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Mania precipitated by meditation: A case report and literature review

DOI:10.1080/713685624
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Graeme Yorston
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Abstract

Meditation is a popular method of relaxation and dealing with everyday stress. Meditative techniques have been used in the management of a number of psychiatric and physical illnesses. The risk of serious mental illness being precipitated by meditation is less well recognized however. This paper reports a case in which two separate manic episodes arose after meditation using techniques from two different traditions (yoga and zen). Other cases of psychotic illness precipitated by meditation and mystical speculation reported in the literature are discussed.
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Mania precipitated by
meditation: A case report and
literature review
Graeme A. Yorston
Published online: 19 Aug 2010.
To cite this article: Graeme A. Yorston (2001) Mania precipitated by meditation: A case
report and literature review, Mental Health, Religion & Culture, 4:2, 209-213
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Mania precipitated by meditation: a case report and
literature review
GRAEME A. YORSTON
St Andrew’s Hospital, Northampton, UK
AB S T R A C T Meditation is a popular method of relaxation and dealing with everyday stress.
Meditative techniques have been used in the management of a number of psychiatric and physical
illnesses. The risk of serious mental illness being precipitated by meditation is less well recognized
however. This paper reports a case in which two separate manic episodes arose after meditation using
techniques from two different traditions (yoga and zen). Other cases of psychotic illness precipitated
by meditation and mystical speculation reported in the literature are discussed.
Introduction
Meditation as a method of relaxation and dealing with everyday stress is becoming
increasingly popular in the West with an estimated six million practitioners in
the USA alone (Graham, 1986). A variety of techniques are in use but most owe
their origins to oriental practices. Meditation has also been used as a therapeutic
tool in psychiatry for behaviour modi cation (de Silva, 1984), as part of a holistic
programme for chronic schizophrenia (Lukoff et al., 1986) and as an adjunct to
dynamic psychotherapy (Kutz, 1985). A number of recent studies have examined
the effects of meditation on physical illness (Kabat-Zinn et al., 1998; Wenneberg
et al., 1997)
Meditation is generally considered safe with bene cial effects on mental health
rather than as a potential trigger for psychiatric illness but there are reports in the
literature of the hazards of meditation: Walsh and Roche (1979) described three
cases of psychotic illness precipitated by meditation in subjects already diagnosed
as suffering from schizophrenia who had discontinued medication. Garcia-Trujillo
et al. (1992) described a further two cases of acute psychosis precipitated by oriental
meditation in subjects previously diagnosed as schizotypal personality disorder.
Chan-Ob and Boonyanaruthee (1999) report a further three patients who presented
with psychotic symptoms after practicing meditation. French et al. (1975) reported
a single case of ‘altered reality testing’ after transcendental meditation. The
precipitation of psychotic illness by Jewish mystical speculation has also been
Mental Health, Religion & Culture,Volume 4, Number 2, 2001
Mental Health, Religion & Culture
ISSN 1367-4676 print/ISSN 1469-9737 online © 2001 Taylor & Francis Ltd
http://www.tandf.co.uk/journals
DOI: 10.1080/13674670110067560
Correspondence to: Graeme A. Yorston, St Andrew’s Hospital, Billing Road, Northampton,
NN1 5DG, UK; e-mail: Graeme@yorston.fsbusiness.co.uk
Downloaded by [University of Chester] at 09:27 11 August 2015
reported (Greenberg et al., 1992). Krieger and Zussman (1981) reported a case of
a brief reactive psychosis in a Thai immigrant to the USA which occurred after
confronting a family Buddhist mortuary ritual.
A review of the literature failed to reveal any cases of affective disorder being
precipitated by meditative techniques. This paper reports a case in which two
separate manic episodes were precipitated by periods of intense meditation using
techniques from two different traditions (yoga and zen).
