There is an interesting Tucson connection to the Atlantic article, The Dark Side of Mindfulness, and I have several responses to what it says about the dangers of mindfulness practice.

In 2004, a young doctoral candidate in clinical psychology at the University of Arizona, just up the road from us, recruited twenty-six people for a sleep study. Her name is Willoughby Britton. She was a devoted meditator and she was certain, the way we are all certain about the things that have saved us, that she would show meditation improves sleep. She put her participants in a lab overnight and measured their brain waves.

The meditators slept worse. More awakenings. More micro-arousals. More time in the lightest stage of sleep. And the more they had practiced, the worse it was.

She did not publish it. She was confused by the findings and by what they meant for her, and she worried that publishing would mean harming the dharma, criticizing the very teachings that had reordered her life.

I have been teaching yoga, meditation, mindfulness, and MBSR for the entirety of my professional life, and I want to say plainly that I understand that hesitation to bring forward evidence against something so sacred and so hopeful. I also think she was wrong to keep it in a drawer, and she clearly came to terms with that, because she has spent the twenty years since then doing the harder thing.

What the research now shows

Britton eventually published, and then she and her colleague Jared Lindahl did something almost nobody in our field had done: they asked meditators what had gone wrong. Their 2017 study, “The Varieties of Contemplative Experience,” and the body of work that followed it, tell us roughly this:

Something like one in ten people who take up meditation experience an adverse effect. The most common are fear, anxiety, panic, or paranoia, along with shifts in motivation so pronounced that practice stops feeling like practice and starts feeling like drifting. In her data, the difficulties lasted a median of one to three years. Other research groups, working independently and often from a firmly pro-meditation position, land in the same neighborhood: nine percent, thirteen percent, a quarter reporting at least one particularly unpleasant experience.

These are not, mostly, people who arrived with a psychiatric history. Many of them are high achievers, which is the finding I find most instructive, and I’ll come back to it.

The strongest single signal in the data is dose. More time on the cushion, more difficulty. Britton puts the practical threshold at about thirty minutes a day. Beyond that, the risk curve begins to bend. The other strong signal is intensive retreat: somewhere between half and three-quarters of the people who come to her nonprofit for help began having symptoms after one.

There is more I will say about dose and intensives at the end.

Why none of this should shock us

Here is what I feel is important to emphasize. The mindfulness traditions of the East knew about this, and they had ways of understanding it and working with it. We are the ones who have been experimenting with it, removing it from its context.

The Satipatthana Sutta, one of the key texts on the practice of mindfulness, is not a stress-reduction protocol. It is a set of instructions for dismantling your relationship to your own experience, for the greater goal of lessening or ending suffering. Pierce Salguero, a historian of Buddhism and medicine quoted in the article, points out that an eighth-century Chinese text has the Buddha warning of fifty “demonic states” that a contemplative can become trapped in: hallucinations, sorrow, anxiety, suicidal thought. “Meditation sickness” is not a modern Western complaint. It is old enough to have a literature.

What is new is the delivery system. What was once a specialized practice, undertaken by people who had renounced ordinary life, supervised closely by someone who had gone that way before, is now framed as a commodity or an experience one can simply have on one’s own terms. I have been part of mainstreaming mindfulness meditation and practice, and I have great regard for the teachers and the teaching I have received, from both the secular and the Buddhist perspectives. And context and container, wise and caring support, mean a good deal more than we sometimes afford them.

Also, concentration practice is stimulating. That is the whole point of it. It is not a sedative. When we sit for long periods on our own, or choose to attend a retreat, we can find ourselves vacillating between checking out and freaking out. There is a line from the writer Anne Lamott: “My mind is a bad neighborhood I try not to go into alone.” So yes, the challenge to nervous system regulation with intensive practice is very real.

The part that is our responsibility

The hardest passage in Khazan’s article is not about neuroscience. It is about teachers.

Over and over, the people in Britton’s studies brought their symptoms to a teacher and were told: It gets worse before it gets better. What you resist persists. Everything arising is an opportunity. One teacher, asked why his dharma books never mentioned any of this, is reported to have said: Well, it’s not good advertising. When Britton described her own dissociation, months of feeling like a bird perched on her own shoulder, of walking into a creperie and thinking oh my God, I forgot that I am a person, she was congratulated. She had seen the truth of no-self. She should keep going. She did, and it got worse.

Britton calls these responses thought-terminating clichés: statements so unanswerably wise-sounding that they end the conversation.

I have probably said versions of some of that in the classroom, hopefully in the attempt to normalize a fuller range of present-moment experience, rather than as encouragement toward the insight of no solid self. That is not my purview.

