Nothing for something?

There is nothing we possess more fully than our own minds, writes journalist Cindy Dampier in the Chicago Tribune. Yet “consumer culture has managed to sell them back to us to the tune of billions in profits.”

Enrichmentality is all about enriching your future by learning the language of money. It’s about mindset just as much as it’s about wealth. So it makes sense to begin the new year with a post on enriching our minds.

But Dampier’s observations beg the question – are we paying something for nothing?

Mindfulness as an industry

In 2017, Scientific American published an exposé on the meditation and mindfulness industry – worth $1.1 billion in the US. Growing by 11% annually, the industry is forecast to top $2 billion in the US by 2022.

Variation in the market is huge, but almost every offering is heavily commercialised. Today, you’ll find your phone’s app store flooded with mindfulness apps promoting everything from better study to sleep. And a week at the Six Senses meditation and yoga retreat will set you back close to $20,000.

While flashy retreats might get more press, the mindfulness trend is most visible online, especially in the time of covid. Meditation apps like Calm and Headspace are advertised daily on social media. As Dampier reports, these apps have each been valued at around $250 million.

But where is the evidence that mindfulness is worth the price tag?

According to a 2015 review in American Psychologist, only around 9% of the research on mindfulness has involved clinical testing that included a control group. And when large, placebo-controlled meta-analyses are conducted (that is, where the findings of multiple studies are looked at together, and compared to doing nothing), the results are unimpressive.

A 2014 review of 47 meditation trials involving over 3,500 participants, Scientific American reports, ‘found essentially no evidence for benefits related to enhancing attention, controlling substance abuse, aiding sleep, or controlling weight‘. Yet, plug the word ‘mindful’ into Google’s Play Store, and that’s exactly what you’ll get. Apps claiming to offer ‘meditation for sleep’, ‘mindful eating hypnosis’, ‘quit smoking affirmations’, and ‘mindful study habits’.

The lead author of this review, clinical psychologist Nicholas Van Dam, cautions that the report does not mean mindfulness meditation is not helpful for some things. Rather, the evidence is simply not there. Further, what potential benefits do exist are being overblown and oversold for massive financial gain.

Worryingly, as of 2015, Van Dam and his co-authors found that fewer than a quarter of meditation trials included monitoring for potential negative effects.

Side effects

In most interventions – a change in diet or exercise, a new style of psychological therapy – researchers monitor patients not only for benefits, but for negative side effects.

Consider vitamin A. We all need it, but taking too high a dose of vitamin A supplements, or taking them for too long, increases many health risks, as well as overall risk of death. Or calcium. Researchers have tested the theory that calcium is good for our bones. But in monitoring patients taking calcium supplements, they found some important negative side effects – kidney stones and heart disease.

It turns out that increasing calcium intake alone doesn’t mean the calcium will go to your bones. Too much calcium can wind up elsewhere in your system. Without sufficient other important nutrients like magnesium and Vitamin D, calcium can end up in your kidneys or your arteries instead of in your bones (as far as I understand. Don’t listen to me on that, I am not a medical doctor!)

Natural therapies have side effects, too

I suspect one of the reasons so few studies look for negative results is not simply a lack of scientific rigor, but rather, a strong belief (among both researchers and practitioners) that mindfulness is inherently a good thing. That it is free of side effects. In fact, this is one of the major reasons people turn to alternative therapies.

In short, there’s a belief that there can be no such thing as “too much mindfulness”. But what if mindfulness is like Vitamin A? What if too much is a bad thing? Or, if meditation, like calcium, without other key ingredients in mental and physical wellbeing, might be misdirected and harmful?

Overselling the bright side

Even serious advocates warn against overselling the benefits of mindfulness. Dr. Itai Ivtzan, who writes about mindfulness for wellbeing at Psychology Today says it was a comment from one of his students that gave him pause:

“What you’re actually saying here,” the student said, “is that meditation is great, and it does not have any dangers or side effects”

This comment made Ivtzan realise “how easy it is to highlight the bright side of meditation while disregarding its potential dark side”.

What is ‘mindfulness’?

The word ‘mindful’ simply means ‘awareness’. In Buddhism and psychology, the derived term ‘mindfulness’ means paying attention on purpose, in the present moment, and non-judgementally.

How could any of that be a bad thing?

And yet, the National Centre for Complementary and Integrative Health cautions that while meditation is considered safe for healthy people, “there have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched”.

A tragic case

In The Independent, psychologist Miguel Farias writes about the case of a man who started attending chanting and meditation at a Buddhist temple in Washington… and wound up shooting 12 people dead. Just 24 hours later, a journalist asked ‘Can there be a less positive side to meditation?’ Western Buddhists, Farias says, immediately reacted. “This man represented the Dharma teachings no more than 9/11 terrorists represented the teachings of Islam.”