Case report
Miss X, a 25-year old self-employed, university graduate presented with a two week
history of increased talkativeness, sleeplessness, over-activity and disinhibited
behaviour. The onset followed a weekend yoga course that encouraged psycho-
logical release. She telephoned her instructor frequently, often in the middle of the
night, offering undying love. She also pushed her hand through a window and
sustained minor lacerations. There was no past psychiatric history but she had
experienced brief periods of low mood 10 and six years previously which had
resolved without psychiatric intervention.There was a family history of depression
in her father who had received electro-convulsive therapy, and of late life depression
in her paternal grandmother. Her birth and milestones were normal.There was no
history of illicit drug use.
She was admitted informally to hospital but was detained when she became
irritable and aggressive and insisted on leaving. At interview she shouted and tried
to embrace some members of staff, but struck out at others.There was pressure of
speech, thought disorder with ight of ideas, her mood was elevated and there were
grandiose delusions including the belief that she had some special mission for the
world: she had to offer ‘undying, unconditional’ love to everyone. She had no
insight. A diagnosis of manic episode was made and she was treated with haloperidol
10mg daily and lorazepam up to 4mg daily and her symptoms were gradually
controlled over the next six weeks. She refused mood-stabilizing medication.
At outpatient follow up she was noted to be mildly hypomanic on two occasions
(the second after a sesshin or intensive Zen meditation weekend) but these episodes
responded to chlorpromazine without admission to hospital. She agreed to a trial
of carbamazepine 800mg daily which she took for two years. She also underwent
twice weekly psychodynamic psychotherapy for over two years.
Two months after entering a Zen Buddhist retreat that she had been associated
with for two years, she re-presented with a five-day history of sleeplessness,
decreased appetite and labile affect. At interview she laughed inappropriately and
had outbursts of activity – lying on her bed one moment, jumping off the next.
She made stereotypical praying movements, was sexually disinhibited, restless,
distractible and irritable. She was thought disordered with pressure of speech.
Though admitted informally she soon insisted on leaving and attacked a member
of staff. She was detained and transferred to an intensive psychiatric care unit
for three days where treatment with haloperidol 6mg and lorazepam 3mg was
210 Graeme A.Yorston
Downloaded by [University of Chester] at 09:27 11 August 2015
commenced. Her mental state settled over the next eight weeks. She continued to
refuse mood stabilizing treatment and re-entered the Buddhist retreat.
Discussion
The precipitation of mania by meditation has not been described before yet descrip-
tions of the altered state of consciousness (ASC) associated with contemplative
practice abound in the mystic literature of different religions (Buckley, 1981). Zen
is a Japanese school of Buddhism – the word itself derives from Sanskrit dhyana or
meditation and it is meditation or mindfulness that forms the essence of the Zen
philosophy of life. A euphoric state of enlightenment called satori is sometimes
achieved by experienced monks (Humphreys, 1962). Thapa and Murtha (1985)
compared the subjective accounts of ASCs in subjects with complex partial seizures,
schizophrenia and meditators from ashrams and other religious organizations in
India.They found the core experiential characteristics of perceptual distortion were
common to all three ASCs but important differences existed such as only the
meditative ASC being accompanied by a positive emotional effect.The authors did
not include manic patients in their study so were unable to make direct comparisons
with the experiences in mania. Lukoff (1988) however reported in a single case
study that seven of the eight dimensions of mystical experience described by Stace
(1960) were experienced by a manic patient.
There is evidence that mystical experiences have a neuro-biological basis
possibly in the right temporal lobe (Fenwick, 1996) and contemplative meditation
which can lead to such experiences can be studied in experimental conditions
(Deikman, 1963, 1964). Lou et al. (1999) have shown a differential cerebral blood
ow distribution in meditative states and normal consciousness.
Students practise Zen to develop concentration without thinking (Watts, 1962)
but this can be dif cult and novices are often bombarded by distracting stimuli –
both external and intrapsychic which can continue after the meditation session
leading to insomnia. There is evidence to suggest sleep deprivation may act as a
nal common pathway in the onset of mania (Kasper & Wehr, 1992; Wehr, 1991;
Wright, 1993) and it is possible that it was the pressure of thought stirred up by
meditation that disrupted the patient’s sleep and precipitated the manic episode in
this case and in two of the cases reported by Chan-Ob and Boonyanaruthee (1999).
