you cycle per year, and a prior history of crashes, traffic violations, and the like. With meditation, I think this is likely to be more individual – one guy may never experience anything seriously unsettling, whereas another one might have a really rough time about it.

I'm sure that a good teacher with lots of experience with different students will be able to make educated guesses after getting to know a student, but I think it's gotta be a good deal trickier to do from hard data, beyond relatively obvious predictions such as that someone who has previously had a psychotic episode is more likely to have another one than someone who hasn't.

I would like to know what I'm getting into. Risk tolerance is individual, too. I don't mind crashing too much, if I believe that the likeliest outcome of the crash isn't more serious than some minor bruises and perhaps losing a bit of skin, but if I thought that cycling is so dangerous that a crash would probably mean broken bones, brain damage, or death, I wouldn't bother.2

I've been reading up on this a bit lately, or, rather, reviewing stuff I've already read, with these questions in mind. I have decided to go on with my meditation project – even including intensive practices, once I feel I'm ready for them. The picture I've formed is a bit like this:

The risk of serious psychological damage is real, but relatively small. Meditation-induced psychosis severe enough to require medical intervention or significantly screw up the meditator's life does happen, but it's pretty rare, and it's even rarer among people who don't have a history of psychotic episodes.

The risk of encountering something highly unpleasant is big. Many, if not most people practicing intensive meditation appear to have to deal with some pretty difficult stuff. We have extreme emotional states running the full gamut from ecstasy to abject terror, and we have psychosomatic effects like extreme pain, muscle cramps, gastrointestinal symptoms like diarrhea, nausea, or vomiting, and so on. I don't particularly like the idea of running into this stuff, but since most people don't suffer permanent damage from it, I'm willing to take the risk.

What, then, can be done about mitigating these risks?

First, there's stuff I can do. I am going to err on the side of caution, and not apply for a sesshin before I'm relatively certain that I have the concentrational ability and mental stability to benefit from it while dealing with the possible side effects. I've only been on one weekend retreat so far. I'm going to stick with that level until I feel, at the end of such a retreat, that I would really like to keep going rather than go home. At that point, I'll seriously consider participating in a four-day sesshin. If and when I get that far, I'll worry about what to do next.

Second, there's stuff that teachers and sanghas can do. First and foremost, they can make sure that people applying for retreats know what they're getting into, simply by making all relevant information about their retreats and practices available, and offering it to all applicants for them. They can ask applicants about a history of psychotic episodes, and then talk to these applicants more, to make sure they understand the risks they're running – and to make an informed guess about whether they're likely to benefit from the retreat in the first place. They can build working relationships with the local mental health specialists, in order to consult them about problematic situations.

I don't think intensive meditation is particularly dangerous, compared to stuff most of us do all the time. However, most of us have a pretty poor idea of what the risks are, what we're likely to encounter, and what we can do to mitigate those risks. I don't think the right approach to risk management is to water down the practice – it's pretty clear that many people can benefit from the pressure-cooker environment of an intensive meditation retreat. However, perhaps we could do more make sure people know what they're getting into.

And, perhaps, if we notice a culture developing that sees intensive meditation as the only kind of "real" meditation, we could do something about that too – because I believe that slower paths up Mount Sumeru will work better for some (me too, perhaps?), and it would be entirely unnecessary if they were to think of themselves as second-class Zennies.

Addendum: Kyle and Mumon continue this discussion on their blogs. Go check them out.


1I would expect samadhi and kensho to be classified as "nonordinary states of consciousness" too. That would make these states if not exactly the point, at least fully intended consequences of intensive meditation.
2This, incidentally, is the main reason I don't have a motorcycle. I really enjoyed riding one once, but not so much I'm willing to assume the downside risk of a typical crash.

13 comments:

  1. Hi Petteri, Interesting stuff! As you say it is very complex. A few follow up musings ...

    - I often ponder as to how we can know whether the form of meditation that we feel most affinity or fascination with is necessarily the one most suited to us?

    - How well can a teacher ever know the mind of a new student? Sometimes I think that the gradual preliminary teachings in certain schools are not essential but offer a chance for teachers to assess the character and psychology of their students.

