Meditation risks, safety, goals, methods

This page is mostly a tweetstorm from February 2nd, 2021. I’ve expanded and revised it a bit, with additions in italics.

1️⃣ Risks, safety, emergencies
2️⃣ Methods, goals, results
3️⃣ Recommendations

Risks, safety, emergencies

Save this link in case of emergencies (you or someone you know is having trouble with meditation that affects your ability to function normally for more than a little while after stopping meditation): Cheetah House.

Much of the academic and clinical work on negative effects of meditation has been done by Willoughby Britton and her colleagues. See her site for details!

Being a sciency kinda guy, I’d like quantitative evidence about risk factors. The science so far isn’t as sciency as I’d like, so I won’t quote any numbers. However, its general conclusions match what I’ve seen in decades of meditation practice and informal conversations with thousands of meditators:

Meditation is not entirely safe. See the Cheetah House symptom list for a long list of things that can go wrong. In the worst case, meditation can cause disabling psychiatric breakdowns lasting years. That is very rare. Mild emotional disturbances, confusion, and odd sensations are common, and not usually a problem. Problems of intermediate severity are probably the ones to be most concerned about.

Since I wrote this, there are two new studies from Britton et al. that seem to be the best available so far: “Prevalence of meditation-related adverse effects in a population-based sample in the United States” and “Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs .” A very loose summary might be “minor bad effects in ~50%, significant in ~10%, serious in ~1%.”

Meditation has a “dose-response effect”: generally, the more you do, the more intense the results will be, whether positive, negative, or just weird.

Usually, if it is producing negative effects, stopping meditating stops the problem. I am not an expert or teacher, so I rarely give advice, but this is my one main recommendation:

🛑 Just stop until the problem goes away. Take a break. You can come back to it later.

Meditators may be reluctant to stop even when it has impaired their ability to function: because it feels good, because they think “no pain, no gain,” because they mistake dysfunction for incipient “enlightenment,” or because their teacher tells them to push through.

It is sometimes true that pushing through what looks like imminent psychosis can produce spiritual breakthroughs. It can also lead to months of psychiatric hospitalization. Do not attempt this without intensive guidance from an expert. (How do you know who is qualified?)

Methods, goals, results

Anecdotally, some meditation methods are safer and/or more effective than others. As far as I know, there is no good quantitative data on this. There is lots of vehement religious opinion, though.

This implicitly posed the question: so, which methods are safer and/or more effective? And several people asked that explicitly. I didn’t reply, because I’m not confident of any answer, as will become clear later. What I suggested instead was finding out what a method does, and then seeing whether that’s something you want. The main risk I point to is that a method works as originally intended, which wasn’t what you wanted. This is common because the functions and mechanisms of methods are often not made clear by meditation teachers.

As an engineer, I take a first-principles, mechanistic approach to meditation methods.

Western teachers usually say “meditation” is supposed to make your life better, and also possibly someday you will become “enlightened.” This is all very nice and super vague, and the lack of precision is harmful. It (deliberately) obscures the actual goals and risks.

Different meditation systems are not different methods for accomplishing the same thing. In their Asian origins, they were each engineered to achieve specific, very different conceptions of enlightenment, taking you in quite different directions.

Most currently popular meditation methods derive from “Sutrayana,” one branch of Buddhism. These methods include secular mindfulness, vipassana, and (with asterisks) Zen.

There are thousands of branches of Buddhism, which can be grouped in different ways. Particular groupings highlight particular similarities and differences between Buddhist systems. In the tweetstorm, I contrasted Sutrayana and Vajrayana. This wasn’t exactly the relevant distinction for the discussion. A more accurate explanation would have been too complicated for twitter. A fully accurate one would take a book (if it is even possible).

The main meditation methods I discuss are the modern vipassana techniques that come from Theravada Hinayana. I avoided using the word “Hinayana” because that is widely misunderstood to be a derogatory synonym for Theravada, and mentioning it would have triggered some people and derailed the tweet thread. Hinayana is a yana, meaning a set of methods for getting from a particular starting point to a particular end-point. Hinayana’s starting point is revulsion for existence and its end point is cessation of rebirth. Its method is to cut all ties with the world.

