Dark Nights, Spiritual Crises and Psychotic Breaks: The Side Effects of Meditation
Meditation is often considered calming, relaxing and helpful for stress. As a result, it is now widely recommended by therapists and doctors for various purposes. Sam Harris even referred to Buddhist enlightenment as “the epitome of stress reduction”, but I feel the reality may even be the opposite of this claim.
I believe everyone who meditates for long enough will almost certainly develop at least moderate side effects from it, and even serious harm is quite common. My own issues have been mostly relatively mild, but I have watched friends writhing in pain, trashing around, rolling on the ground, involuntarily screaming, crying uncontrollably, going into psychosis and other symptoms that have been shocking to witness.
Three contemporary authors in particular have been documenting the adverse effects of meditation. Daniel Ingram, who is also a medical doctor, has focused on the Progress of Insight in his book Mastering the Core Teachings of the Buddha. David Treleaven writes about the interactions between meditation practice and trauma in Trauma-Sensitive Mindfulness and some academic papers. Willoughby Britton and her research group at Brown University have looked more widely at different types of harm.
That spiritual practice can cause difficulties is nothing new, of course. Most Buddhist traditions discuss this at least in passing. The famous transpersonal psychologists Stanislav and Christina Grof coined the term “spiritual emergency” in the 1980s and wrote a book titled Spiritual Emergency: When Personal Transformation Becomes a Crisis. The Zen master Hakuin wrote of Zen sickness back in the 18th century. Yet the public discussion on mindfulness still neglects this aspect.
One of the most important papers on the side effects of meditation was published by the Brown University research group in 2017. They only interviewed people who had reported serious adverse effects and concluded e.g. that “Meditation-related adverse effects that were serious or distressing enough to warrant additional treatment have been reported in clinical and medical literature. These include reports of meditation-induced psychosis, seizures, depersonalization, mania and other forms of clinical deterioration.” (1)
In that paper, it’s also interesting how the time range of the appearance of marked adverse effects varied from one day to more than ten years, the latter even applying to 25% of the respondents. On the other hand, 12% reported harm within the first 10 days of practice, so it was also quite common to experience harm almost immediately.
The field of Western psychology has generally neglected to report on the side effects of non-spiritual practices as well, simply focusing on their benefits, as has happened with psychotherapy research. The same has unfortunately applied to meditation, contributing to the idea of its harmlessness. “First, the vast majority (>75%) of meditation studies do not actively assess adverse effects; instead, they rely solely on patients to spontaneously report any difficulties to the researchers or teachers. However, patients are unlikely to volunteer information about negative reactions to treatment without being directly asked due to the influence of authority structures and demand characteristics.” (1)
There are differing opinions on whether severe side effects of practice are unavoidable or a sign that you’re doing something wrong. This, of course, is not a falsifiable claim, as one can always claim you must be doing something wrong, or you wouldn’t be experiencing these symptoms. No type of meditation is free of risk, but dry insight practices like noting have been claimed to be particularly risky. David Treleaven warns that even though body scanning can sometimes be helpful in trauma healing, he feels it’s also among the most potentially destabilizing practices. (2)
I strongly suspect that The Mind Illuminated practices are especially risky. Most people I’ve known in real life who practiced TMI developed severe side effects, including multiple cases of psychosis. Several of these people had been safely practicing other types of meditation for a long time and felt that the forceful focus TMI has on the unification of the mind, which can exacerbate traumatic dissociation, was heavily related to their difficulties.
There are several possible causes of the adverse effects from a materialist point-of-view. “Meditation can cause symptoms of hyperarousal (anxiety, panic, traumatic-re-experiencing, perceptual hypersensivity) through multiple pathways, including sensitization, somatosensory amplification, dual process theory, and relaxation-induced panic.” (3) However, some phenomena may not explainable by neuroscientific perspectives alone.
Personally I would divide the side effects of meditation into six categories, even though they aren’t fully distinct. Multiple things may be going on at the same time and it may not always be clear which category a particular symptom belongs in, as physical ailments tend to be tied to the insight stages and so on. This classification, like classifications often are, is incomplete and oversimplified.
