Greta Christina’s review of my book, Secular Meditation, in The Humanist magazine includes two points of criticism. Here, I’ll address her statement “My other quarrel is with the book’s approach to meditation and mindfulness for people with mental illness, namely that it barely addresses it.”
I agree that this is a limitation of the book. My qualifications for writing the book are that I’ve led group meditations for six years and that, as a journalist, I’ve interviewed neuroscientists, psychologists and mindfulness teachers about meditation. My main focus in the book with regard to mental illness is to do no harm. See the bottom of this post for an excerpt from the book in which I talk about harmful side effects that have been observed among meditation practitioners.
Negative side effects from meditation are uncommon and when they do occur are usually the outcome of long silent retreats rather than the type of short meditations I share in the book. Nonetheless, I recommend that people suffering from mental illness approach meditation cautiously and do so with the support of a qualified mental health professional.
That said, I’ll add some comments here that could be useful to a person seeking to work through mental health issues with a therapist. An analysis of published literature on anxiety and depression finds that mindfulness-based therapies can be helpful. However, I don’t see any randomized trials comparing mindfulness-based therapies to other therapies to determine whether mindfulness is as good or better than other forms of therapy. Different therapies may work better for different people.
There is evidence that Mindfulness-based Cognitive Therapy can help prevent relapse into depression. The key word here is “relapse.” Teasdale et. al. write ”It is important to note that MBCT was specifically developed for remitted patients and is unlikely to be effective in the treatment of acute depression, where factors such as difficulty in concentrating and the intensity of negative thinking may preclude acquisition of the attentional control skills central to the programme.” In other words, mindfulness can help prevent depressive episodes, but it’s hard to learn mindfulness during an acute episode of depression.
There is a literature on mindfulness-based therapies for Obsessive-Compulsive Disorder. It makes sense to me that mindfulness can help with OCD. A few years ago, I interviewed a couple of therapists about OCD for an article that was never published. I learned that OCD is a disorder of the habits system. Mindfulness can help us recognize the things that trigger us to perform habits. When we understand what triggers us, we can outsmart the triggers by, for instance, seeking environments that don’t contains those triggers.
There is interest in exploring whether mindfulness can be helpful in treating Post-traumatic Stress Disorder. However, it does not appear to me that the evidence is in as to whether it’s effective.
I found a pilot study showing that loving-kindness meditation might be helpful for people dealing with schizophrenia. However, it seems very preliminary.
Mindfulness and meditation by themselves may not be adequate substitutes for therapy for people with mental illness. Nevertheless, it may be worthwhile to find a therapist who is supportive of meditation and mindfulness, and to do so, the place I’d start is the directory at the Institute for Meditation and Psychotherapy.
Here is the excerpt from pp. 233-235 of Secular Meditation on whether meditation can do harm:
Are there any risks associated with meditation?
Just because meditation is “natural” and does not involve the ingestion of drugs doesn’t mean it can’t have negative effects. It’s unlikely that a twenty-minute meditation like the ones presented here will cause such problems. But meditators on long retreats that involve days of silence and isolation have occasionally developed mental illnesses that require professional treatment. So if you have any history of mental health problems or severe trauma, exercise caution and seek out a good teacher as you start to meditate.
One reason negative effects may occur is that, while meditation seems to deactivate brain areas responsible for stress, it may also deactivate brain areas that repress traumatic memories. The psychiatrist Michael Grodin, cofounder of the Boston Center for Refugee Health and Human Rights, has treated refugee Tibetan monks who were tortured in China. Grodin said in an interview with Bostonia magazine that the monks suffered from post-traumatic stress disorder and sometimes had flashbacks during meditation. He said, “I think the Tibetans doing higher-level meditation were having a disinhibition: their frontal lobes were keeping a hold on things, but when they got into this deep meditative state, all kinds of bad experiences and feelings came out.”
The Brown University neuroscientist Willoughby Britton, who is a meditation practitioner, warns that most advanced practitioners face challenging side effects along the way. This can include anxiety, mood changes and awareness of unusual bodily sensations. “It does seem to be the case that the longer that you practice and the more intensely that you practice that these types of experiences seemed to be the norm,” she told Vincent Horn in an interview for the Buddhist Geeks podcast.
When I asked the psychiatrist Daniel Siegel about possible negative side effects of meditation, he said:
I’ve asked the exact same question, concerned that at least we “do no harm.” The answers I’ve gotten are this: in short-term ways of focusing on the breath or focusing on something internally for a few minutes, there is no negative side effect and there is no condition for which that’s a problem. Even for someone with psychosis, three, four minutes of inward focusing where you’re present with them — they can come right out of it and talk to you about it. That’s what I’ve been told by professionals in the field. For long, extended meditations, that can become problematic, and for week-long silent retreats, it can become extremely problematic because the brain is a very social organ and it requires social communication to maintain its sense of equilibrium. …For these longer ones, we want to really be careful.
Herbert Benson warns against meditating for too long in The Relaxation Response. Benson writes, “From our personal observations, many people who meditate for several hours every day for weeks at a time tend to hallucinate.” Benson wrote that he’d never observed such a side effect in people who practiced meditation for ten to twenty minutes at a time once or twice a day.
Treat meditation as a form of exercise. Trying to bench press too much weight can lead to injury. Sitting quietly for twenty minutes is unlikely to harm you. But if you have little experience, meditating for long periods can be risky. It’s wise to build up a meditation practice slowly, and ideally in a community with other people.
If you meditate and you experience disturbing thoughts, stop. Instead of meditating on your own, seek the guidance of an experienced teacher.
 Mary Garden, “Can Meditation Be Bad for You?” Humanist, September–October 2007.
 Caleb Daniloff, “Treating Tibet’s Traumatized: SPH’s Michael Grodin blends Eastern Healing and Western Medicine to Aid Torture Victims,” Bostonia, Fall 2009.
 Willoughby Britton, “BG 232: The Dark Night Project,” Buddhist Geeks, September 2011, www.buddhistgeeks.com/2011/09/bg-232-the-dark-night-project.
 Herbert Benson, The Relaxation Response (New York: Morrow, 1975), 172.