Hi everyone,

I apologize if this is not the correct forum, but this is time sensitive "diagnosis" as my friend is currently suffering.

On Saturday (2 days ago), a close friend of mine was halfway through a 14 day Theravada-style retreat when he called me to be picked up. Apparently he was asked to leave because the facilitators were concerned for his well-being. He informed me that  in the past 24 hours he had a traumatizing experience in the forest where he felt "forest spirits" tricked him and injected something into his brain. He felt positive he was going to die imminently. He reported sleeping <3 hours per night during most of the retreat. Ultimately his parents picked him up instead of me, because it became clear this was a psychotic episode induced by his intensive meditation. According to his parents, the retreat facility offered no resources to help the situation (I will be investigating this further, as I find that shocking and disconcerting given the retreat center's otherwise positive reputation).

He was closely watched by his parents the first night, and after sleeping there was some improvement in his clarity of mind and reduced panic, but he still felt like he was being mind-controlled by the forest. On Sunday, I recalled the MCTB chapter "Crazy?" (which seems to directly reference the type of experience he is going through) and sent him the instructions in that chapter to cease all meditation and perform clearly-verbalized resolutions. He reported this helped, and he seemed to have a marked improvement over the course of Sunday.

However, this morning his condition had worsened. His parents brough him to the ER, but ultimately decided to not have him committed to a psychiatric ward. As you may expect, the psychiatrists had never heard of meditation inducing such a psychosis. The current plan is that if his condition stays the same or gets worse by Thursday, they will have him committed.

I am hoping you can help me to help my friend. I've directed his parents to Cheetah House, but apparently the resources they recommended have an 8 week waitlist. He told me he contacted Daniel Ingram, and while Daniel graciously agreed to meet with him, he's currently on vacation. What other lifelines might be available that I can explore to help stabilize my friend?

Potentially relevant details about my friend:

• Practicing meditation for 30-60 minutes 5-7 days a week for 3+ years, mostly via techniques from The Mind Illuminated (anapanasati) and MCTB (Mahasi noting)
  • To my knowledge, he has passed the A&P, has achieved jhana (1-3) a handful of times, but has not achieved stream entry, which was his main goal
• No other past psychotic episodes that resemble this

Thank you so much for any advice or resources you might have. I will answer follow up questions to the best of my ability.

TL;DR
Friend is suffering a traumatizing psychotic episode that was induced while on retreat. The retreat center had no advice. Cheetah House offerings have long wait lists. Daniel Ingram is unavailable for now. Who else can we reach out to that might have dual competency in meditation and psychiatry?

Update: This friend is now relatively stable, and we are in contact with Dan Gilner (https://thecaringspace.net). Things are trending in a positive direction. Also removed personally identifying information.

Is there a therapist or counselor he could speak with while waiting for other resources?

I imagine it would be helpful for him to have a safe environment to communicate what is going on. 

Has he had any episodes like this before?

And does he have a meditation teacher?
​​​​​​​

His family is getting in contact with his psychiatrist, but that psychiatrist is based in Alaska.

He does not have a formal teacher, but the teacher on his previous retreat (last year, not this recent one) was Greg Scharf. If anybody has Greg's contact information, I would appreciate it (feel free to message me directly with that information).

​​​​​​​As stated, he's had no past psychotic episodes that resemble this.

I would recommend they see someone, soon, that they can speak to about the issue. A therapist or a counselor. There's likely someone nearby they could speak with relatively quickly. I think finding them a safe space to communicate their experience ASAP would be helpful. 

Agreed -- I'm hoping to track down someone with meditation+psychiatry dual compentency for him while we wait for his psychiatrist in Alaska to respond.

Hello Matt

I am very sorry to hear about your friend's distressing experience. I hope from the bottom of my heart that he will find relief immediately and on a long term basis he will be able to bring his practice back on track. I want to offer the following to you - some thoughts regarding meditation practice and themechanics of why stuff go wrong. Some resources / advice for the long term -  this is not applicable immeditately, but maybe after this acute distress is taken care of.