Interestingly the patient herself likened both episodes of mania to a release of
tension and blocked energy from years of not dealing with emotions in a helpful
way.
Other evidence for psychological precipitants for mania comes from life events
(Sclare & Creed, 1990) and expressed emotion (Miklowitz et al., 1986) research.
These factors appear to be most important in the rst episode of illness, the effects
lessening with each subsequent episode. These observations have been suggested
as evidence in support of the kindling hypothesis (Silverstone & Romans-Clarkson,
1989).The move to the retreat and adoption of a different lifestyle in this case must
have been a signi cant stressor. Indeed, religious change in itself can be associated
Mania precipitated by meditation 211
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with psychiatric illness:Witztum et al. (1990) showed high rates of serious mental
illness in converts to ultra-orthodox Judaism in Jerusalem and speculated that,
for some, the conversion may have been an attempt to control emerging signs of
psychiatric illness.
Other more established risk factors for mania in this case are the positive family
history of affective disorder and the discontinuation of carbamazepine (Scull &
Trimble, 1995).
The orthodox psychiatric diagnosis in this case was bipolar affective disorder.
Grof and Grof (1986) have argued however that traditional psychiatric thinking fails
to recognize the difference between mystical and psychotic experiences, tending to
underestimate the potential for a healing and positive transformation of what the
authors term a transpersonal crisis. It is important to remember that other cultures
have and do classify what we now call psychoses in different ways and that, as Carey
(1997) has advocated, knowledge drawn from different approaches should be
respected and allowed to contribute to the scienti c study of mental illness. The
absence of previous reports of mania precipitated by meditation despite its apparent
potency at inducing euphoric states of consciousness suggests that adequate
practice and supervision may enable the subject to learn to control the emergence
of intrapsychic material. If this is so, then it could have implications for reducing
the risk of relapse in this patient and potentially in others. Thus, although our
understanding of the psychology and neurobiology of meditation is growing (see
West, 1987) for a comprehensive review) it deserves more study.
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... Left anterior brain activity which is associated with happiness was shown to rise considerably during meditation. There's also some evidence that meditation might worsen psychosis by elevating dopamine levels [18][19][20]. We do not yet know enough about the possible downsides of meditation for patients with mental illness since this research lack randomised controlled trials. ...
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Chapter
  • Jan 2021
Recent decades have seen increased scientific interest in the practice of mindfulness as a form of clinical intervention. It has been found effective in reducing psychological distress and has been used in the treatment of mental disorders. This chapter begins with a discussion of the concept of the mindfulness in view of eastern cultural and traditional practices and the western modifications. Various interventions where mindfulness is an integral part have been discussed briefly along with techniques involved in each intervention. It also highlights possible mechanisms of action from the psychological and neuroscientific perspective. The chapter later discusses current literature available for the association between mindfulness and psychological health along with emerging scientific evidence base for its effectiveness and potential utility in various psychiatric disorders such as anxiety, depression, eating disorder, SUD, etc. The limitations of the existing literature have also been highlighted.
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... More common, less serious MRAEs that have been reported in surveys of meditators who meditate less than an hour per day include increased depression, anxiety or panic; re-experiencing of traumatic memories; dissociation; executive dysfunction; headaches or body pain, insomnia and social impairment (Cebolla et al., 2017;Farias et al., 2020;Lindahl, Fisher, Cooper, Rosen, & Britton, 2017;Lomas, Cartwright, Edginton, & Ridge, 2014). More serious MRAEs including mania, psychosis, and suicidality have also been reported, often in the contexts of intensive retreats (>5 hrs/day) or in conjunction with pre-existing psychopatholog (Kuijpers et al., 2007;Kuyken et al., 2012;Lindahl et al., 2017;Yorston, 2001). and basic science phases of treatment development (Phase 0-1) in the form of case reports, dose-response curves and observational studies before proceeding to randomized controlled trials (RCTs) (Gitlin, 2013). ...
Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs
Article
  • May 2021
Background: Research on the adverse effects of mindfulness-based programs (MBPs) has been sparse and hindered by methodological imprecision. Methods: The 44-item Meditation Experiences Interview (MedEx-I) was used by an independent assessor to measure meditation-related side effects (MRSE) following three variants of an 8-week program of mindfulness-based cognitive therapy (n = 96). Each item was queried for occurrence, causal link to mindfulness meditation practice, duration, valence, and impact on functioning. Results: Eighty-three percent of the MBP sample reported at least one MRSE. Meditation-related adverse effects (MRAEs) with negative valences or negative impacts on functioning occurred in 58% and 37% of the sample, respectively. Lasting bad effects occurred in 6-14% of the sample and were associated with signs of dysregulated arousal (hyperarousal and dissociation). Conclusion: Meditation practice in MBPs is associated with transient distress and negative impacts at similar rates to other psychological treatments.
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... Indeed, several studies reported serious psychotic symptoms, including hallucinations (Ataria, 2018;Kornfield, 1979;Lindahl et al., 2017 ;VanderKooi, 1997) and delusions VanderKooi, 1997). In addition, the case studies that met our inclusion criteria often reported meditation-induced hallucinations and delusions (Chan-Ob & Boonyanaruthee, 1999;French, Schmid, & Ingalls, 1975;Kennedy, 1976;Miller, 1993;Nakaya & Ohmori, 2010;Prakash, Aggarwal, Kataria, & Prasad, 2018;Sethi & Bhargava, 2003;Sharma, Singh, Gnanavel, & Kumar, 2016;Yorston, 2001). Other case studies reported changes in the self as manifested through depersonalization and derealization, associated with meditation practice (Castillo, 1990;Kennedy, 1976). ...
Adverse effects of meditation: A review of observational, experimental and case studies
Article
Full-text available
Despite numerous benefits of practicing meditation, a growing body of evidence posits possible detrimental effects on one’s mental health and well-being. As meditation’s popularity is steadily increasing in the general population, it is critical to assess, discuss and educate the public of any possible risks associated with available practices. Here, we review existing literature on the adverse effects (AEs) of meditation in non-clinical samples. Relevant original research articles were found through various academic search engines. The bibliographies of the selected studies were reviewed to identify additional articles of interest. A total of 39 studies were retained. These articles were divided into one of three categories: Observational (n = 19), Experimental (n = 9), or Case Studies (n = 11). AEs varied substantially across the studies, yet trends were identified. Common AEs included affective difficulties, distorted senses of self, derealization, hallucinations, delusions, interpersonal challenges, and susceptibility to false memory. Other AEs that were less commonly reported are also summarized. Meditation-related AEs in non-clinical samples are apparent in the literature. We discuss how the perceived valence of a meditative experience can vary, particularly if the experience is considered beyond the secular framework. We conclude that the general public should be aware of any potential effects derived from meditation in order to assert the meditation community’s safety and well-being.
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Religion/Spirituality and Psychosis
Chapter
  • Mar 2009
Although medicine is practised in a secular setting, religious and spiritual issues have an impact on patient perspectives regarding their health and the management of any disorders that may afflict them. This is especially true in psychiatry, as feelings of spirituality and religiousness are very prevalent among the mentally ill. Clinicians are rarely aware of the importance of religion and understand little of its value as a mediating force for coping with mental illness. This book addresses various issues concerning mental illness in psychiatry: the relation of religious issues to mental health; the tension between a theoretical approach to problems and psychiatric approaches; the importance of addressing these varying approaches in patient care and how to do so; and differing ways to approach Christian, Muslim and Buddhist patients.