Yet others noted that, for all its de-stressing and self-developing potential, meditation “can take you deeper into the recesses of your mind than you may have wished for”. This observation prompted Farias to examine the notion that meditation, without the guidance of an expert, can have adverse effects. At the time, he was teaching a course on the psychology of spirituality. Most students were in their 50s and 60s, retired professionals, priests, psychiatrists, and yoga/meditation instructors.

More troubling stories

One of Farais’ students, Louise, had taught yoga for more than 20 years. She stopped only when something unexpectedly changed her life. During one meditation retreat, her sense of self changed dramatically. ‘Good’, she initially thought, although she couldn’t help but feel anxious. ‘Don’t worry, just keep meditating and it will go away’ her teacher told her. But it didn’t. Back home, her body was numb, and she didn’t want to get out of bed. After an assessment by her GP, she saw a psychiatrist. Louise spent the next 15 years undergoing treatment for psychotic depression, including electroconvulsive therapy. While she may have had a genetic predisposition to psychosis, she never attended another meditation retreat.

A BBC investigation describes the case of one woman who, during a 10-day silent meditation retreat, suffered a panic attack. Her teachers urged her to continue. When she returned home, she effectively collapsed in her mother’s house. “I could not get out of bed anymore. I could not eat. I was having symptoms of terror and panic. I had a lot of fear and I had ‘depersonalization’ – that’s basically when you look at yourself in the mirror and you’re unable to recognize yourself – and ‘derealization’, which is when you look at the world around you and it seems unreal.” Eventually, she was admitted to a psychiatric hospital and administered antipsychotic medication which, a year later, she still has to take.

Research on the side effects of meditation

Farais looked into the scholarly literature, turning up more accounts of people troubled by meditation. One young woman experienced delusions and was diagnosed with mania after attending a meditation retreat. After six weeks’ medication, and 2 years’ regular psychotherapy, her symptoms were controlled.

That was, until she took part in a Zen Buddhist retreat. Afterwards, she required further hospitalization, unable to sleep for five days straight. She was “irritable, sexually disinhibited and restless” and “made repeated praying gestures and attacked a member of staff”.

An emerging pattern

It’s tempting to think of these cases as simply outliers. Yet a 1992 study of 27 meditation practitioners found that 63% had suffered at least one negative effect (anxiety, panic, depression, pain, confusion, disorientation etc.). Furthermore, 7% suffered profoundly adverse effects. Surprisingly, the number of adverse effects did not appear to be correlated with experience.

And while the above cases may be extreme, the BBC’s Jolyon Jenkins suggests they may not be as uncommon as we would think. She interviewed a number of people who had apparently good mental health before trying meditation, but suffered severe crises during and after. Nor is in only those who go on intense retreats that suffer issues.

Meditation is not for everyone

Although particularly severe negative effects may be rare, meditation is certainly not for everyone. In one recent study, more than a quarter of mediators reported particularly unpleasant meditation-related experiences which they attributed to the meditation itself.

It’s important to note that these were not novices but experienced mediators. All had at least two months history meditating, and all meditated on a regular basis. Crucially, participants with higher levels of repetitive negative thinking, those who only engaged in deconstructive types of meditation like vipassana/insight meditation, and those who had attended a meditation retreat, were the most likely to report unpleasant meditation-related experiences.

For some, mindfulness “made them aware of their distress but unable to deal with it”. Ultimately, they found that meditation was “not only unhelpful but counterproductive”. The authors conclude that scientific understandings of meditation need to expand beyond the simplistic view of them as a (mental) health promoting, self-regulating technique.

What kinds of negative effects can occur?

A qualitative study on Buddhist-derived meditation techniques in a Western context provides an overview of the sorts of effects which are often underreported in the mindfulness literature. The researchers found that of those who had experienced negative effects from meditating, levels of distress and functional impairment ranged from minimal and transient, to severe and enduring. They broke these effects into seven groups:

1. Cognitive

Inability to concentrate, the disconnection of percepts and concepts. Having a racing mind, unpleasant vivid imagery, delusions, irrationality, or paranormal beliefs.

2. Perceptual

Hypersensitivity to light, sound, or sensation, hallucinations, disillusion or distortion of perception, derealization, illusions.

3. Affective

Increased emotionality or the flattening of emotions, fear, anxiety, panic. Paranoia, changes in doubt and faith, self-conscious emotions like guilt, shame, or pride. Re-experiencing traumatic memories, involuntary crying either in response to sadness or for no reason. Increased agitation, irritability, anger, depression. Some meditators and experts even described experiences as ‘mania’ or ‘psychosis’, although these terms were not used by the researchers in their coding.