- Physical symptoms, often called kundalini symptoms
- “Dark night of the soul” and other insight stages
- “Energy stuff” (purifications, processing trauma somatically)
- Dissociation either worsening or lifting
- Increased rumination (e.g. worsened anxiety, depression or OCD or increased awareness of physical illness or bodily processes)
- Downsides of the intended effects of meditation
Much wider categorizations have been used by some, e.g. in the field of transpersonal psychology. Monica Goretzki lists several additional categories of spiritual crises, many of which aren’t directly related to meditation, in her thesis “The Differentiation of Psychosis and Spiritual Emergency”, such as “the shamanic crisis”, “the crisis of psychic opening”, “the past-life experience”, “the near-death experience” and “spirit possession”. (4)
Kundalini Symptoms
Kundalini refers to a concept of “life force” energy that is central to Hinduism and Tantric Buddhism. It is considered to normally lie dormant at the base of the spine but can be “awakened” from there. Other schools of Buddhism do not have such a concept, but people practicing in those traditions can also experience kundalini symptoms.
Many Internet resources abound that discuss a number of symptoms of “kundalini awakening”. They often include a combination of physical complications but also a number of ecstatic spiritual/religious symptoms, such as ESP, spontaneous whole-body orgasms and the body spontaneously adopting yoga poses. Among people I know, the effects have mostly been more mundane, and in general the deeply spiritual symptoms often characteristic of the initial stages tend to give way to a different set of more chronic ailments.
Kundalini is particularly associated with effects that are subjectively described as feeling like “energy”, such as tingly, prickly and electric sensations, jolts and crackles and experiences of powerful energy rising up through the spine. The Brown University research group has conducted a very interesting study on this calling them “ELSEs” or “energy-like somatic experiences” to avoid the pitfalls of the kundalini framework. (5)
Other common physical symptoms include e.g. fasciculations, trembling, muscle pain and tension, kriyas (involuntary movements), insomnia, exhaustion, flu-like malaise, irritability, stomach upset, pimples and various skin rashes, eye irritation, nasal congestion, hot and cold flashes, migraines, changes in libido and lymph node swelling. Less commonly there may be vomiting, urinary retention, fever, vocalizations and hallucinations. Periods and the menstrual cycle can also be affected.
Some of these symptoms that seem like allergies (like nasal congestion) do appear to be essentially allergic in nature. Quite a few people I know have reported new symptoms of allergy or allergy symptoms that are associated with practice and that respond to antihistamines. Many sources, though most of them questionable in veracity, also suggest a link between kundalini and histamine. (6)
One thing that must be emphasized when we talk about symptoms that are caused by energetic or psychological reasons is to not assume causation too hastily. For example, some practitioners are used to a bizarre variety of energy symptoms that may change on daily basis and they are likely to attribute any new symptom to such a cause. This can be dangerous if a medical condition is missed, or at least cause major discomfort that could have been avoided.
For example, vitamin B12 deficiency is common and it can cause tingling and other paresthesias — as well as numerous other symptoms — and is easily treatable, so it would be unfortunate to miss. Even in the pandemic, some people have reported symptoms that to me sound very suspicious of COVID, yet have concluded it must be just energetic.
One common question about kundalini is whether these symptoms, which can be intense and scary, can even be dangerous or cause damage to the body, and there doesn’t seem to be a clear agreement about this. Obviously indirect harm is possible, such as having an accident because of involuntary movements or sleep deprivation. One Brown University paper mentioned several cases where adverse effects from meditation impaired the ability to drive, including one actual incident where the person hit several parked cars. (7)
Insight Stages
The insight stages are a series of stages that everyone is thought to cross during the course of their spiritual practice, though their intensity varies greatly: some people feel they don’t even notice them, for others they are very clear. The most striking insight stage is Arising & Passing Away, commonly shortened to just A&P. If you practice vipassanā (insight meditation), you will probably notice how sensations arise and then pass away, but A&P tends to be an intense, profound experience and its other aspects often still dominate. An A&P can last from seconds to months, though from a few days to a few weeks seems to be the most typical.
People in an A&P can resemble someone having a manic episode or even psychosis. They tend to feel great and energized and naturally wake up after 5–6 hours of sleep feeling refreshed. Their sexuality may be greatly elevated and they may report experiences that sound uncharacteristic or even unbelievable. All of these sound typical of a manic episode. There are also many other possible symptoms, such as seeing colorful lights when meditating and vivid dreams featuring spiritual or supernatural themes, colorful lights or vortices of energy.
