Coping with Mental Health Challenges on Retreat

[Many thanks to Daniel for some helpful additions and amendments to this article.]

Insight meditation is the expansion of our understanding of the true nature of experience. This can include aspects of experience that appear unsettling or “unreal” from the perspective of our current understanding. For this reason, meditation can present us with feelings, thoughts, and sensations that are unusual, extreme, and highly challenging.

What follows are some theoretical speculations and practical advice for dealing with experiences of this type. The scientific research in this area is quite sparse, so these ideas are offered on the basis of personal experience only and should not be taken as proven or definitive. Having had to deal with situations described below, and having observed positive results in most cases, it is hoped that the following may nevertheless prove of benefit to others.

The link between psychosis and meditation

In meditation we subject our minds to a degree of pressure, applying sustained concentration upon the moment-to-moment awareness of experience. As we investigate how experience presents itself, we begin to understand how it is different from what we may have supposed.

Mental illness is multifactorial, one cause of which is external pressures beyond our control (for example: traumatic events, or unhealthy relationships) that forcibly cause our sense of self to begin to unravel.

People on retreat sometimes say and do things that are no different from things said and done by persons in psychosis, a term used to describe the state of a person experiencing perceptions, feelings, or thoughts that have no obvious basis in “consensus reality”. However, someone in psychosis on retreat has arrived at that state by participating in a certain kind of environment and choosing to engage with a particular practice. Ceasing that practice, or modifying it, or (should both of those fail) changing the environment in some way, or removing the practitioner from it, are all courses of action that are likely to be both helpful and easy to implement. It is perhaps easier to help someone in psychosis on retreat than someone displaying the same symptoms in daily life.

The specifics will vary wildly, but the following is a rough guide to the kinds of psychotic experiences that may arise for meditation practitioners, though far from a complete list:

  • That something will cease or vanish, or something bad will happen, if the practitioner stops meditating, or that the practitioner for some other reason cannot stop, and so is left in terror of remaining in their currently unbearable state forever.
  • That the meditator has died and is existing now in some kind of dead or unreal state, or that the external environment is instead fake, unreal, or lifeless. This is often referred to as “depersonalization” or “derealization”.
  • That something is wrong with the meditator’s body or mind, and some kind of unusual process (e.g. clearing a “blocked chakra”, or emitting one’s “energies” into the surrounding landscape) is needed to produce a different, healing state, or simply to bring everything back to how it was.
  • Symptoms that may mimic a manic episode, with grandiosity, lack of the need for sleep, radically increased level of arousal, flights of ideas, pressured speech, and the like.
  • That the meditator is now interacting with some sort of spirit, entity, demon, god, angel, disembodied teacher, etc. Not all interactions are necessarily bad, and some might be quite positive, but some clearly can be detrimental to the practitioner and those around them, particularly when involving a sense of attack, possession, hauntings, thought insertion, dark prophecies and messages, or commands to do harmful acts, inflict curses, and the like arise.
  • Paranoia, particularly when coupled with strong delusion, and particularly when it involves projection regarding others on the retreat.

When in the throes of such an experience we may feel terror and bewilderment (except for the more manic forms, which tend to be very compelling for the meditator), and it may also be frightening for the people around us. Retreat organisers too often conclude that an “underlying mental illness” is the cause of such episodes. The assumption seems to be that meditation is purely beneficial and does not cause mental distress, so any problems must lie with the practitioner, and are not the fault of the retreat organisers or of the practices taught.

But perhaps there is a clear and direct connection between insight meditation practice and the list of psychotic experiences described above. They seem to correspond with what is taught in Buddhism as the “three characteristics” of experience. These are:

  1. Impermanence
    Nothing sticks around; everything is always morphing in and out of existence.
  2. No-self
    Nothing has inherent existence; its semblance of being is always the product of forces other than itself.
  3. Suffering
    Wishing things were permanent or had selves goes against reality; whilst we maintain this delusion, we inhabit a place that really sucks.

On retreat, experiential insights into the three characteristics may traumatise the healthy sense of ego in the psychological sense, and thus it will seek to reject them, but this leaves the meditator struggling to process an insight purely within a terrified ego’s frame of reference.

