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Depersonalization, Meditation, and the Experience of (No-)Self
Abstract
This paper aims to contribute to an integrated understanding of what goes missing in adverse meditation experiences and in cases of depersonalization disorder. Depersonalization disorder is characterized by distressing alterations in, and sometimes the complete disappearance of, the 'I'-sense. This paper examines the nature of the 'I'-sense and what it means to lose it from a Buddhist perspective. We argue for a nihilist position that the loss of the sense of self arises from misidentifications of the psychophysical complex with non-self elements, such as memories, thoughts, or body movements. Drawing from meditation experiences and depersonalization symptoms, we propose that the sense of self is not a static entity given in experience but fluctuates between various senses of self (and no-self) depending on circumstances. This pluralistic understanding of the various senses of self offers a more nuanced understanding of symptoms in depersonalization disorder and adverse effects of meditation practices.
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The extrastriate body area (EBA) is a body-selective focal region located in the lateral occipito-temporal cortex that responds strongly to images of human bodies and body parts in comparison with other classes of stimuli. Whether EBA contributes also to the body recognition of self versus others remains in debate. We investigated whether EBA contributes to self-other distinction and whether there might be a hemispheric-side specificity to that contribution using double-pulse transcranial magnetic stimulation (TMS) in right-handed participants. Prior to the TMS experiment, all participants underwent an fMRI localizer task to determine individual EBA location. TMS was then applied over either right EBA, left EBA or vertex, while participants performed an identification task in which images of self or others' right, or left hands were presented. TMS over both EBAs slowed responses, with no identity-specific effect. However, TMS applied over right EBA induced significantly more errors on other's hands than noTMS, TMS over left EBA or over the Vertex, when applied at 100-110 ms after image onset. The last three conditions did not differ, nor was there any difference for self-hands. These findings suggest that EBA participates in self/other discrimination.
An Exploration of the Hidden Side of Meditation
The Dark Side of Dharma explores some of the possible undesirable side effects – also known as ‘adverse effects’ - of meditation and mindfulness. Researcher Anna Lutkajtis investigates why these effects, which are well-known in spiritual and religious traditions, have been ignored in contemporary secular contexts, such as Western psychology.
Lutkajtis’ research reveals that while meditation is commonly portrayed as a practice that is overwhelmingly positive, a growing number of research studies and anecdotal reports suggest that meditation can also have negative effects. Some meditators believe that these adverse effects are a normal part of the contemplative path and a welcome sign of progress. For others, such effects are completely unexpected and can be psychologically harmful.
In religious traditions like Buddhism, difficulties associated with meditation are acknowledged and are usually viewed as milestones on the path to enlightenment or the result of an unbalanced practice. In such traditional contexts, meditation teachers are equipped to deal with adverse effects if and when they arise. However, in the modern West, meditation adverse effects have been overlooked, under-researched, and generally misunderstood.
Given the current popularity of meditation, Lutkajtis argues that it is important to understand why meditation adverse effects have been ignored in contemporary secular settings.
ANNA LUTKAJTIS is a postgraduate researcher from Sydney, Australia.
Her research focuses on mysticism, psychedelics, and the relationship between mental health, religion and spirituality.
Depersonalisation/derealisation disorder (DPD) refers to frequent and persistent detachment from bodily self and disengagement from the outside world. As a dissociative disorder, DPD affects 1-2% of the population, but takes 7- 12 years on average to be accurately diagnosed. In this systematic review, we comprehensively describe research targeting the neural correlates of core DPD symptoms, covering publications between 1992 and 2020 that have used electrophysiological techniques. The aim was to investigate the diagnostic potential of these relatively inexpensive and convenient neuroimaging tools. We review the EEG power spectrum, components of the event-related potential (ERP), as well as vestibular and heartbeat evoked potentials as likely electrophysiological biomarkers to study DPD symptoms. We argue that acute anxiety- or trauma-related impairments in the integration of interoceptive and exteroceptive signals play a key role in the formation of DPD symptoms, and that future research needs analysis methods that can take this integration into account. We suggest tools for prospective studies of electrophysiological DPD biomarkers, which are urgently needed to fully develop their diagnostic potential.