Some connected thoughts regarding what could have gone wrong

1. The mind is a meaning making machine - but that meaning making isnt purely based on perception and cognition, it also has a major role for affect to play in the process of the meaning making itself. When we look at a rope and we perceive a snake our cognitive models come into play and trigger the affect function of our mind to generate negative affect. This negative affect gets intertwined in perception and cognition and constructs an entire story about doom that we then act on. The twist here is that our ability to perceive is itself shaped and directed by our affective state as a starting condition. When we are relaxed ropes usually look like ropes but when we are already agitated and feel threatened due to a prior story line then the chances of perceiving a rope to be a snake increases. In fact if there is persistent agitation in the heart without a clear connected story line that we can attribute it to then the mind goes out looking for snakes in order to attribute the agitation to and in that process tends to increasingly see snakes instead of ropes simply to have a neat logically consistent story to make the agitation 'fit'

2. In a retreat like situation where a yogi has the skills to get to the udaya abbbaya nana - but currently has no skill of getting the nana or the knowledge of dissolution, fear, misery, desperation - the yogi is likely to get the experience but not the knowledge. This creates a continuing ongoing experience of agitation in the heart. My theory is that retreats have noble silence in order to prevent people from ripping each other's throats out. I believe your friend experienced the Dukkha, did not get the nanas, continuously stayed in an agitated state for an extended period. His mind then constructed the story of forest spirits poisoning him in order to contextualize and explain away the near continuous agitation he was feeling. This is of course speculation on my part 

3. Is your friend undergoing clinical psychosis the way it is defined in the DSM 4 - I dont know. The clinicians that meet him will have to decide and their advice will have to be taken. But what I can understand is that your friend has the ability to get to the Dukkha Nanas - but is only getting  the experience of Dukkha and has no skill or appropriate guidance of how to get the nana. Your friend has an imbalance of skill. He is good at observation and not good at gaining knowledge and wisdom. I am speaking freely. I dont have any hostility towards your friend or his teachers / retreat guides. But I genuinely think that your friend should from this point onwards not join a 'Sotapanna Factory' like setting and should work with teachers one on one in an at-home atmosphere with his friends, family, parents accessible to him always. After addressing this acute highly elevated state of agitation and perverted dysfunctional perception/cognition, your friend should return to systematic structured practice


Some advice and resources:

1. Your friend should right now seek guidance from qualified clinicians - psychiatrists preferably, maybe therapists and strictly follow their treatment advice.

2. Once the acute maginified distress has significantly reduced, the feeling of 'I am in danger' has passed, your friend needs to educate himself on meditation and how it works

3. Patrick Kearney's talk on google podcasts app on Dukkha and the Dukkha nanas - https://podcasts.google.com/feed/aHR0cHM6Ly93d3cuZGhhcm1hc2VlZC5vcmcvZmVlZHMvdGVhY2hlci81MTYvP21heC1lbnRyaWVzPWFsbA/episode/MjAxNTA5MjItUGF0cmlja19LZWFybmV5LUJNSU1DLW9uX2R1a2toYV9kdWtraGFfbmFuYS0zMjMxOC5tcDM?ep=14

4. An article on when practice gets rough - https://www.reddit.com/r/Arhatship/comments/11z7cyn/when_practice_becomes_tough/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button

5. An article on how to get the nana in the dukkha nana - https://www.reddit.com/r/streamentry/comments/osqhcg/vipassana_the_progress_of_insight_part_3_dukkha/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button

6. A way of getting back to practice as and when your friend does get back to practice - while keeping his physicians in confidence - https://midlmeditation.com/meditation-for-anxiety

7. Teacher suggestion in case your friend would like to engage with them - Stephen Procter - midlmeditation.com, r/midlmeditation (reddit)


​​​​​​​I hope your friend finds relief. Best of luck to him and to you.

If you can't locate contact info for Greg Scharf try reaching out to the administration at Insight Meditation Society in Massachusetts they should be able to connect you (Greg's a layman who also spent some time as a Theravadan monk; he taught there at a retreat I attended).

Good luck getting your friend grounded.

Sounds like he is in good hands. Let the psychiatrist  deal with the acute phase. Let him get grounded.  . Sounds like he is somewhat of an advanced meditator.   He had a hard time crossing the abyss in the DN . Ego fought back.  He might have some issues he needs to deal with a therapist for a while than re implement  practice(gradually). I have a gut feeling he is on his we to stream entry 
​​​​​​​

 Hi,

Do you want me to share your post with the emergent phenomenology research consortium maillist? There are people in there who have skill in handling this sort of thing. There are also people he might be able to talk to about the experience, either now or when more stable, who will be able to relate, as this actually happens to many people.