For instance, if the ego is spooked by impermanence, it will insist it can prevent it by refusing to stop meditating, or by concentrating on a specific object in order to prevent it from ever vanishing. Spooked by no-self, taking its current experience as “death” neatly side-steps a more disturbing insight for the ego: that there was never anyone to “die” in the first place. And spooked by suffering, no matter how improbable it might be, the notion of a better state avoids the need to recognise that the actual source of suffering is the ego itself. Also, periods of profound disgust regarding things that one previously didn’t feel that level of disgust for, such as relationships, family members, jobs, careers, projects, and possessions, may arise that can be similarly very disorienting and distressing. Feelings of claustrophobia can also arise, as well as the profound sense that one must simply leave wherever one is, and these can also cause distress and confusion.

Personal psychology versus insight

Insight fails when the ego cannot recognise itself as just another phenomenon among phenomena, as fully subject to impermanence, no-self, and suffering as every other thing. This failure is caused by the triggering of psychological defences, those especially strong stories we use continuously to keep at bay our personal fears and hurts.

For insight to occur, the process we refer to here as “ego” would need to accept something about its own nature that would contradict the stories about itself it has previously used to keep hurt at bay. Depending on the degree of importance attached to these stories by the ego, it would seem that insight is more possible at certain times than at others.

Meditation is a combination of talent and skill. Ideally, the ego becomes flexible enough to allow room for insight whilst remaining robust. The labour of meditation is often focused on developing greater flexibility in this respect, because the ego is usually too rigid at first to allow insight. But sometimes, however, the ego simply proves too fragile whenever insight approaches.

This can be the case from the outset and is perhaps especially likely if a practitioner has a history of trauma or mental health issues. But it also seems to be the case that practitioners may attain insight with few problems, but unexpectedly run into psychological issues or traumas later, which prove an obstacle to deeper levels of insight.

Pragmatic Dharma emphasises incorporating periods of working with experience exactly how it presents, avoiding distraction by the contents of experience or by any of our thoughts and beliefs about it. The meta-cognitive ability to choose either skilful way of working, skilfully working with the content or skilfully working with the bare sensations, is of great value. When someone runs into difficulty on retreat, sometimes switching to addressing the specific stories and the reactions to those stories that are arising can be very helpful. These can provide a handle on what might have been triggered for the person concerned and what might have triggered it, which gives us a better sense of what the practitioner is likely to be thinking and feeling.

If someone’s life is directly at risk, or there is a risk to the lives of others, then police and medical assistance is necessary. But if not, bear in mind that law-enforcement and medical professionals are unlikely to appreciate how meditation can produce extreme but temporary changes in behaviour, and consequently they will not be making any special allowances. A night in a prison cell, or a dose of anti-psychotic medication, may prove even more traumatising to a practitioner in a vulnerable state than an encounter with insight.

Practical advice for keeping safe

Difficulties first appear in the practitioner’s relationship to the rest of the group

Usually distress will initially manifest as withdrawal, but hostility can also be a sign. It is important to check regularly with all members of a retreat how they are feeling and that they are okay. This implies that the retreat schedule allows for periods of social interaction. Although they may make life easier for organisers, and may offer better opportunities for insight to experienced practitioners, retreats that stipulate silence and/or solitary practice present a higher degree of risk than those allowing communication between participants.

The group is a powerful resource

What contributes hugely to a sense of safety and support is feeling surrounded by good, kind people who will come to our assistance if we are in need. As long as these feelings are genuine, it may be comforting and stabilising for a participant to be reminded of this by other members of the group during periods of social interaction. Sometimes, a participant may be fending off insight simply because they fear that fully displaying or expressing certain feelings or behaviours will seem bizarre to others. It is also common and understandable to be embarrassed by such feelings. Making it clear that the group will accept and understand is sometimes all that is needed for the individual to relax and move forwards, often with far less difficulty or disturbance than he or she may have feared.

