Abstract
The word meditation is much used these days, covering a wide range of practices with an ultimate aim of controlling the mind and enhancing psychological health. Altered perceptions, and surfacing of repressed memories and conflicts have been reported during meditation [1]. There have been few reports of precipitation of psychosis in vulnerable individuals [1, 2]. We discuss the possible factors operative in the precipitation of psychosis in two meditators.
Case 1 Mr A, a 20-year-old male, presented with a one-month history of aggressive behaviour, inappropriate laughter and suspiciousness. Examination revealed delusions of persecution and of reference, and auditory hallucinations. Prior to the onset of illness he had been practicing intensive meditation for 4 days without communication of any kind with outer world; he had also been fasting, and sleep had been reduced. There was no previous personal or family history of psychiatric illness. A diagnosis of schizophrenia was made. Treatment with olanzapine was started with good response. The patient discontinued treatment after 3 months and again became symptomatic. Treatment was reinstituted and he responded rapidly.
Case 2 Mr D, a 30-year-old married male, was brought home by his colleagues from a meditation retreat centre as he started to exhibit bizarre behaviour on the sixth day of the retreat. At the time of examination, he appeared to be perplexed and exhibited bizarre religious delusions. His sleep was markedly disturbed. He was hospitalized and treated with risperidone. The final diagnosis was schizophrenia. Reportedly, he had had two previous psychotic episodes, each one after attending the annual religious retreat, and with complete interepisode recovery.
These cases raise the issue of whether meditation can induce psychosis. Fischer [3] described perception– hallucination–meditation on a continuum; creative, psychotic and ecstatic experiences on one end and hypoarousal states of Zazen and Samadhi on the other. Normal persons may travel freely between states [3]. Vulnerable individuals may get stranded at this stage and eventually have a psychotic breakdown, especially under stress. People with a previous history of psychosis have been recognized as more vulnerable to have a psychotic breakdown during intensive meditation [1]. Also, it is arguably not the meditation alone that is causal; the associated fasting, and sleep and sensory deprivation could be other factors contributing towards the precipitation of psychosis. On the other hand, there are data to suggest that meditation in moderation can be helpful in treating a range of psychopathology [4]. Review of the history from the two reported patients, as well as from the their families, did not suggest that these patients were psychologically unwell prior to attending the meditation courses.
Attending meditation retreats is a common and regular practice in northern India. When carried out under proper guidance and in moderation, meditation can enhance psychological wellbeing [1].