Objective
Meditation techniques are widely used as therapy and wellbeing practices, but there are growing concerns about its potential for harm. The aim of the present study is to systematically review meditation adverse events (MAEs), investigating its major clinical categories and its prevalence.
Method
We searched PubMed, PsycINFO, Scopus, Embase and AMED up to October 2019. Eligible studies included original reports of meditation practices (excluding related physical practices such as Yoga postures) with adult samples across experimental, observational and case studies. We identified a total of 6742 citations, 83 of which met the inclusion criteria for MAEs with a total of 6703 participants who undertook meditation practice.
Results
Of the 83 studies analysed, 55 (65%) included reports of at least one type of MAE. The total prevalence of adverse events was 8.3% (95% CI 0.05–0.12), though this varied considerably across types of studies – 3.7% (95% CI 0.02–0.05) for experimental and 33.2% (95% CI 0.25–0.41) for observational studies. The most common AEs were anxiety (33%, 18), depression (27%, 15) and cognitive anomalies (25%, 14); gastrointestinal problems and suicidal behaviours (both 11%, 6) were the least frequent.
Conclusion
We found that the occurrence of AEs during or after meditation practices is not uncommon, and may occur in individuals with no previous history of mental health problems. These results are relevant both for practitioners and clinicians, and contribute to a balanced perspective of meditation as a practice that may lead to both positive and negative outcomes.
There has recently been a resurgence of philosophical and scientific interest in the foundations of self-consciousness, with particular focus on its altered, anomalous forms. This paper looks at the altered forms of self-awareness in Depersonalization Disorder (DPD), a condition in which people feel detached from their self, their body and the world (Derealisation). Building upon the phenomenological distinction between reflective and pre-reflective self-consciousness, we argue that DPD may alter the transparency of basic embodied forms of pre-reflective self-consciousness, as well as the capacity to flexibly modulate and switch between the reflective and pre-reflective facets of self-awareness. Empirical evidence will be invoked in support of the idea that impaired processing of bodily signals is characteristic of the condition. We provide first-hand subjective reports describing the experience of self-detachment or fracture between an observing and an observed self. This split is compared with similar self-detachment phenomena reported in certain Buddhist-derived meditative practices. We suggest that these alterations and changes may reveal the underlying and tacit transparency that characterises the embodied and basic pre-reflective forms of self-consciousness, in the same way that a crack in a transparent glass may indicate the presence of an unnoticed window.
So far, the large and expanding body of research on meditation has mostly focussed on the putative benefits of meditation on health and well-being. However, a growing number of reports indicate that psychologically unpleasant experiences can occur in the context of meditation practice. Very little is known about the prevalence and potential causes of these experiences. The aim of this study was to report the prevalence of particularly unpleasant meditation-related experiences in a large international sample of regular meditators, and to explore the association of these experiences with demographic characteristics, meditation practice, repetitive negative thinking, mindfulness, and self-compassion. Using a cross-sectional online survey, 1,232 regular meditators with at least two months of meditation experience (mean age = 44.8 years ± 13.8, 53.6% female) responded to one question about particularly unpleasant meditation-related experiences. A total of 315 participants (25.6%, 95% CI: 23.1 to 28.0) reported having had particularly unpleasant meditation-related experiences, which they thought may have been caused by their meditation practice. Logistic regression models indicated that unpleasant meditation-related experiences were less likely to occur in female participants and religious participants. Participants with higher levels of repetitive negative thinking, those who only engaged in deconstructive types of meditation (e.g., vipassana/insight meditation), and those who had attended a meditation retreat at any point in their life were more likely to report unpleasant meditation-related experiences. The high prevalence of particularly unpleasant meditation-related experiences reported here points to the importance of expanding the scientific conception of meditation beyond that of a (mental) health-promoting and self-regulating technique. We propose that understanding when these experiences are constitutive elements of meditative practice rather than merely negative effects could advance the field and, to that end, we conclude with an overview of methodological and conceptual considerations that could be used to inform future research.