Agree in advance to accept the advice of the group

It may not be as clear to the person in difficulty as to everyone else that they need to take a break, so having agreed beforehand to concede to the advice of the group is a vital measure. However, if certain kinds of psychological issues are in play – particularly competitiveness, fear of failure, or envy – a participant may still refuse to comply. Talking through these issues with the practitioner, and re-framing the cessation of practice as merely a temporary break to consolidate the impressive gains they have already made, may offer a way forwards. If this also fails then it should be impressed upon the participant that they will be asked to leave, or the retreat will have to be abandoned if they persist, because the group has decided it is unsafe for them to continue. If further opposition is offered and no further solution is found then, sadly, these measures must be enacted.

Put the dharma on hold

Taking a break from practice really means completely taking a break. Engaging someone in difficulty with dharma talk, or any kind of technical discussion of practice, is not conducive to this. Practice has led to distress and so, for now, practice needs to cease. The aim of taking a break is to reconnect the practitioner with his or her everyday sense of self and reality; providing respite, so that the ego can reassemble itself and (possibly, hopefully) practice may resume. There are a range of “grounding” interventions that can assist with this:

Positive bodily experiences

These include: food, rest, simple forms of physical work, exercise, and orgasm. What works best is likely to be whatever sits most comfortably with the practitioner’s usual character and habits. Because they are very likely to make a challenging experience even more extreme, avoid any bodily practices intended for spiritual development, such as pranayama, breathwork, tantric sexual practices, or any form of yoga. Emphasizing attention to the hands and feet can be more helpful than the head, chest, and abdomen if the practitioner is having powerful feeling in those more central areas.

Walks in nature

Depending on the degree of distress it may be necessary to accompany the practitioner, in which case it can be helpful to invite them to describe their immediate physical sensations as you walk together, and to suggest they make physical contact with objects along the way, such as trees, fences, stones, the ground, noticing the breeze or warmth of the sun, etc. The aim is to provide support that is as natural and unthreatening as possible, with a view to enabling the participant to feel safe, accepted, ordinary, and normal.

Contact with family members, offspring, partners, or friends

The helpfulness of this depends upon how healthy, supportive, and stabilising the relationships in question happen to be, but taking time away from practice to talk via phone or video link with persons with whom we enjoy intimate connections can help reinstate a sense of everyday reality and self.

Modifications to practice

This is likely to help, rather than to exacerbate, only in cases where the level of distress is (or has become) relatively mild, and is manifesting not as psychosis but as persistent anxiety or low mood. If a form of vipassana is being practised, it can be revitalising to switch to any form of concentration practice that generates pleasurable bodily sensations, such as anapanasati or “mindfulness of breathing”. Even more grounding and stabilising are compassion-based practices such as metta bhavana or tonglen.

Meditation is not a therapy

Insight meditation produces insight into the true nature of experience. It does not generate solutions to personal psychological issues; meditation usually does not fix these. It is true that sometimes psychological insights and breakthroughs may arise in meditation, but they are unpredictable. That said, insight into the nature of experience may furnish us with wisdom or inspiration to tackle whatever psychological changes are needed to resolve our issues.

When mental health difficulties arise on retreat it may be because insight has not been able to be accepted or integrated, and psychological issues have gained the upper hand. The good news, however, is that sometimes skilful engagement in the right context with psychological stories can relieve meditation-induced distress; in other words, distress experienced as a result of meditation practice, even when it seems severe, is sometimes very amenable to simple, psychological interventions of the kinds described above.

Given the popularity and success of mindfulness-based therapies, this last piece of advice may sound as if it contradicts established truth. But bear in mind that, firstly, the current evidence base for the efficacy of mindfulness therapies applies only to a narrowly-defined range of psychological difficulties [1], and secondly, in the Buddhist literature, mindfulness (sati) on its own is not a sufficient cause of awakening, but requires combination and balance with various other factors.

The potential of mindfulness for producing insight is likely to be much weaker than (for example) kasina meditation, Mahasi-style noting practice, or Goenka-style body scanning, and many other types of practice that specifically aim to produce insight and awakening. The therapeutic effect of mindfulness might even be related to its deficiency in this regard: as described above, grounding activities such as positive bodily experiences and walks in nature both employ mindfulness, not for insight, but as a means of restoring the ego when integration of insight has failed.