For context, I know several pople (e.g. in the EPRC group), who have had seeming psychotic episodes during meditation retreats or outside of it, some of whom have been forced hospitalized for a bit, and though these were not easy experiences to integrate, have moved way past it without recurrance and are now doing fine or better than fine.

Also, if this is really an emergency, I can signal boost your message to Daniel Ingram, as I think he's probably as good as it gets for handling this kind of stuff. But busy indeed.

Let me know.

As an fyi, people like David Lukoff, who is one of the people responsible for the introduction of the V62.89 Religious or Spiritual problem into the DSM, list (1) acute onset of the episode, (2) good functioning previous to episode, and (3) an exploratory attitude towards the experiences, as good prognosis factors usually leading to good outcomes. At least (1) and (2) seem to be the case with your friend.

IMHO, just my 2 cts, a degree of insight, some ability to distance oneself from the experiences and to maintain some form of critical judgment around it, although it may still be really weird and disturbing, is an important factor as well.

Best,

​​​​​​​Olivier
 

@oliviers yes, I think sharing with the EPRC would be helpful (edit: my email is mattrslattery@gmail.com if anyone wants to contact me directly).

Regarding V62.89 Religious or Spiritual problem features, my hope is we can convert him to 3) as well. Thank you for that reference!

I'm going to reach out directly to Daniel now and try to fill in the gaps of where he's at and what his availability looks like.

Thank you everyone for the help so far. I'm super appreciative of the community coming together for this one.

Update: My friend is doing better today. Me and two other friends are visiting him tomorrow at his request. We're going to relax, play some games, get some good laughter in, and ground him down.

​​​​​​​Someone helped put me in contact with Dan Gilner who worked with Dr. Willoughby Britton to develop Cheetah House. Dan is going to meet with us Wednesday and Friday.

I think we're on the right course of action now. Thanks so much for all the advice and support. Will update again when there's more to say.

That's really good to hear. I'm glad that you're getting him the right help, he's lucky to have you. I hope he gets through this soon. 

Matt, out of caution and discomfort with the amount of information you have posted about a third party, does your friend know you're posting this here? Do they approve of this information being posted?

These boards are publicly available, and we need to be careful about posting personal or medical information that could be used to trace someone or use the information in unhealthy ways.

That said, it is impressive how the group here has jumped in to assist.

Chris M
DhO Moderator

Chris,

I have mentioned to him that I posted to online forums asking for assistance, to which he did not seem to care and was thankful. He has shared intimate details of his practice in other forums, but I appreciate your concern and will remove some of the identifying information, just to be extra cautious.

Thank you, Matt. 

Hey Matt,

I'll assume I can then hold off from reaching out to the group now that your friend has found support?

Please continue to update the final point.
No one ever gives the conclusion to these issues.
Thanks for the info.
​​​​​​​~D

Yes Olivier, you can hold off on sharing with the group. I believe my friend has what he needs for now. 

I'll do my best to close the loop on this, and share which resources were most helpful. 

Hi Matt,

Sorry for the late response, it sounds like you and your friend have the resources you need to resolve their problem.

Unfortunately, most meditation centers and teachers don't want to acknowledge that meditation induced psychosis exists. Having experienced this twice during and after intensive retreats, the measures I would recommend it seems your friend has been taking: stop meditating, get more sleep and undertake activities that ground your mind in your body. If your mind is still making things up, it might be worthwhile to see a psychiatrist and get a prescription to an anti-psychotic for a couple months, something like risperidone (Risperdal). These drugs all have side effects, but if you only take it for a couple months, long enough for the symptoms to subside (assuming you don't have a history of psychosis), then there should be no long term issues. Anti-psychotics helped a lot when I had an incident of meditation induced pychosis in 2011. Ultimately, your friend needs to decide whether their mind can handle the intensive altered states of conciousness associated with a long retreat and act accordingly. In my case, the answer was "no", so I don't do long term retreats anymore.

Best wishs and I hope your friend does better!

       svm

Matt, 

What is the name of the retreat center?
What kind of meditation were they teaching?
Who was leading the retreat?

Thanks,