There is the reality that meditation disrupts the status quo. Discomfort is often the doorway, and equanimity toward what arises is the practice. That is what we aim to communicate and fortify. The trouble is that a true teaching used to close a student’s mouth becomes a false one. And when the only diagnostic tool a tradition has is “keep practicing,” it cannot tell the difference between a student who is working through something and a student who is being set back.

Which brings me back to the high achievers. I think the reason so many of Britton’s harmed meditators hold graduate degrees is that they had been rewarded, their whole lives, for overriding the signal that something is wrong. They came to meditation and they tried to ace it. Meditation is not supposed to be about achievement, and yet it sneaks in again and again and again, for teachers and students alike.

Also, what a lot of teachers were missing in the early romance with mindfulness were the equally important trainings in compassion and self-compassion, along with the evolving understanding of trauma-informed teaching. These are things that are better understood and better integrated now than they once were.

Six things I want to say to our community

1. The research indicates that more than thirty minutes can be activating. In our Mindfulness Based Stress Reduction curriculum and on many modern retreats, forty-five minutes is often used as a typical period. In the right context this has value, but in the reality of your personal practice, always adjust to what is tolerable, doable, and leaves you with a generally positive feedback loop.
2. Different practices do different things to different nervous systems. In Britton’s work, noting practices (labeling thoughts and sensations) skewed toward anxiety, while sustained breath-anchor concentration skewed toward low mood. If you are already exquisitely attuned to every sensation in your body, a body scan may not be your medicine right now. Come talk to us about a different practice. This is precisely what our individual mindfulness coaching sessions are for.
3. A long retreat with an experienced leader is a great gift, and you have to be ready and have your own sincere intention. I go on retreat to unwind and unplug, and to get a clearer sense of how I can meet life with care. In MBSR we train people for six weeks to be able to endure a “Day-Long Retreat.” It can be a lot for people, but it can be the turning point too, where they feel both a deeper calm and a willingness to ride the waves of their moment to moment experience. It is also a good group experience, being together but not socially on. This may be enough. Multi-day meditation retreats are not needed in order to apply mindfulness well in life.
4. If your practice is going badly, tell someone, and tell someone who will actually listen. Say it to me. Say it to your teacher. Say it out loud in the room. If the answer you get is only keep sitting, get a second opinion, and know that asking for one is not a failure of faith or of understanding.
5. You are permitted to stop. Britton says many of the people who come to her seem relieved when she tells them it is okay to stop meditating. Her framing is characteristically blunt and I think it’s right: treat meditation like a relationship. If you consistently feel worse with that person, maybe it’s time to break up, or at least to spend some time apart. A balanced practice has an enormous toolkit. Movement, breath, mantra, chanting, singing, dancing, service. Walking in the Rillito in October. Prayer. Sleep. Contemplative practice is a very large house, and the silent, still room is only one room in it.
6. Bring a professional in when a professional is needed. Dissociation, depersonalization, intrusive imagery, and psychosis are clinical events, not attainments. Yoga and mindfulness practice sit alongside good clinical care beautifully. They do not replace it, and we will always tell you so.

The middle way, again

Khazan ends her piece where I would end it. The Buddha’s first teaching after his awakening was not a technique. It was a warning about extremes: against indulgence on one side, and against austerity so severe it immiserates you on the other. Avoiding these two extremes, the Realized One understood the middle way of practice.

We are, culturally, in an era of contemplative maximalism. More minutes, more days, more silence, longer retreats, higher states, and a quiet competitive hum underneath all of it. Britton’s twenty years of unpopular research are, read generously, an empirical rediscovery of the middle way. She paid an enormous price to hand it back to us: she lost the community that had been her whole life, and she no longer meditates at all. She takes care of her plants and chops wood in Vermont.

There is something in that image I find true and beautiful. The article mentions the example Britton’s parents set for her, that a person should find a problem nobody is solving and embrace it as their niche. She did, and I for one am grateful. I still think of her as a Tucsonan, and this city’s practice community is part of what her work came out of.

I love the practice. I love the teaching. I believe in this work with my whole heart, and I believe the benefits are real because I have watched them arrive in real bodies in this building for years. Believing that is exactly why I want us to be the kind of practice community that speaks frankly about both the light and the dark sides of the process.

Awareness is like the light of the sun. It reveals what is there. Sometimes what is there is hard, and the practice is to look anyway, and to know the difference between looking at something hard and doing yourself harm.

If any of this is describing your experience, please come find me. We will sit down together, and we will figure out what your practice should actually be.

Ungated reading for the The Dark Side of Mindfulness