Concluding remarks

Most retreats will be happy and rewarding occasions that will not require any of the measures described above. However, the scientific research appears to be beginning to confirm anecdotal reports that meditation practice is not unconditionally benign [2]. There has perhaps been a reluctance among the meditation community to admit a direct causal link between practice and the kinds of psychological distress experienced by some participants on retreat, as if this were detrimental to the standing of meditation as a transformational practice.

On the contrary, the link implies that interventions on retreat have the power to reduce as well as to exacerbate distress, and also confirms that insight and awakening are actual, powerful experiences, which transcend and challenge common psychological preconceptions.


[1] Farias, M, & Wikholm, C (2016). Has the science of mindfulness lost its mind? BJPsych bulletin, 40(6), 329–332.

[2] Lindahl JR, Fisher NE, Cooper DJ, Rosen RK, Britton WB (2017) The varieties of contemplative experience: a mixed-methods study of meditation-related challenges in western buddhists. PLoS ONE 12(5): e0176239.


Commentary on the Vimuttimagga

The following includes passages from the Vimuttimagga (The Path of Freedom) by the Arahant Upatissa, Fascicle IV, Chapter VIII, Section I, and Fascicle V, Chapter VIII, Section II. The translated passages appear in italics. Our commentary follows these in normal text.

Three Ways Of Sign-Taking

The yogin should meditate on the form of the mandala and take the sign through three ways: through even gazing, skilfulness and neutralizing disturbance.

‘Even gazing’ is important because the practice is all about looking at the object of attention. In order to look you must, at all times, be seeing something. What you see is your object. It is always what is actually seen, rather than your thoughts or feelings about it. If you are not at all times able to see your object and know that it is your object, then you should probably refocus your attention.

Q. How, through even gazing?

A. When the yogin dwells on the mandala, he should not open his eyes too wide nor shut them entirely. Thus should he view it. If he opens his eyes too wide, they will grow weary, he will not be able to know the true nature of the mandala, and the after-image will not arise. If he faces the mandala closing the eyes fast, he will not see the sign because of darkness, and he will arouse negligence. Therefore, he should refrain from opening his eyes too wide and closing them fast.

If your eyes are open too wide when looking at the candle flame, they will grow strained or dazzled or it will take longer for the after-image to form (if at all). If you squeeze your eyes too tight, likewise the after-image will not form, or (if it has formed already) you may squeeze it out of existence. If you fail to see the after-image, you will probably become bored and your attention will then drift. When practised correctly, it should take anything from only seconds or up to a couple of minutes at most for the after-image to form. The after-image is a purely physical reaction, resulting from exposing your eyes to a light source. It is not a mysterious, mental or ‘spiritual’ process.

He should dwell with earnestness on the mandala. Thus should the yogin dwell (on the mandala) in order to gain fixity of mind. As a man looking at his own face in a mirror sees his face because of the mirror, i.e., because the face is reflected by the mirror, so the yogin dwelling on the mandala sees the sign of concentration which arises, because of the mandala. Thus should he take the sign by fixing the mind through even gazing. Thus one takes the sign through even gazing.

We see our face in a mirror because the mirror reflects light. Likewise, when we stare at a candle flame we will see an after-image, because our retina reacts to light from the flame. Look at the flame, keep your eyes steady, and the after-image will form. It is no harder or more special than seeing your reflection when you look in a mirror.

Q. How, through skilfulness?

A. Namely, through four ways. The first is to put away any internal lack;

As you begin concentration, do you notice any sensations of wanting or craving for anything? Do not get drawn into those! Focus on the object.

the second is to view the mandala squarely;

Have a clear view of the candle flame, and keep looking at it.

third is to supply the deficiency should a partial sign or half the mandala appear;

If the after-image is not clear or otherwise imperfect, do not continue – sort it out! Adjust your gaze, position or the length of time spent gazing until an adequate after-image appears. An adequate after-image is one that is bright and clearly apparent when the eyes are closed.

(fourth:) at this time if his mind is distracted and becomes negligent, he should endeavour like a potter at the wheel and, when his mind acquires fixity, he should gaze on the mandala, and letting it pervade (his mind) fully and without faults consider calmness (?). Thus should skilfulness be known.

If you feel distracted or sleepy, keep bringing the mind back to the object. A potter must maintain a constant awareness of the clay under his hands, otherwise it will spin off his wheel. Aim for a tight, constant, moment-by-moment awareness of the sight of the object.

