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.