Content uploaded by Graeme Yorston
Author content
All content in this area was uploaded by Graeme Yorston on Oct 08, 2015
Content may be subject to copyright.
This article was downloaded by: [University of Chester]
On: 11 August 2015, At: 09:27
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954
Registered office: 5 Howick Place, London, SW1P 1WG
Mental Health, Religion &
Culture
Publication details, including instructions for authors
and subscription information:
http://www.tandfonline.com/loi/cmhr20
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
To link to this article: http://dx.doi.org/10.1080/713685624
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the
information (the “Content”) contained in the publications on our platform.
However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness,
or suitability for any purpose of the Content. Any opinions and views
expressed in this publication are the opinions and views of the authors, and
are not the views of or endorsed by Taylor & Francis. The accuracy of the
Content should not be relied upon and should be independently verified with
primary sources of information. Taylor and Francis shall not be liable for any
losses, actions, claims, proceedings, demands, costs, expenses, damages,
and other liabilities whatsoever or howsoever caused arising directly or
indirectly in connection with, in relation to or arising out of the use of the
Content.
This article may be used for research, teaching, and private study purposes.
Any substantial or systematic reproduction, redistribution, reselling, loan,
sub-licensing, systematic supply, or distribution in any form to anyone is
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
Downloaded by [University of Chester] at 09:27 11 August 2015
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.
References
B
U C K L EY
, P. (1981). Mystical experience and schizophrenia. Schizophrenia Bulletin, 7, 516–521.
C
A R EY
, G. (1997). Towards wholeness: transcending the barriers between religion and psychiatry.
British Journal of Psychiatry, 170, 396–397.
C
H A N
-O
B
, T. & B
O ON Y A N A R U T H E E
, V. (1999). Meditation in association with psychosis. Journal
of the Medical Association of Thailand, 82(9), 925–930.
D
E
S
IL V A
, P. (1984). Buddhism and behaviour modi cation. Behavioural Research and Therapy,
22, 661–678.
D
EIK M A N
, A.J. (1963). Experimental meditation. Journal of Nervous and Mental Disease, 136,
329–343.
D
EIK M A N
, A.J. (1966). Implications of experimentally induced contemplative meditation. Journal
of Nervous and Mental Disease, 142, 101–116.
F
EN W IC K
, P. (1996) The neurophysiology of religious experience. In D. B
H U G R A
(Ed.) Psychiatry
and Religion (pp. 167–177). London: Routledge.
F
RE N C H
, A.P., S
CH M ID
, A.C. & I
N G AL L S
, E. (1975). Transcendental meditation, altered reality
testing and behavioral change. Journal of Nervous and Mental Disease, 161, 55–58.
G
A R C I A
-T
R U JILL O
, R., M
O N T E R R EY
, A.L. & G
ON Z A LE Z
D
E
R
IV IE R A
, J.L. (1992). Meditacion
y psicosis. Psiquis Revista de Psiquiatria Psicologia y Psicosomatica, 13(2), 39–43.
G
R A H A M
, H. (1986) The human face of psychology: humanistic psychology in its social and cultural
context. Milton Keynes: Open University Press.
G
R E EN B ER G
, D., W
IT Z T U M
, E. & B
U C H B IN D E R
, J (1992). Mysticism and psychosis: the fate of
Ben Zoma. British Journal of Medical Psychology, 65(3), 223–235.
G
R O F
, C. & G
R O F
, S. (1986). Spiritual emergency: The understanding and treatment of
212 Graeme A.Yorston
Downloaded by [University of Chester] at 09:27 11 August 2015
transpersonal crises. Special Issue: The psychotic experience: disease or evolutionary crisis?
ReVision, 8(2), 7–20.
H
U M P H R EY S
, C. (1962). Teach Yourself Zen. Aylesbury: English Universities Press.
K
A B A T
-Z
IN
, J., W
H E E L E R
, E., L
IG H T
, T., S
K ILLIN G S
, A., S
C H A R F
, M.J., C
R O P L E Y
, T.G.,
H
O SM E R
, D. & B
E R N H A R D
, J.D. (1998). In uence of mindfulness meditation-based stress
reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis
undergoing phototherapy (UVB) and photochemotherapy. Psychosomatic Medicine, 60 (5),
625–632.