Grasping Sign

There are two kinds of signs, namely, the grasping sign and the after-image.

This term ‘sign’ seems to have caused more confusion than anything else among prospective kasina practitioners. Probably it arises from difficulties in translation. For this reason, we have decided to avoid using the term ‘sign’ altogether, to avoid the idea that what is being described is not something completely obvious.

What is the grasping sign? When a yogin, with undisturbed mind dwells on the mandate, he gains the perception of the mandala and sees it as it were in space, sometimes far, sometimes near, sometimes to the left, sometimes to the right, sometimes big, sometimes small, sometimes ugly, sometimes lovely. Occasionally (he sees it multiplied) many (times) and occasionally few (times). He, without scanning the mandala, causes the grasping sign to arise through skilful contemplation. This is named grasping sign.

What is being described here is the effect that appears around the flame (or other kasina object) that indicates an after-image is in the process of forming on the retina. This effect commonly appears as an apparent shadow or coloured aura around the candle flame. Its position in relation to the flame will vary, depending on how steady we have been able to keep our gaze. The more steady the gaze, the quicker the effect will grow, the more apparent it will become, and the more it will approximate to the position and dimensions of the candle flame itself. The more apparent this aura about the flame, the more vivid the after-image is likely to be.

The After-Image

Through the following of that (the grasping sign) again and again the after-image arises. The after-image means this: what when a man contemplates appears together with mind.

When the aura has established itself, this means the after-image has arisen. The after-image is the effect of brightness on the retina. It is not an actual, external object, but an artefact caused by how our perception is hard-wired. It is in this sense that it ‘appears together with mind’: i.e. it is a ‘mental’ thing, rather than something relating to an external physical object.

Here the mind does not gain collectedness through viewing the mandala, but it (the after-image) can be seen with closed eyes as before (while looking at the mandala) only in thought.

At this point the mind puts its focus no longer on the external candle-flame but on the internal after-image, which becomes fully visible only when the eyes are shut. So we are being told to close our eyes at this point, and to focus no longer on a physical object but on a ‘mental’ phenomenon.

If he wills to see it far, he sees it afar. As regards seeing it near, to the left, to the right, before, behind, within, without, above and below, it is the same. It appears together with mind. This is called the after-image.

Because the after-image is a retinal effect, its apparent position can be altered by moving the eyes. Whilst they are closed, if the eyes look to the right, then the after-image will move to the right. Similarly, if the closed eyes focus into the distance, or close-up, or upwards, or down, then an equivalent effect occurs.

The Sign

What is the meaning of sign?

The meaning of (conditioning) cause is the meaning of sign. It is even as the Buddha taught the bhikkhus: “All evil de-meritorious states occur depending on a sign”. This is the meaning of conditioning cause. And again, it is said that the meaning of wisdom is the meaning of the sign. The Buddha has declared: “With trained perception one should forsake”. This is called wisdom. And again, it is said that the meaning of image is the meaning of the sign. It is like the thought a man has on seeing the reflection of his own face and image. The after-image is obvious.

Pavlov’s famous dogs salivated when they heard the bell ring, because for them the ringing bell had become entrained as a sign that food was about to arrive. ‘Sign’ is being used in a similar sense here. Just as we look in a mirror and immediately recognise the image we see there as ourselves, so we should habituate ourselves to the kasina practice. It should become habitual. When we see the after-image we should recognise it as such, and associate it with the activity of concentrating. We must condition ourselves to focus intently whenever we recognise the after-image, for just as bad habits are a result of conditioning, so are good habits (‘wisdom’).

Protecting The Sign

After acquiring the sign the yogin should, with heart of reverence towards his teacher, protect that excellent sign. If he does not protect, he will, surely, lose it.

‘Protecting’ means simply cultivating the practice, making the after-image as clear as possible and making the concentration upon it strong. (Reverence towards me, in return for this information, is optional.) If you do not continue to practise then you will lose interest, because you will not get proficient enough to start to experience any interesting effects.

Q. How should he protect it?

A. He should protect it through three kinds of actions : through refraining from evil, practice of good and through constant endeavour.