In contemporary Western society, meditation techniques that were previously taught within the context of Eastern religious traditions are now increasingly being practiced in secular settings. While the boundary between the secular and the religious is blurred, popular meditation techniques such as Transcendental Meditation, vipassana, and mindfulness are generally promoted as being derived from Eastern religions, but inherently non-religious, aligned with Western psychology, and suitable for a general audience. Over approximately forty years, thousands of research studies suggest that there are many psychological and physiological benefits associated with these forms of meditation; however, a small but growing literature indicates there could also be adverse effects. In Eastern religious traditions, difficulties associated with meditation are acknowledged, and are usually understood to be milestones on the path to enlightenment, the result of improper practice, or due to individual differences. However, in a Western secular context, negative effects associated with meditation have largely been overlooked. This article argues that this is in part due to the fact that in contemporary Western society the goal of meditation has shifted from enlightenment to symptom relief and personal transformation, leading to the assumption that meditation is harmless and 'good for everyone'.
A flood of new multidisciplinary work on the causes of depersonalization disorder (DPD) provides a new way to think about the feeling that experiences “belong” to the self. In this paper I argue that this feeling, baptized “mineness”(Billon 2013, 2018a, b) or “subjective presence” (Seth, Trends in Cognitive Sciences 17(11): 565–573, 2013) emerges from a multilevel interaction between emotional, affective and cognitive processing. The “self” to which experience is attributed is a predictive model made by the mind to explain the modulation of affect as the organism progresses through the world. When the world no longer produces predicted affect, the organism needs to explain or explain this unpredicted absence of feeling away. It is important to this account that cognition and perception are otherwise intact. Consequently the mind’s representation of the world and its emotionally salient properties are unchanged, leading the mind to predict a characteristic affective response. When that prediction is not fulfilled the organisms feels as if she is no longer present in experience. This is reported at the as feeling of depersonalization.
The intent of this article is to stimulate a conversation and encourage interdisciplinary discussion and dialog between “secular” and “Buddhist” camps around the notion of adverse psychological experiences that might occur in the context of meditation practice and training, be that as part of a day-to-day practice or in the context of a residential and intensive retreat. Depending on the context, there are significant differences in the way that such experiences are made sense of and, as a result, there may be significant variations in tradition-specific accounts of how to manage such experiences. In each context, implicit foundational values (about, for example, what counts as mental health, or the goals of meditation practice) may lead to very different accounts about what counts as harmful or helpful, and therefore about what is an appropriate course of action. For those teaching meditation, either in secular or religious contexts, this has clear ethical implications—how are the best interests of the student served? This paper will explore examples of this tension by comparing and contrasting accounts about adverse meditation experiences from Buddhist and secular perspectives. A case will be made for a dialogic, mutually engaged, and supportive relationship between Buddhist and secular approaches to adverse meditation experiences.
Contemplative science is usually conceived either as an introspective investigation of the meditative mind or as following methods of other scientific disciplines to study the mind in meditation. Here, I suggest a conception of a comprehensive contemplative science that includes both. Drawing on Paul Hoyningen-Huene's work in the philosophy of science, I develop an understanding of contemplative science based on the idea that science consists of systematicity in nine dimensions of scientific activity. Hoyningen- Huene uses everyday knowledge as the main contrast to scientific knowledge, claiming that the latter is more systematic than the former. Since the contemplative traditions already exhibit a high degree of systematicity, these traditions are used as an additional contrast. This results in a description of the nature and current state of contemplative science and an indication of how it should develop in the future in order to become more systematic and thereby more scientific.