Besides resembling mania or psychosis, A&P can sometimes also lead to them. “In other cases, intense positive affect did not alternate with low arousal states, but instead escalated into destabilizing conditions resembling mania and psychosis, which often required hospitalization.” (1) Sometimes an A&P can happen spontaneously, without any spiritual practice, e.g. in a life crisis. Even if it feels pleasant, the mania-like intensity can make it terrifying, if the person has no idea what’s going on.
The term “dark night” originates from a Christian mystic St. John of the Cross, who was having a hard time with his practice in the 16th century. More recently it has become widely used in Buddhist circles. In the context of the insight stages, it’s synonymous with the dukkha nanas (knowledges of suffering), a sequence of stages that can feel very rough (or, if you’re lucky, only mildly unpleasant). However, others use the term only to refer to highly distressing and perhaps especially existentially wrenching phases of spiritual experience, whether experienced during the dukkha nanas or not, when I would be more likely to use a term like spiritual crisis.
The dukkha nanas kick off with a stage called Dissolution, which can feel a lot like low-grade depression: you’re tired and feeling low and everything feels a bit drab. It’s followed by Fear, which tends to have the jittery “fight or flight” consistent with fear, while actual fears may or may not be present. Sometimes really bizarre fears can arise at this stage.
The stage of Misery is usually not nearly as bad as its name suggests. It’s followed by Disgust which can feature some physical nausea or revulsion, but also more existential aspects. These can make it hard to differentiate it from the next stage, Desire for Deliverance, which can vary from very mildly unpleasant to nerve-wracking desire to get away from everything.
If Misery has a misleading name, so does Reobservation, just in the opposite direction. It can last anywhere from minutes to years. The first phase of Reobservation can feel like sadness, depression, anger and trauma blending into agony, often with severe fatigue and sometimes also flu-like symptoms or paranoia. Everything feels unpleasant, intolerable and off. The latter part of Reobservation tends to feel like exhausted relief. There is no known way to get “out” of the progress of insight, one can only practice to get through the dark night and end up at a much more serene stage called Equanimity.
“Energy stuff”
“Energy stuff” is a very nonscientific term that most of my friends use, typically in the context of “I have energy stuff coming up”. This generally isn’t the same as experiencing “kundalini symptoms”, but something more akin to how the term “purification” is used in some schools of Buddhism. Some people also call this “cleansing the energy body”. It just sounds much less clunky and pompous to say “Could we maybe talk about this a bit later, I have energy stuff coming up really badly?” than talk about purification and cleansing. Also, I’m not a huge fan of good/bad-focused terminologies involving things like “purity”.
So what is this “energy stuff? A poorly definable phenomenon that different people describe and experience differently, but generally it refers to strong emotions thought to be related to past trauma coming up both psychologically and in the body with the sense that they can’t be avoided and need to be processed. Sometimes it is related to something going on in your life, but often it comes randomly, out of nowhere.
I have also included “energy stuff” separately from other manifestations of trauma. Typical of energy stuff is that new stuff bubbles up almost constantly, it feels pretty much unavoidable and impossible to suppress and it tends to be heavily somatic — sometimes it’s only experienced in the body with no mental aspect. These experiences tend to be accompanied by symptoms like exhaustion, bodily pains, migraines, muscle tension and kriyas, feeling hot and cold, changes in body temperature, sometimes also outwardly visible signs like skin rashes or a runny nose.
The intensity of energy stuff also seems to have a strong correlation with how much the person dissociates. In one small study of practitioners of Tibetan Buddhism reporting mainly energetic and emotional symptoms, “While some practitioners viewed these experiences in relation to a normative Tantric soteriology of purification, almost all practitioners with a trauma history reported traumatic re-experiencing and tended not to adopt a purification framework.” (8)
Rumination, Trauma, Dissociation and Psychosis
Especially developmental trauma, encountered in early childhood, often leads to dissociation: trauma is “split off” from the consciousness so as not to feel unbearable. This provides an important survival mechanism particularly in cases of continuing maltreatment, e.g. living with abusive or neglectful caregivers. Often people who dissociate manage to convince themselves they don’t really have trauma, as it’s blocked out. However, nearly 10% of the general population struggles with severe dissociation (9), so this is not a marginal problem. I suspect that in spiritual circles the percentage is much larger considering that trauma is a common reason to seek out relief in spirituality.