How does one refrain from evil? One should refrain from pleasure of work, of various kinds of trivial talk, of sleeping, of frequenting assemblies, immoral habits; (one should refrain from) the non-protection of the faculties, intemperance as regards food, non-practice of the meditations, jhanas, and non-watchfulness in the first and last watches of the night, non-reverence for that which he has learned (the rule), the company of bad friends and seeing improper objects of sense. To partake of food, to sit and to lie down, at the improper time, are not wholesome. To conquer these states is (to do) good. Thus he should always practise.

Organise your life and everyday behaviour in a way that supports your practice, and consequently the practice will become easier. Not enough time to spare for the practice? Get up earlier or go to bed later. Busy mind? Set aside some intentional quiet time. Distracting friends? Drop them! etc., etc.

Q. What is the meaning of constant endeavour?

A. That yogin having taken the sign always contemplates on its merit as if it were a precious jewel. He is always glad and practises. He practises constantly and much. He practises by day and by night. He is glad when he is seated. He is at ease when he lies down. Keeping his mind from straying hither and thither, he upholds the sign. Upholding the sign, he arouses attention. Arousing attention, he meditates. Thus meditating, he practises. In his practice, he contemplates on the mandala. Through this constant endeavour, he sees the sign and protecting the sign in this way, he acquires facility. And if the (after-) image appears in his mind, he gains access-meditation. And if access-meditation appears in his mind, he, by means of this, accomplishes fixed meditation.

Take every opportunity you can to practise. And enjoy it! This practice cultivates some very intense and enjoyable states of trance and bliss. Make the most of these, because this is partly what the practice is for.

The Fire Kasina

Q. What is the fire kasina? What is the practising of it? What are its salient characteristic, function and near cause? What are its benefits? How is the sign grasped?

A. The thought that is produced relying on fire – this is called the fire kasina. The undisturbed dwelling of the mind – this is called practising. The skilfulness of sending the mind forth into the fire sign is its salient characteristic. Non-abandonment of fire perception is its function. Undivided thought is its near cause.

The fire kasina is that mental activity which results from concentrating totally and uninterruptedly upon the perception of fire. Based upon my experiences so far, this is how I understand the following passages:

“What are its benefits?” There are five distinctive benefits. These are displayed in the fire kasina. A man is able to produce smoke and flame,

i.e. exceedingly vivid and intense mental images of fire arise spontaneously, to such a degree that they appear more like sensory perceptions than mental images.

is able to reveal things through producing brightness,

i.e. mental imagery becomes so vivid it reveals things that are not intended by the mind, in the way that sensory perceptions reveal what is not intended by the mind.

is able to destroy the light of other forms, is able to burn whatever he likes,

i.e. the mental imagery is so intense that it can be seen with the eyes open, and overrides ordinary visual impressions as and how we choose.

is able to know fire through the arising of brightness. The other benefits are equal to those of the earth kasina. Owing to the practice of the fire kasina, a man is able to see fire everywhere.

As a flame is bright and malleable so these are recognised also as characteristics of everyday perception. Everyday perception becomes to us as bright and malleable as a flame.

“How is the sign grasped?”: The man who takes up the fire sign grasps the sign in fire, i.e., in a natural or a prepared place. Here, a practised yogin grasps the natural sign. (He grasps the sign) on seeing any fire, i.e., a grass-fire, a wood-fire, a forest-fire or a house that is on fire. He develops the natural or the prepared as he pleases and sees the appropriate sign. Thus the after-image of fire occurs to him.

The person well-practised in fire kasina can enter the states it makes accessible by taking any form of fire s/he happens to encounter as the object.

The new yogin is different. He is able to grasp the sign only in a prepared place and not in an unprepared place. He follows what is expedient in the practice of the fire kasina. The new yogin should at first gather fuel, heap it up in a clean place and burn it. He burns it from below, at about the time the sun rises or sets. He does not think of the smoke or the flames that rise up. He sends his mind towards the fire sign by directing it to the middle of the thick flames and grasps the sign through three ways : through even gazing, skilfulness and the elimination of disturbance. (The rest) is as was fully taught before.

The person new to this practice is likely only to be able to enter the states it makes accessible by using a bright and well-defined object, as is described above.

The fire kasina has ended.