Buddhist-derived meditation practices are currently being employed as a popular form of health promotion. While meditation programs draw inspiration from Buddhist textual sources for the benefits of meditation, these sources also acknowledge a wide range of other effects beyond health-related outcomes. The Varieties of Contemplative Experience study investigates meditation-related experiences that are typically underreported, particularly experiences that are described as challenging, difficult, distressing, functionally impairing, and/or requiring additional support. A mixed-methods approach featured qualitative interviews with Western Buddhist meditation practitioners and experts in Theravāda, Zen, and Tibetan traditions. Interview questions probed meditation experiences and influencing factors, including interpretations and management strategies. A follow-up survey provided quantitative assessments of causality, impairment and other demographic and practice-related variables. The content-driven thematic analysis of interviews yielded a taxonomy of 59 meditation-related experiences across 7 domains: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Even in cases where the phenomenology was similar across participants, interpretations of and responses to the experiences differed considerably. The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring. In order to determine what factors may influence the valence, impact, and response to any given experience, the study also identified 26 categories of influencing factors across 4 domains: practitioner-level factors, practice-level factors, relationships, and health behaviors. By identifying a broader range of experiences associated with meditation, along with the factors that contribute to the presence and management of experiences reported as challenging, difficult, distressing or functionally impairing, this study aims to increase our understanding of the effects of contemplative practices and to provide resources for mediators, clinicians, meditation researchers, and meditation teachers.
This paper presents functional MRI work on emotional processing in depersonalization disorder (DPD). This relatively neglected disorder is hallmarked by a disturbing change in the quality of first-person experience, almost invariably encompassing a diminished sense of self and an alteration in emotional experience such that the sufferer feels less emotionally reactive, with emotions experienced as decreased or “damped down,” so that emotional life seems to lack spontaneity and subjective validity. Here we explored responses to emotive visual stimuli to examine the functional neuroanatomy of emotional processing in DPD before and after pharmacological treatment. We also employed concurrent skin conductance measurement as an index of autonomic arousal. In common with previous studies we demonstrated that in DPD, there is attenuated psychophysiological response to emotional material, reflected in altered patterns of (i) regional brain response, (ii) autonomic responses. By scanning participants before and after treatment we were able to build on previous findings by examining the changes in functional MRI response in patients whose symptoms had improved at time 2. The attenuation of emotional experience was associated with reduced activity of the insula, whereas clinical improvement in DPD symptoms was associated with increased insula activity. The insula is known to be implicated in interoceptive awareness and the generation of feeling states. In addition an area of right ventrolateral prefrontal cortex emerged as particularly implicated in what may be “top-down” inhibition of emotional responses. The relevance of these findings to the wider study of emotion, self-related processes, and interoception is discussed.
Importance
Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation.
Objective
To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health–related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations.
Evidence Review
We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals.
Findings
After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health–related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies).
Conclusions and Relevance
Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.
There is a long tradition in philosophy for claiming that selfhood is socially constructed and self-experience intersubjectively mediated. On many accounts, we consequently have to distinguish between being conscious or sentient and being a self. The requirements that must be met in order to qualify for the latter are higher. My aim in the following is to challenge this form of social constructivism by arguing that an account of self which disregards the fundamental structures and features of our experiential life is a non-starter, and that a correct description and account of the experiential dimension must do justice to the first-person perspective and to the primitive form of self-referentiality, mineness or for-me-ness that it entails. I then consider and discuss various objections to this account, in particular the view that an endorsement of such a minimal notion of self commits one to an outdated form of Cartesianism. In the final part of the paper, I argue that the self is so multifaceted a phenomenon that various complementary accounts must be integrated if we are to do justice to its complexity.
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.
Depersonalisation disorder is a poorly understood and underresearched syndrome.
To carry out a large and comprehensive clinical and psychopathological survey of a series of patients who made contact with a research clinic.
A total of 204 consecutive eligible referrals were included: 124 had a full psychiatric examination using items of the Present State Examination to define depersonalisation/derealisation and 80 had either a telephone interview (n=22) or filled out a number of self-report questionnaires. Cases assessed were diagnosed according to DSM-IV criteria.
The mean age of onset was 22.8 years; early onset was associated with greater severity. There was a slight male preponderance. The disorder tended to be chronic and persistent. Seventy-one per cent met DSM-IV criteria for primary depersonalisation disorder. Depersonalisation symptom scores correlated with both anxiety and depression and a past history of these disorders was commonly reported. 'Dissociative amnesia' was not prominent.