4. Somatic

Dizziness, gastrointestinal distress, cardiac irregularity, breathing irregularity. Fatigue, headaches, sexual issues, loss of sleep, insomnia, nightmares, lucid dreaming, (unwanted) loss of appetite. Temperature regulation issues, pressure, tension, and pain which becomes more acute over the course of contemplative practice. Feeling of electric shocks to the body when reliving traumas, sometimes with involuntary body movements.

5. Conative

Loss of desire for activities one previously enjoyed. Loss of motivation to pursue goals, negative changes in social and occupational behaviours.

6. Sense of self

Loss of sense of ownership and agency, loss of the sense of basic self.

7. Social

Difficulties reintegrating after attending a retreat or intensive practice. Difficulties at work. Feelings of estrangement or rejection from meditation community (especially when experiencing changes in worldview or doubt in faith), relationship problems.

Of course, this study only looked at mediators who have had negative experiences, and meditation was also reported to have positive effects in each of these domains.

As self-report data from a relatively small group (60 practitioners) it’s difficult to conclude whether meditation caused or exacerbated these issues. Nevertheless, it is obvious that meditation is not a universally pleasant experience for all. Nor is it a cure-all. And it is vital for studies on mindfulness to take potential negative effects such as these into account.

Additionally, not all types of meditative practices are appropriate for people with physical limitations. In conclusion, the NCCIH recommends “Individuals with existing mental or physical health conditions should speak with their health care providers prior to starting a meditative practice and make their meditation instructor aware of their condition.” And herein lies the crux of the issue: It’s a pretty solid bet that most people seeking mindfulness have some sort of mental or physical condition prompting them to do so. And many choose apps as a way of avoiding stigmatised discussions of mental health.

Why meditate?

The American Mindfulness Research Association reproduces statistics from a 2012 National Heath Interview Survey to investigate who uses mindfulness meditation and why.

Mindfulness meditators were more likely than average to be white, highly educated women. They were more likely to engage in regular exercise, less likely to be obese, and less likely to report chronic heart diseases. All of which we might expect based on the demographic.

But here’s where it gets interesting: meditators were also more likely to smoke than non-meditators. More likely to report aches and pains. More likely to report mental disorders. Far more likely to report nervousness. More likely to report sadness, and stress. And far more likely to report suffering insomnia.

A perfect storm

Does this mean meditation causes mental disorders, anxiety, and trouble sleeping? Of course not! But it definitely suggests that people dealing with addiction like smoking, with physical ailments that cause them aches and pain, or with depression and other mental conditions are probably more likely to seek out meditation.

Mindfulness apps and other online services, then, would appear particularly problematic. Especially as their appeal has grown thanks to the perfect storm of COVID-19 causing people to seek alternative treatments to avoid overburdened medical practitioners, social distancing restrictions closing many traditional avenues, and an increase in worries for most people, including financial woes, which may prompt people to look for more affordable alternatives.

Adverse effects, some say, may be the result of “improper use” of meditation, prompting the NIH to recommend mediators “ask about the training and experience of the meditation instructor”. But when downloading an app, there is no instructor to notify of your existing conditions, nor any ability to question the qualifications of those who programmed it.

Mindfulness as avoidance

Aside from potential adverse effects from the meditation itself, meditation can also be problematic when used as a way to avoid facing ongoing problems or emerging crises. Rather than using meditation to escape, mindful attitudes should be applied to actively engage with life problems. Yet this may be difficult given the number of meditators who report difficulties transitioning from particularly intense meditation to ‘the real world’. Clearly, other strategies are needed in our mental and physical health toolkits. For this reason, the NIH recommends meditation not be used as a replacement for conventional health care.

So what of the mediator who killed twelve people? Dr. Farias asked Swami Ambikananda what she thought. Did his killing have anything to do with meditation? “I don’t know” she responded. “I don’t dispute that he had serious mental health problems; but meditation probably didn’t help him either. Meditation is about looking into the abyss within. It wasn’t created to make you or me happy, but to help us fight the illusions we have and find out who we truly are.”

And this is perhaps the most interesting part of the issue: As Assistant Professor of psychiatry and human behaviour Dr. Willoughby Britton says, “Ironically, the main delivery system for Buddhist meditation in America is actually medicine and science, not Buddhism”. As a result, says Tomas Rocha in The Atlantic, in an article describing the experiences of people who feel they were “permanently ruined” by meditation, many people think of meditation and mindfulness simply as a way to reduce stress and enhance executive skills. Meditation exists, he contends most believe, to reduce stress and increase labor productivity “because that’s what Americans value”.