K
A S P E R
, S. & W
EH R
, T.A. (1992). The role of sleep and wakefulness in the genesis of depression
and mania. Encephale, 18 Spec No 1, 45–50.
K
R IEG ER
, M.J. & Z
U S S M A N
, M. (1981). The importance of cultural factors in a brief reactive
psychosis. Journal of Clinical Psychiatry, 42(6), 248–249.
K
U T Z
, I. (1985) Meditation as an adjunct to psychotherapy: an outcome study. Psychotherapy and
Psychosomatics, 43(4), 209–218.
L
OU
, H.C., K
JA E R
, T.W., F
R IBE R G
, L., W
IL D S C H IO D T Z
, G., H
O L M
, S. & N
O W A K
, M. (1999).
A 150-H2O PET study of meditation and the resting state of normal consciousness. Human
Brain Mapping, 7(2), 98–105.
L
U K O F F
, D. (1988). Transpersonal perspectives on manic psychosis: creative, visionary and
mystical states. Journal of Transpersonal Psychology, 20, 111–140.
L
U K O F F
, D., W
AL LA C E
, C.J., L
IB E R M A N
, R.P., & B
U R K E
, K. (1986) A holistic program for
chronic schizophrenic patients. Schizophrenia Bulletin, 12, 274–282.
M
IK L O W IT Z
, D.J., G
O L D S T E IN
, M.J. & N
U EC H T E R L EIN
, K.H. (1986). Expressed emotion,
affective style, lithium compliance and relapse in recent onset mania. Psychopharmacology
Bulletin, 22, 628–632.
S
C L A R E
, P. & C
R E E D
, F. (1990). Life events and the onset of mania. British Journal of Psychiatry,
156, 508–516.
S
C U LL
, D.A. & T
R IM BL E
, M.R. (1995). Mania precipitated by carbamazepine withdrawal. British
Journal of Psychiatry, 167, 698.
S
IL VE R ST O N E
, T. & R
O M A N S
-C
L A R K SO N
, S. (1989). Bipolar affective disorder: Causes and
prevention of relapse. British Journal of Psychiatry, 154, 321–335.
S
T AC E
, W. (1960). The teachings of the mystics. New York: Mentor.
T
H A P A
, K., & M
U R T H Y
, V.N. (1985). Experiential characteristics of certain altered states of
consciousness. Journal of Transpersonal Psychology, 17, 77–86.
W
AL S H
, R. & R
O CH E
, L. (1979) Precipitation of acute psychotic episodes by intensive meditation
in individuals with a history of schizophrenia. American Journal of Psychiatry, 136 (8),
1085–1086.
W
AT T S
, A.W. (1962) The way of zen. Harmondsworth: Penguin Books.
W
EH R
, T.A. (1991) Sleep loss as a possible mediator of diverse causes of mania. British Journal of
Psychiatry, 159, 576–578.
W
EN N E B E R G
, S.R., S
C H N E ID E R
, R.H., W
A L T O N
, K.G., M
A
C
LE AN
, C.R., L
E V ITSK Y
, D.K.,
S
A L E R N O
, J.W., W
A L LA C E
, R.K., M
A N D A RIN O
, J.V., R
A INFO R T H
, M.V. & W
A Z IRI
, R.
(1997) A controlled study of the effects of the transcendental meditation program on
cardiovascular reactivity and ambulatory blood pressure. International Journal of Neuroscience,
(89) 15–28.
W
EST
, M.A. (1987) The psychology of meditation. Oxford: Clarendon Press.
W
IT Z T U M
, E., G
R E E N B E R G
, D. & D
A S B E R G
, H. (1990) Mental illness and religious change.
British Journal of Medical Psychology, 63, 33–41.
W
RIG H T
, J.B. (1993) Mania following sleep deprivation. British Journal of Psychiatry, 163,
679–680.
Mania precipitated by meditation 213
Downloaded by [University of Chester] at 09:27 11 August 2015