Theravada is not a yana and is not equivalent to Hinayana. It is a “school”—a term equivalent to “sect” in Christianity. Theravada includes all the major yanas, including Mahayana and Vajrayana. The Tibetan traditions also include Hinayana, Mahayana, and Vajrayana, and give honored place to Hinayana.

When I said “Zen (with asterisks)” I was fudging a ton of details. Zen practice can sometimes have the same unwanted effects as Theravada vipassana, but there are important differences in both theory and technique.

Interrupt

🚨🚨🚨 We interrupt this broadcast to bring you a message from the MEDITATION EMERGENCY NETWORK 🚨🚨🚨

A bunch of twitter replies say “I don’t believe meditation has any risks.”

Please check medical studies on this and take their warning seriously.

Figure from Lindahl et al. on duration and severity of negative meditation outcomes

The 88% here is of people the researchers interviewed because they had bad meditation experiences, not a random sample of meditators. The frequency of bad outcomes is much less than 88%. What this early study demonstrated was mainly that extreme negative effects are possible, which hadn’t been clinically documented before. (It has always been known by serious meditators, but unfortunately this isn’t usually told to beginners.) As far as I know, there is still no solid quantitative data on the frequency of bad effects among meditators at large, although there are some suggestive studies.

To be clear, I meditate sometimes, sometimes intensively. I accept the risks, and believe meditation is usually beneficial. The point is not “don’t meditate,” it’s “understand how to decrease the risks and increase benefits.”

… aaand, we’re back

Sutrayana—mainstream Buddhism—has a precise logic, which you probably already know, and have decided to ignore and forget because you don’t like it:

😫 Existence is unrelentingly awful. There is nothing of any worth in the world 🌏. You can’t fix that, even the slightest bit, and you can’t escape, even in death ☠️, because you will just be reborn, probably as an intestinal parasite.🐛

The best thing would be to cease existing. How can you prevent rebirth? 🐣

What causes rebirth? 💫

(I know you don’t believe any of this, and I don’t either! I promise it is going to explain how and why mainstream meditation works, and why it’s risky, though.)

In life, we can’t stop ourselves doing things that cause suffering, because we’re compelled by emotions, thoughts, perceptions, involvements, and our sense of selfness.

Same after death: we choose rebirth because of all the emotionally-compelling loose ends left over from life.

If, in life, we can end our emotions, thoughts, perceptions, involvements, and sense of self, we won’t have loose ends after death. We’ll have developed the skill of not making stupid suffering-causing choices (like rebirth), and will retain that after death.

Phew! The way out!

So there’s a two-step recipe for ending existence:

  1. Renunciation: withdraw from the physical and social worlds, avoid anything that provokes any emotion, end all activities (ideally up to and including eating).
  2. Meditation: Kill any remaining emotions, thoughts, sensations, and your sense of self.

The methods for this kind of meditation are surprisingly effective… and are the historical basis for current secular mindfulness, which is pretty much the same thing.

Typical risks of these meditation methods: dissociation, depression, derealization, pathological spaciness, and depersonalization.

Those are precisely the goals of the practice, as traditionally understood: the end of involvement, emotions, perception, thought, and self!

So why is a practice engineered to turn you into a zombie often beneficial in small doses for normal people?

Because we do suffer from insurance paperwork, political outrage, clutter, self-defeating thought-loops, and tedious unresolvable self-esteem issues. (The same list of topics, in different terms reflecting more modern manifestations.)

Stepping back temporarily from busyness, upset, complexity, trying to figure stuff out, and neurotic self-involvement is a great relief. And “mindfulness” (and vipassana and Zen, etc.) can help us do that!

There’s two problems. First is that the dose-response effect is somewhat unpredictable. Rarely, someone does their first 10 minutes of mindfulness and loses their sense of self and contact with reality.

Which was the original goal of the practice! But absolutely not their goal!

The other risk is that you meditate intensively and turn into a drooling zombie. You could do that because the world does seem unrelentingly awful, and being a zombie seems better.