Depersonalisation disorder is a recognisable clinical entity but appears to have significant comorbidity with anxiety and depression. Research into its aetiology and treatment is warranted.
Buddhists maintain that the enlightened person is freed from the illusion of 'self' with its ideas of 'me' and 'mine'. What notion of self is at stake here? What must be the case, with regard to the self and consciousness, for nirvana to be psychologically possible? Is the picture that emerges a plausible one in the philosophy of mind? Part One outlines the notion of self under consideration in the Pali Buddhist sutras. Part Two argues that in Pali Buddhism the self illusion has two tiers: a tier of non-illusory ownerless consciousness, and a tier of content that yields a personalized identity in the world. It is the latter, not the former, that makes the self illusory. Arguments against the alternative 'bundle theory' interpretation of no-self in Buddhism are also presented. Part Three gives independent evidence to suggest that the everyday mind is structured by a two-tiered illusion of self.
According to Thomas Metzinger, no such things as selves exist in the world: nobody ever had or was a self. All that exists are phenomenal selves, as they appear in conscious experience. The phenomenal self, however, is not a thing but an ongoing process; it is the content of a "transparent self-model." In Being No One, Metzinger, a German philosopher, draws strongly on neuroscientific research to present a representationalist and functional analysis of what a consciously experienced first-person perspective actually is. Building a bridge between the humanities and the empirical sciences of the mind, he develops new conceptual toolkits and metaphors; uses case studies of unusual states of mind such as agnosia, neglect, blindsight, and hallucinations; and offers new sets of multilevel constraints for the concept of consciousness. Metzinger's central question is: How exactly does strong, consciously experienced subjectivity emerge out of objective events in the natural world? His epistemic goal is to determine whether conscious experience, in particular the experience of being someone that results from the emergence of a phenomenal self, can be analyzed on subpersonal levels of description. He also asks if and how our Cartesian intuitions that subjective experiences as such can never be reductively explained are themselves ultimately rooted in the deeper representational structure of our conscious minds.
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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.
Adverse effects of meditation were assessed in twenty-seven long term meditators (average 4.27 years) both retrospectively (time one) and prospectively at one month (time two) and six months (time three) following a meditation retreat. At both time one and time three subjects reported significantly more positive effects than negative from meditation. However, of the twenty-seven subjects, seventeen (62.9%) reported at least one adverse effect, and two (7.4%) suffered profound adverse effects. When subjects at time one were divided into three groups based on length of practice (16.7 months; 47.1 months; 105 months) there were no significant differences in adverse effects. How the data should be interpreted, and their implications both for the clinical and psychotherapeutic use of meditation as a relaxation/self-control strategy, and as a technique for facilitating personal and spiritual growth, are discussed. Limitations of the study and suggestions for future research are also offered.
Depersonalization syndrome is an intriguing condition which entails the inclusion of both philosophical and psychiatric considerations. The author presents a clinical review of the syndrome with the inclusion of four essential components classically included in the literature. These components include a possible preformed response of the brain, an obsessional quality, a depressive element and a tendency towards a peculiar perseveration.
Existing self-rating scales to measure depersonalization either show dubious face validity or fail to address the phenomenological complexity of depersonalization. Based on a comprehensive study of the phenomenology of this condition, a new self-rating depersonalization questionnaire was constructed. The Cambridge Depersonalization Scale is meant to capture the frequency and duration of depersonalization symptoms over the 'last 6 months'. It has been tested on a sample of 35 patients with DSM-IV depersonalization disorder, 22 with anxiety disorders, and 20 with temporal lobe epilepsy. Scores were compared against clinical diagnoses (gold standard) and correlated with the depersonalization subscale of the Dissociation Experiences Scale (DES). The scale was able to differentiate patients with DSM-IV depersonalization disorder from the other groups, and showed specific correlations with the depersonalization subscale of the DES (r=0.80; P=0.0007). The scale also showed high internal consistency and good reliability (Cronbach alpha and split-half reliability were 0.89 and 0.92, respectively). The instrument can, therefore, be considered as valid and reliable, and can be profitably used in both clinical and neurobiological research.
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