    - What or where is the line between a tough or transformative period of practice and outright mental breakdown. I would think that the former is an integral, dare I say essential, element of practice and a meditation practice that was all plain sailing would surely be one that had gone astray into self-delusion. I have heard some teachers say you have to have a pretty stable ego or identity before you start exploring the whole not-self thing safely.

    - Another issue may be the exaggerated emphasis on seated meditation in some circles which excludes other possibilities that would allow people to continue to progress in their exploration of the Dharma when having major difficulties. For example many Zen teachers traditionally offered chanting practice to students as well as or instead of zazen. mental helath issues often come with experiences, or at least feelinsg, of rejection and themost compassionate thing may be not to turn away students but rather to give them some other practice that seems less risky. Of course it requires discernment on the part of the teacher to tell whether someone is running away from their practice or genuinely in need of a breather. A lot of this comes down to the teacher-student relationship and that is not something that is ever going to be straight-forward.

    All the best.

    ReplyDelete
  2. During retreats, especially intensive ones people can leave or skip a session if they feel they are at the point of damaging themselves. This is not a very popular viewpoint, and if someone has spent a lot of money to be there they will perhaps drive themselves too hard. As well the social pressure aspects and occasional competitive nature of the thing has to be taken account of. There are some places and teachers that will put on so much pressure not to leave or to sit with a highly disturbed state that a person will feel highly coerced. This is not right. Coercion of this kind is not beneficial.

    When someone is in really deep waters it takes time to get over that fear. Like swimming in the deep end the first time. If one becomes absolutely terrified they will likely not go there again and probably not learn to swim. It is better upon reaching that point to take the time to gather one's self for a while and then move gently forward. If necessary get out of the pool, take a look at what's happened from a "safe" place, realize fear, anger or whatever is present, examine it, befriend it a little and then try again.

    There is a certain bravado that is brought about in some schools, and taken too literally, too competitively, that one should practice as if they are in a pressure cooker, or as if their hair is on fire. That's OK for those who've got quite a lot of experience but not so good for the new person. So I think you've got a sensible approach Petteri.

    There are those who say they've reached some kind of kensho within 6 months of starting practice. I think that's either bullshit, or they don't understand kensho and have just hit another altered state rather than a perceptual shift, or they've done some other kind of practice before, or they have psychologically prepared themselves in some way.

    ReplyDelete
  3. @Kyōshin: I'm pretty sure you're right about not knowing what the right practice is. For my part, if I was doing this on my own, there's no way I'd have had the patience to stick to the same practice for a year – and it's only now that I'm starting to figure out what it's even about. So I'm going with the program, and sticking to it until my teacher says otherwise. I understand that's the way Zen training is supposed to work, no?

    And yeah, I think you put your finger on it regarding the hardest part of the teacher's job. It's a tangled jungle all right!

    @NellaLou – Thanks a lot for your thoughts and encouragement. The more I do this and think about it, the more I understand the Soto de-emphasis on kensho – that it's something highly significant that happens as you do the practice, but it shouldn't be a goal in and of itself, and treating it as such can actually be rather damaging. (OTOH I also get more and more irritated when I see/think I see this sliding into "buji Zen" – the idea that kensho isn't significant at all, or shouldn't be discussed, or that "there is nothing to attain" in a trivial sense.)

    ReplyDelete
  4. Good post, and I have written about this issue as well. Meditation does have a small, but very real, possibility to exasperate serious existing, and even sometimes latent, mental issues. This is why a teacher is so very important, especially with those that have a history of some of the more difficult mental issue such as schizophrenia.

    Intense experiences, such as Kensho, but even just smaller realizations that happen to people who do meditate aren't a joke. Hence, why BigMind can be so dangerous. I like your ideas about making sure people know what they are getting into before starting and the teachers and centers not dismissing traditional mental health practices and professionals.

    Honestly, my two cents is I think Vipassana meditation, especially with a good teacher is perhaps better fit for those with serious existing mental disorders. It's slower, its more step by step and its most importantly more guided than Zazen, or hell even Koan practice. From your post about when you were on the weekend retreat, you saw first hand the emotional roller-coaster that can and will ensue. I remember vividly, when I was at a retreat, just bursting into tears for a minute right at the end of one of the sessions. I had no idea why, and I had never had any mental health issues outside the occasional night terrors I've encountered since I was a small kid. (is that even considered a mental health issue?)