Probably a bad choice. There’s a great group discussion in “How to Ignore Your Emotions (while also thinking you’re awesome at emotions)” and in the comments on it:

I was really stressed out trying to manage my girlfriend’s fragile mental state. Developed acid reflux and thought I was having a heart attack because I ate through the inner lining of my esophagus and breathing was extremely painful. So I picked up meditation. And without a teacher I only focused on quieting my “monologue of upsetness”. I had some symptoms of depersonalization before, but this is when it really developed into a full on disorder. And honestly until I realized it was a disorder I was quite proud of it. I’d leave my body and then I wouldn’t feel any pain, I’d just observe “notme” handling it. A downright superpower if you ignore all the horrible side effects.

[Holly Elmore]: As someone who fatefully discovered dissociation/depersonalization/derealization around 10 only to have shit hit the fan in my 20s, I think I can articulate what’s lost when you lose touch with emotions. At first it feels great to ride above the pain, for me social pain in particular, and only come back down when it’s safe, like at home with my family. But eventually you can’t come back down to experience even essential things like interest, excitement, most of all love and connection. I feel that I was slowly bleeding out the entire time I was away from my body, never fully replenishing what was lost, and after years I was just empty and shriveled. I had my first real depression at the end of college and I felt mostly numb but also miserable and heavy. There was a deep sense of loss for I didn’t know what. Now I know what I was craving was a sense of being embodied, of feeling real and being connected to the world.

Healing sucks immensely because years of dissociating from emotion makes them very intense and when you come back and your coping skills extremely weak. But coming back to your body and your feelings is really the only way to come back to life. Being estranged from them is actively rejecting the reality of your experience and dividing yourself. It’s the autoimmune disease of the soul. Someone who’s checked out of a major part of their experience is not only missing the experience, but engaged in a civil war to keep it that way. You may be safe from barbed emotions when you’re dissociated, but eventually you’re not able to rest even in your own experience. It’s a torture that’s difficult to describe to someone who hasn’t experienced it to understand but I hope I’ve given some insight.

You can turn yourself into a zombie by not understanding that different Buddhisms have extremely different ideas of what “enlightenment” means. For some, it’s avoiding rebirth through becoming a zombie; for some others, it’s becoming an immortal sky god.

These two correspond very roughly to Hinayana and Mahayana, although both terms cover diverse systems that include other concepts of enlightenment as well.

If you fantasize about becoming an immortal sky god (and who doesn’t?), and pursue that with a method designed to turn you into a zombie, and practice more and more intensively when it doesn’t seem to be working yet… you will definitely turn yourself into a zombie.

If meditation is heading you in this direction, make sure it’s what you want, and get help if not.

Recommendations

These apply if you meditate fairly seriously, meaning half an hour or more per day for a year or more. If you meditate casually, the risks are small, and the differences between methods are not that important.

My main recommendation is to get clear about what you want from meditation, what method might lead to that, and what unwanted side-effects it might have.

This will take serious personal inquiry plus external research, due to clouds of motivated vagueness. There’s been a century-plus of deliberate obfuscation of the functions of meditation. At this point many/most meditation teachers have no idea what the methods they teach are for or how they are supposed to work. (This is bad.)

Clarifying what you want is also difficult, partly because it depends on what is available. You’d probably rather become a sky god than a zombie, but as a sciency kinda guy, I don’t think the methods that are supposed to turn you into a sky god are likely to work.

Figuring out what the objectives of different meditation methods are requires—unfortunately—learning some theory and history that is not clearly set out anywhere. (Especially not if you are considering methods deriving from different religions. But even within Buddhism, the only one I can talk about, most popular presentations are quite confused.)

I said most modern meditation systems derive from Sutrayana, which aims to escape the world into non-existence or into celestial godhood. It contrasts with Vajrayana, which is about human functioning in the actual world. The aims and methods of Vajrayana are, on the whole, more compatible with what most people want nowadays, and on the whole seem more realistic.