Mindfulness for productivity and profits

As Dampier points out, “Perhaps most controversial in the long list of mindfulness’ claims to do good is the claim that promoting mindfulness among workers will increase their output, thus leading to healthier profits”. Dampier cites evidence of this in examples such as the Google-spawned Search Inside Yourself Leadership Institute. Professor of religious studies Jeff Wilson says “if you look at it from a Buddhist meditation standpoint, you shouldn’t be so concerned about how well your company is doing because that’s not an important question in the universe.

In fact, one recent study seems to prove this, showing that mindfulness meditation might make people feel more focused, but it also damages their motivation through a sense of detachment. This results in a wash – no change to task performance.

This focus on productivity and work has narrowed the scientific scope. When researchers develop hypotheses around meditation, the questions that are acceptable to ask (that is, those that they can get funding to study) are those which promise to deliver the answers we want to hear.

“Does it promote good relationships? Does it reduce cortisol? Does it help me work harder?” asks Britton, referencing these more lucrative questions. Because studies have shown that meditation does satisfy such interests, the results, she says, are vigorously reported to the public. “But,” she cautions, “what about when meditation plays a role in creating an experience that then leads to a breakup, a psychotic break, or an inability to focus at work?”

The economics of the mindfulness movement

There is a lot at stake – economically as well as mentally – when it comes to the mindfulness movement, says Rocha. Meditation was not developed to enable us to stare comfortably at our computers for hours. Nor to help us get in the zone and climb the corporate ladder. And it can lead to some pretty painful, dark experiences. The Buddhist meditation teacher Shinzen Young blogs:

Almost everyone who gets anywhere with meditation will pass through periods of negative emotion, confusion, [and] disorientation…The same can happen in psychotherapy and other growth modalities. I would not refer to these types of experiences as ‘dark night.’ I would reserve the term for a somewhat rarer phenomenon. Within the Buddhist tradition, [this] is sometimes referred to as ‘falling into the Pit of the Void.’ It entails an authentic and irreversible insight into Emptiness and No Self. Instead of being empowering and fulfilling…it turns into the opposite. In a sense, it’s Enlightenment’s Evil Twin. This is serious but still manageable through intensive… guidance under a competent teacher. In some cases, it takes months or even years to fully metabolize, but in my experience the results are almost always highly positive.

Dark nights

Britton’s findings, Rocha goes on to state, appear to corroborate these claims. Among the nearly 40 ‘dark night’ subjects her team interviewed, most were “fairly out of commission, fairly impaired for between six months [and] more than 20 years.” Something subscription and ad-supported apps and expensive retreats never mention in their glossy promises, nor are they equipped to deal with or support people through such crises.

Yet even Britton finds that she is challenged by the notion that mindfulness might not be all we want it to be:

“I understand the resistance,” says Britton, in response to critics who have attempted to silence or dismiss her work. “There are parts of me that just want meditation to be all good. I find myself in denial sometimes, where I just want to forget all that I’ve learned and go back to being happy about mindfulness and promoting it, but then I get another phone call and meet someone who’s in distress, and I see the devastation in their eyes, and I can’t deny that this is happening. As much as I want to investigate and promote contemplative practices and contribute to the well-being of humanity through that, I feel a deeper commitment to what’s actually true.”

Language and money

In essence, I see two big issues affecting mindfulness research. One of which is linguistic, and one of which is economic:

First, the slippery use of terminology.

The term ‘mindfulness’ is still relatively poorly and inconsistently defined. Many studies and practitioners and products do not specify what type of ‘meditation’ they are using. Even when they do, there’s no guarantee it will mean the same as when someone else uses the same words. Terms like ‘gratitude’ and ‘prayer’ and even ‘thought’ may be used interchangably.

To determine what types of practices might be beneficial for what types of people and problems, and which we may need to avoid, we have to start off by clearly defining terms. More precisely defining terms will also help to avoid the unwarranted positive bias many of us have towards words like ‘mindfulness’, and prompt us to look more critically at claims.

Secondly, more government funding is necessary for research.

In particular, randomised control trials, and researchers must be required to monitor negative effects. If practitioners believe meditation is powerful enough to affect the body and mind, it is only reasonable to assume that there may be negative as well as positive side effects, and we must know what they are in order to mitigate, manage, or eliminate them. Obviously, app developers and luxury retreat owners can’t be trusted to fund bias-free research on a multi-billion dollar money-spinner.

If you’re considering mindfulness meditation, here’s a list of suggestions:

  • think carefully about what you’re hoping to get out of it
  • talk to your doctor first, especially if you have any physical or mental conditions that may be worsened by practice
  • choose your instructor or method carefully – and don’t be afraid to change if something doesn’t feel right
  • monitor any unpleasant experiences you have
  • consider talking to a friend or family member about your journey, so they can look out for you too

Have you tried mindfulness meditation? Let me know your experiences – positive or negative. Is it worth the money?

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