Meditation can have a pronounced effect on dissociation, either making it worse or lifting it. I’ve had several people confide in me that they realized their practice mostly consisted of dissociating. One of them was still convinced that if he just continues to do more of his practice (of dissociating), it will fix the dissociation. Increased dissociation can also be confused with attaining meditative goals with a reduced sense of self, this also seems to be quite common.
The latter possibility, dissociation lifting, may sound like a positive occurrence, but dissociation is a protective mechanism that exists for a reason. When important safety barriers are pulled down at once, it can lead to overwhelm by trauma, potentially resulting in severe destabilization or an acute crisis. I suspect this is the main cause of severe spiritual crises where people even become suicidal.
Dissociation may be hard to catch, and people may have suffered from severe dissociation without having sought mental health care (or only sought it for temporary depression or anxiety, which does not appear alarming). One person I knew who developed psychosis on a retreat had admitted on the intake form that he dissociates, but was still allowed to attend. An article in the Buddhist magazine Tricycle recommends and I concur: “If you are suffering from severe depression, anxiety, or PTSD, it is probably not a good idea to join an intensive retreat. Try meditation classes instead, or a one-day or non-residential weekend retreat.”(10)
Meditation is unfortunately well-known for causing psychoses and they hardly seem rare — I know half a dozen cases even among friends I’ve met in real life. Sometimes psychoses or psychosis-like episodes only last minutes, but in several cases I know, they endured for more than six months. Some of these people have also had severe mental health problems like bipolar disorder, while most hadn’t. Psychosis is often connected to kundalini phenomena, though several of these people had no discernible kundalini symptoms at the time. Pretty much all of them, however, have had severe dissociation before the psychotic break.
Most of the psychotic breaks featured paranoia, as psychoses usually do, but in several cases, the most prominent feature was delusions of grandeur. A&P is a common time for people to get psychotic, especially with the delusions of grandeur, while paranoia tends to hit in the dark night. Antipsychotics are not pleasant drugs at all and can have serious side effects, but sometimes they may be necessary as otherwise there may be a threat to life, other people, employment or important relationships.
Stanislav and Christina Grof listed some factors to tell spiritual crises apart from psychosis: those having a spiritual crisis tend to be “much more objective about their condition, communicate and cooperate well, show interest in sharing their experiences with open-minded people, seldom act out”. (11)
Excessive rumination and obsessive focus on mental and bodily sensations can be a feature of e.g. depression, anxiety, OCD and neurodivergence. Some studies have pointed out the propensity of mindfulness meditation to sometimes help these traits while making them worse in some individuals. Occasionally these tendencies can worsen to a highly distressing extent, like the person developing a constant hyperawareness of interoceptive bodily sensations which may be similar to what has been called sensorimotor OCD.
Dark Sides of Intended Effects
In some Prajnaparamita (Perfection of wisdom) sutras central to the Mahayana Buddhist canon, there are depictions of people vomiting blood and having heart attacks simply because they heard the Buddha talk about emptiness. (12) In the highly disturbing Vesali sutta (SN 54.9), sixty monks succumb to self-destruction after the Buddha got them so disgusted by their own bodies. Luckily these kinds of things are not likely to pose a risk in modern times, but Buddhism didn’t develop as a relaxation practice for stress relief, but to dismantle some very core ideas about reality.
It is important to keep in mind that even when everything goes well, when you manage to dodge heavy dark nights and bizarre physical symptoms, meditation in itself is disorienting and destabilizing. It is meant to deconstruct parts of your cognitive structure, and what the process actually feels like is unpredictable. These changes are largely permanent, and while most people like them, not everyone does, and they can be harsh. Your worldview and interpersonal relationships might also be drastically affected.
In the Tricycle article, meditation teacher Daniel Lawton details the experience he had on his 15th or so retreat that caused PTSD and led him to quit his own practice. “Intensive meditation has to some extent changed the way that I experience the world, and some of those perceptual changes just don’t feel very good.” (10)
Meditation doesn’t give you perfect clarity or insight, but it does give you a lot of clarity. Clarity can be great, but many times it’s very unpleasant and can’t be undone. Especially if you’ve been suppressing things about your life, you might discover that you simply have to end your relationship, change careers or carry out another drastic life change, no matter the fall-out. Or as happened to me, you might discover how painfully your life feels “off” and unaligned without any opportunity to change it, which is a wrenching experience. (Privileged people often forget how common this is.)