    This is something that needs to be discussed more than it gets discussed, thanks for posting it.

    ReplyDelete
  5. Shinzen Young has a huge number of videos on YouTube that address such questions as depersonalization, dark night of the soul, dissolution, dealing with encountering emptiness etc. He gives very exact suggestions for managing these states. Here's one short example.

    Advanced FAQs: Regarding Emptiness

    There is a whole channel for him here:

    expandcontract

    He has trained as a Shin priest (Japanese Vajrayana),in Zen and in Vipassana so has a really broad range of experience and traditions to draw from. As well he's worked in science so is pretty rational as well.

    And he's not one of these "get enlightened in 3 weeks" types.

    ReplyDelete
  6. @Kyle, yeah, it does need to be discussed. I didn't go into that retreat entirely unprepared, but that roller-coaster caught me off guard anyway. While I liked Ingram's book a great deal, I think his "full steam ahead and damn the torpedoes" approach could be a bit too much of a muchness for many, if not most of us.

    ReplyDelete
  7. @NellaLou – Thanks a bundle, some very interesting stuff there. I especially liked the "Downsides of enlightenment" one.

    (Great start to the spam filtering on Blogger, by the way – it binned your comment straight away.)

    ReplyDelete
  8. Very true, while Ingram's approach is appropriate for some, even for some of those who are generally stable, it can be too much. It is like the Marine Corp boot camp of practice.

    ReplyDelete
  9. @ nellaLou re: Shinzen Young - you mean 'Shingon' (Japanese Tantric school). 'Shin' generally refers to Jodo Shinshu (Pure Land school).

    ReplyDelete
  10. @Petteri Yeah I think we do we have to try to stick with the program but whilst keeping in mind [a] that we chose the program and it is therefore our responsibility, not something that has been put on us (this matters when we hit tough patches as it stops us getting resentful or projecting our frustrations onto the practice or teacher), and [b] keeping the original mind of exploration fresh and not losing our critical faculties. These both keep the path healthy and can also allow us to change our path constructively, if necessary, without self-deception and guilt.

    ReplyDelete
  11. I like the bicycle analogy, since I recently bought a bicycle and have been pedaling around my city.

    My experience of intensive meditation retreats is limited to Zen retreats in the Kwan Um and Soto schools. My experience as a practitioner, and talking to a great many others, is that very few of us have the "concentrational ability" to stick with it the entire time. In fact, the experience of wandering off and choosing to return focus is part of the experience.

    As for mental stability, well. It is true that difficult things come up on a long silent retreat. Usually, the first things to come up are silly distractions, food cravings, sex fantasies, things like that. Once we get adept at letting those things go, we graduate to harder things. I've had weird things happen with my perceptions, often related to fatigue. That's what the retreat teacher is there for; we talk through stuff and for the most part I've been able to release things with laughter and a tear or two.

    Occasionally it goes a little harder for some of us. When I was head of practice at Providence Zen Center, I made it my business to have referral information handy. Some of our teachers are actually trained and qualified to do crisis counseling, others are not. (They do not, as a rule, mix psychotherapy into what they do at the Zen Center. Patients are not their Zen students, or vice-versa.)

    I guess what I'm leading up to is, I wouldn't wait until you feel ready for a week-long retreat. I'd say, manage your risk by checking out the meditation center, assess its experience running retreats, vet the retreat teacher, and if these check out all right, your risk is pretty low. But you can count on the retreat being challenging, and plan on doubting the whole thing while it's in progress.

    ReplyDelete
  12. @Algernon, thanks for your thoughts. A few of my instructors have told me more or less the same thing. Nevertheless, I'm going to wait a bit more. If it takes me a year or two to get used to the idea, I figure that all that's going to do is make my practice progress a year or two slower. I'm 39. Actuarially, I have about 40 years of reasonably functional life left. I can afford a year or two.

    ReplyDelete
  13. @Kyōshin Yes Shingon it is. Typing too fast and not with 100% attention to it.Thanks for noticing the error.

    ReplyDelete