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Spirituality and cultural psychiatry
Chapter
  • Oct 2007
Cultural psychiatry is concerned with understanding the impact of social and cultural differences and similarities on mental illness and its treatments. A person's cultural characteristics can often lead to misunderstandings, influenced by language, non-verbal styles, codes of etiquette and assumptions. There may also be perceived misconceptions and differences in beliefs and values. In order to provide appropriate, sensitive and acceptable services for different cultural groups, all service providers need to take these factors into account. Written by leading clinicians and academics from around the world, and integrating both practical and theoretical knowledge, the Textbook of Cultural Psychiatry provides a framework for the provision of mental healthcare in a multi-cultural/ multi-racial society and global economy. It will be essential reading for those providing mental healthcare, or who are involved in the organisation and management of services.
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Transpersonal perspectives on manic psychosis: Creative, visionary, and mystical states
Article
Full-text available
  • Jan 1988
Presents the case of a male with manic psychosis, previously described by the author (see record 1989-16388-001), to illustrate how the cognitive, affective, sensory, energetic, and behavior changes that occur during a manic psychosis can foster the development of 3 transpersonal states of consciousness—visionary, mystical, and creative. Artistic creativity and psychosis are contrasted, and a probable genetic link between creativity and manic depressive illness is noted. The cultural role of visionary states and personal and immediate contact or union in the mystical state are described. Treatment implications and the role of the transpersonal therapist are addressed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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A Holistic Program for Chronic Schizophrenic Patients
Article
Full-text available
A 10-week, inhospital holistic health program for male schizophrenic patients was compared with an equally intense social skills training program. The holistic program included training in the stress reduction techniques of exercise and meditation as well as education in stress management. Patients were also encouraged to explore the growth potential of their psychotic experiences and to develop positive beliefs about the outcome of their illness. Both groups showed similar significant decreases in psychopathology from admission to discharge, but the use of medication and a token economy milieu by all patients confounds the interpretability of this finding. After the holistic patients were discharged into the community, there was no maintenance of any of the holistic techniques. The 2-year relapse rate did not differ significantly between the two treatments. Findings from various studies associating schizophrenic relapse with stressful life events and familial tension make further experimentation with stress reduction techniques for the treatment of schizophrenia worthwhile.
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A Typology of Religious Experience
Article
  • Mar 1979
A typology of religious experience was developed based on interviews (N = 45) with individuals claiming to have had religious experiences. Subjects' accounts were content-analyzed to extract the major attributes of the experience. These attributes were then factor-analyzed to determine the number of distinctively different types of the religious experience. A total of four factors were extracted, each descriptive of a distinct type of religious experience.
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Meditation as an Adjunct to Psychotherapy
Article
  • Jul 1985
The effect of a 10-week meditation program on 20 patients who were undergoing long-term individual explorative psychotherapy was studied. Change in the psychological well-being of the patients and the impact of the program on the process of their psychotherapy was evaluated. Results obtained from the patients’ self-ratings and the therapists’ objective ratings demonstrated a significant and substantial improvement in most measures of psychological well-being.
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Experiential characteristics of certain altered states of consciousness.