How to Reduce Harm
With severe adverse effects, having a break in practice can help or even be unavoidable. However, with some types of unpleasant symptoms, this may not provide relief, as they are not so much about the active practice, but a process that keeps running whether you practice or not. In the case of dark nights, meditation can actually be helpful as it greatly increases the chances of getting past them.
The Brown University paper notes: “For example, lack of sleep, inadequate diet, and lack of exercise tended to be associated with (or preceded) destabilizing experiences, and could be corrected as remedies by increasing sleep amount, making dietary changes, or getting exercise, as well as by engaging in other activities described as grounding, calming, or embodying.” (1) This can be particularly tricky in a retreat setting, which often involves little sleep and traditionally only two meals per day eaten before noon. In case of severe adverse effects, many teachers recommend a grounding diet, such as meat and other heavy foods, even drinking alcohol.
The same paper also suggests: “For certain symptoms in the somatic domain, body-based healing regimens (such as massage, acupuncture, or healing techniques that manipulate the subtle “energy” of the body) were also attempted and reported as helpful by some but not others.”
Seeking help for the side effects of meditation can be tricky, as the vast majority of medical practitioners and mental health professionals have no idea what is going on and the symptoms will likely be misdiagnosed. Altered states have a long history of being pathologized in the West as mere signs of mental disturbances. (13) I know people who have experienced this concretely with deeply traumatic consequences.
In general, having the chance to talk openly about the experienced harm would be very important. In several articles and papers about the adverse effects of spiritual practice, people who had experienced such harm were disturbed that they weren’t allowed to discuss it, e.g. because their Theravada or Zen teacher told them that kundalini awakening doesn’t exist and so they should just stop having these symptoms.
Willoughby Britton’s team has compiled a Meditation Safety Toolbox for teachers, which includes material about e.g. screening tools, informed consent, monitoring and the effects of trauma on meditation practice. The page also has a three-hour and 20-hour paid training courses available on the subject.
This article also appears in modified form in my free book Loving Awakening: A Practical Guide to Embodied Spirituality and Healing with Metta, IFS, the Imaginal and Community, which goes deep into both the benefits and downsides of spiritual practice and inner work.
References
1. Lindahl JR, Fisher NE, Cooper DJ, et al. The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in western Buddhists. PLOS ONE. 2017;12(5).
2. David A. Treleaven. Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing. Norton 2018.
3. First Do No Harm: Foundational Competencies for Working Skillfully with Meditation-Related Challenges. https://www.cheetahhouse.org/fdnh
4. Goretzki M. The Differentiation of Psychosis and Spiritual Emergency. PhD thesis. University of Adelaide, Adelaide. 2007.
5. Cooper DJ, Lindahl JR, Palitsky R, et al. “Like a vibration cascading through the body”: Energy-like somatic experiences reported by Western Buddhist meditators. Religions. 2021;12(12):1042.
6. Biology of Kundalini — Histamine. https://www.biologyofkundalini.com/article.php@story=Histamine.html
7. Lindahl JR, Cooper DJ, Fisher NE, et al. Progress or pathology? differential diagnosis and intervention criteria for meditation-related challenges: Perspectives from Buddhist meditation teachers and Practitioners. Front Psychol. 2020;11.
8. Lindahl J. Somatic energies and emotional traumas: A qualitative study of practice-related challenges reported by Vajrayāna Buddhists. Religions. 2017;8(8):153.
9. Sar V. Epidemiology of Dissociative Disorders: An overview. Epidem Res Int. 2011:1–8.
10. Wendy Biddlecombe Agsar. Buddhism’s Biggest Open Secret. Tricycle. Winter 2021. https://tricycle.org/magazine/meditation-sickness/
11. Stanislav and Christina Grof cited in https://www.spiritualcompetency.com/dsm4/dsmrsproblem.pdf
12. Karl Brunnholzl. The Heart Attack Sutra: A New Commentary on the Heart Sutra. Snow Lion 2021. pp. 12.
13. Walsh R. Phenomenological Mapping and Comparisons of Shamanic, Buddhist, Yogic, and Schizophrenic Experiences. J Amer Acad Religion. 1993 Winter;61(4):739–769.