I wish I could say that Vajrayana also seems safer, but I can’t. First, we have no quantitative data on which methods are more dangerous. Second, it’s traditionally considered more dangerous. On the other hand, the danger of methods derived from Sutrayana is that they work as originally intended, but that was not what you wanted. That danger is not accounted for in the traditional comparison.

Responses to my tweetstorm revealed that I was unclear in two ways.

First, some assumed that because I contrasted Sutrayana and Vajrayana, I must be saying that one of them is bad and the other is good. Sutrayana isn’t in any sense bad. It has particular goals that few people share nowadays. If you don’t want to go where it takes you, it would be bad for you, but it is good for people who do want that.

Since few now want to go there, nearly no one teaches Sutrayana straight up. Nowadays, most Buddhism is some form of Buddhist Modernism, meaning a mashup of Sutrayana, Vajrayana, psychotherapy, Romanticism, Protestantism, scientism, leftism, etc.

Buddhist Modernism is also not bad. (In my opinion; hardcore traditionalists disagree.) However, aspects of it may be bad for you, depending on what you want. It’s difficult or impossible to figure out which those may be without analyzing a particular mashup into its functional components.

The relevant example here is that Hinayana vipassana methods are central in many Buddhist Modernist systems. Those methods were originally designed to separate you from reality, and that’s what they still may do. The methods have been modified by modernists in ways that may make this less likely, but the clinical studies demonstrate that it still happens. This should not be surprising if you understand the underlying principles and functions.

Analogously, it’s also important to understand how the Western ideologies in the mashup retain some of their original functions in the different context. If not recognized, they may cause unexpected harms, depending again on what your goals are. Most modern Buddhisms inherit anti-rationalism from their Western Romantic heritage. As a result, Western Buddhists are insufficiently skeptical of “alternative medicine,” for example.

Traditional presentations of the goals of Vajrayana are esoteric, abstract, incomprehensible at first, and often obviously impossible, so clarity about whether you want to practice it takes work. Some traditional goals are compatible with a modern worldview: mastery, power, playfulness, and nobility.

Vajrayana is subdivided into Tantra and what might be called the “essence approaches,” which are Mahamudra and Dzogchen.

I’ve written a lot about Tantra, mostly as a theoretical exercise. It’s not a feasible starting point for many people. Its risks are, again, closely related to its goals: narcissism, aggression, sexual acting-out, and delusional psychosis. (Those are what you get if you develop the “form aspects” of Tantra and neglect its “emptiness aspects.”)

Within Mahamudra and Dzogchen, there is a series of four meditation methods, the four yogas or four naljors. That’s mainly what I practice.

The name is confusing. In the West, “yoga” is a system of physical exercises. In Buddhism, “yoga” is a vague term covering diverse systems of practices, most of which you do while sitting down. It’s roughly equivalent to “meditation” in English. “Naljor” is the Tibetan translation of the Sanskrit word “yoga.”

The overall aim of the four naljors is to relate to pattern and nebulosity (emptiness and form) as inseparable.

That just happens to be what all the “books” I write are about!

In feel, the meditation methods are lighter, more open, more relaxed, more playful than the Hinayana ones. They do not involve close focus, concentration, or thought suppression. They are not easier, though. They require a different mode of precision, which may be difficult to access at first.

I would like to say that the four naljors system is risk-free, but we don’t know that. Its open-endedness can be disorienting. I don’t know of anyone having serious negative consequences. It’s hard to think what bad aspects of “recognizing the inseparability of form and emptiness” could be, but there may be some I’m overlooking.

This site used to have a page, from 2014, on teachers of modern Vajrayana. It started by saying there aren’t exactly any, but here’s some you could look into, with various caveats, and also that I didn’t know much about most of them.

I took it down in 2019 after noticing that several teachers it listed had blown up (sex or other scandals) or fizzled (retreated into bubbles of irrelevance). This leaves me with little confidence for any recommendations, and considerable concern for the future of the religion.

A few months ago, my spouse Charlie Awbery cofounded Evolving Ground, a meditation community which teaches primarily the four naljors system.

I’m confident they are sane, kind, and competent. Obviously, though, I’m biased. Investigate for yourself if this sounds attractive!