Article
  • Jan 1985
Discusses theories and methods of studying altered states of consciousness (ASCs); their manifestations (e.g., meditative, psychotic, epileptic); and criteria for evaluating them. A questionnaire concerning ASCs was administered to 16 20–60 yr olds who had experienced meditative ASCs (contacted in ashrams and religious organizations in India), 15 18–52 yr old psychiatric outpatients diagnosed as having had an acute schizophrenic episode, and 15 19–38 yr old epileptic patients with complex partial seizures. Analyses of Ss' responses indicated that meditative ASCs were characterized by changes in body image, followed by time-sense disturbances, changes in emotional expression, feelings of rejuvenation, and perceptual distortions. Epileptic ASCs were characterized by perceptual illusions and hallucinations, changes in emotionality, and increases in religiosity and philosophical interest. Psychotic ASCs involved perceptual distortions, changes in body image, and changes in meaning and significance, as well as disturbed time sense, hypersuggestibility, and alterations in thinking. The age at which an S experienced an ASC was an important factor mediating the integrative vs nonintegrative consequences of the experience, and the characteristics of the ASC were instrumental in the S's perception of these consequences. Availability of emotional and social support also affected the impact of the ASC. (38 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The Psychology of Meditation
Article
  • Jan 1987
After 15 years on sustained psychological research on meditation, a careful evaluation of the evidence of the effects and effectiveness of meditation techniques is needed. The contents of this book provide just such an evaluation—the contributors being drawn from among those most knowledgeable about meditation research. The book also describes the context of this research by presenting relevant theoretical bases in Eastern and Western psychology. Part I presents an outline of what meditation is and how it has been viewed from the very different perspectives of the spiritual traditions of the East and the positivist orientation of Western psychology. The place and aims of meditation in Buddhist psychology are described along with contemporary Western theoretical approaches to understanding human behavior. Part II reviews research on the phenomenology of meditation, the physiological effects of meditation, and research on personality change associated with meditation practice. Part III offers a new approach to understanding meditation as psychotherapy based on a skills analysis, along with a detailed description of how meditation can be used in clinical settings. Part IV concludes with an overview of the research evidence presented in the book along with comments about the adequacy of the research questions posed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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A 15O-H2O PET Study of Meditation and the Resting State of Normal Consciousness
Article
The aim of the present study was to examine whether the neural structures subserving meditation can be reproducibly measured, and, if so, whether they are different from those supporting the resting state of normal consciousness. Cerebral blood flow distribution was investigated with the 15O-H2O PET technique in nine young adults, who were highly experienced yoga teachers, during the relaxation meditation (Yoga Nidra), and during the resting state of normal consciousness. In addition, global CBF was measured in two of the subjects. Spectral EEG analysis was performed throughout the investigations. In meditation, differential activity was seen, with the noticeable exception of V1, in the posterior sensory and associative cortices known to participate in imagery tasks. In the resting state of normal consciousness (compared with meditation as a baseline), differential activity was found in dorso-lateral and orbital frontal cortex, anterior cingulate gyri, left temporal gyri, left inferior parietal lobule, striatal and thalamic regions, pons and cerebellar vermis and hemispheres, structures thought to support an executive attentional network. The mean global flow remained unchanged for both subjects throughout the investigation (39 ± 5 and 38 ± 4 ml/100 g/min, uncorrected for partial volume effects). It is concluded that the H215O PET method may measure CBF distribution in the meditative state as well as during the resting state of normal consciousness, and that characteristic patterns of neural activity support each state. These findings enhance our understanding of the neural basis of different aspects of consciousness. Hum. Brain Mapping 7:98–105, 1999. © 1999 Wiley-Liss, Inc.
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Precipitation of Acute Psychotic Episodes by Intensive Meditation in Patients with a History of Schizophrenia
Article
  • Sep 1979
These cases suggest that the combination of intensive meditation, fasting, sleep deprivation, a history of schizophrenia, and the discontinuation of maintenance doses of phenothiazines can be hazardous. Schizophrenic episodes can be precipitated by almost any severe stress, including a range of intensive therapeutic modalities, and the combination of intensive meditation practice, together with sleep and food deprivation, is certainly demanding. On the other hand, some data suggest that meditation in moderation can be useful in treating a range of psychopathology, including schizophrenia. The population at risk for the syndrome we have described seems to include only people with a history of schizophrenia, for whom maintenance medication, adequate food and sleep, and a less intensive approach to meditation are indicated.
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Transcendental meditation, altered reality testing, and behavioral change: a case report
Article
  • Aug 1975
This paper presents the case of a 39-year-old woman who, several weeks following initiation into transcendental meditation (TM), experienced altered reality testing and behavior. We discuss the course of this episode, present evidence for a causal relationship between her practive of TM and altered behavior, and discuss the appropriate treatment of such phenomena.
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