Resources for Practioners with a diagnosed mental illness

Hey everyone,

was wondering if there were any go to resources for serious meditators with mental illnesses that help navigate practice. Specifically about understanding sensations and thoughts that arise if possible - though i would be interested to read any information in the area.

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Hi Sean,

The field of psychology/neuropsychology hasn’t really paid much attention to the wonders of what Buddhism and meditation can do unfortunately. At least not yet! Because the field of psychology and neuropsychology is vast and broad and complex, it would be extremely useful to narrow down the research knowing a specific mental health disorder? Of course it’s private and you don’t have to disclose anything.

I cannot however answer for the other way around and perhaps Buddhism has the tools you’re looking for.

As a person diagnosed with a severe mental illness, I’ll say; Take notice, but don’t believe that you are your analyse. And people who have never had to struggle yet give too often unhelpful advice, like; Listen to your doctor and take your medication :thinking:

People who don’t get sick of a profoundly unhealthy society are maybe beyond rescue.

It took me about three years to heal, and I’m deeply grateful for these available wisdom teachings of today.

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Great question. Psychology and counselling has had a growing interst in mindfulness over the past 40 years. It started mainly with Jon Kabbat-Zinn’s creation of a Mindfulness Based Stress Reduction (MBSR) program. This program was tested and demonstrated to reduce stress. A lot of programs are coming out of this work. But this work demonstrated stress reduction through specific mindfulness techniques - to my knowledge a lot of the use of mindfulness in counselling has less evidence behind it.

You also have modalities - like Acceptance Commitment Therapy (ACT) - that make significant use of mindfulness. So mindfulness has been combined with other techniques to create approaches to helping a client.

What I haven’t come across are what you are asking for (research how meditation works with a range of mental illnesses) and clear cautions on when certain meditation practices are contra-indicated. For instance, there is a lot of anecdotal evidence that meditation can be harmful for people with PTSD, but I’m not aware of a rigorous study on this. There is some evidence that meditation can trigger/increase depression. But - to my knowledge - based on smaller studies. Surprisingly, meditating more than 30 minutes a day has been found to interfere with sleep for many people.

But all those warnings are under-studied and suggestive, not conclusive, as far as I know. And it seems that many of the problems arise when people go to intensive, non-monastic meditation retreats that they aren’t ready for. So I’m not sure how well the different variables that could be causing adverse reactions have been teased out.

Good luck on your search! I would love to find the resources you are looking for.

With Metta.

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For what it‘s worth, CBT and DBT have some overlap with Buddhist advice on how to deal with hindrances, and the „skills“ presented in workbooks are often more specific and better suited for dealing with those extreme bundles of harmful views and negative emotion you often get with conditions categorized as mental illness.

I‘ll believe that in a heartbeat! Meditation, even rid of its Buddhist context, can get samvega going. When people shake themselves out of their rut and take an honest look at things, they‘re bound to get a glimpse of the three characteristics, and that might just be enough. Now, combine samvega with a materialist view of the universe, i.e. existential nihilism, which has become the norm in the West; combine it with the usual lack of moral direction and the rapid decline of the natural and political world, and no way to do anything about that buffet of awfulness that is life in a human body (and all the variously dysfunctional human communities) except manage the symptoms, and you‘re likely to get anxiety and depression out of it.
It might just be irresponsible to get people into meditation as some self-improvement or mental health scheme and leave out all the rest of the path - if the goal is to be a bit less stressed, relaxation exercises can do that without the possible side effects.

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This is a really important point. The root of much mental distress and illness is systemic, not personal.

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When I take a look at society I see a being that is basically in a state of phsycosis, and driven further into madness with solutions made by solely using left brain hemisphere mechanical logical thinking and feeling.

Organised religions can’t help us, market forces won’t, and our politicians are corrupt.

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thank you everyone for your responses. the clinical stuff is interesting but as mentioned by others its not very deep in the field. how about personal accounts from say monastics or established practioners with mental illnesses? i think it would be hard to scientifically conclude an answer to the types of questions im interested in right now.

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Hi all. While a general discussion of this topic could be helpful and, I think, would fall within our forum guidelines, just a reminder not to get into discussions describing personal problems or giving personal advice.

Q8 Why don’t you allow discussion of Personal practice, personal problems or diet and medical issues?

A : This forum is not a support group. Moderators cannot ensure that your personal revelations will be well received by the community. It is not possible to render meaningful assistance on such issues through the modality of an anonymous Internet forum! If it is really necessary to discuss such topics, it should be done with reference to generalities, such as would be found in a book or in a Dhamma talk. Alternatively, those interested in such conversation can use the Personal Message (PM) feature to discuss among themselves.

The internet should not be anyone’s prime source of information or advice. Apparently simple life hacks such as diet, exercise and meditation can often produce adverse effects, and sometimes even be life-threatening. Users should always contact their own doctors, dietitians, therapists and spiritual advisors before embarking on any course of action which could potentially be hazardous to their physical or mental health.

Regards,
suaimhneas (on behalf of the moderators)

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To get things rolling the mods will allow us to post links to personal accounts of people practicing with mental illnesses though only so long as we don’t try to skirt the rules and make it a discussion about personal practice/problems.

What i would love to have here is just a compilation of resources for practioners with mental health concerns to explore. If i come across anything i will endeavor to add here and i encourage everyone else to also do so.

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This is such an important topic! Thanks for starting the conversation @SeanB

We often hear people are told that meditation is a cure-all for everything from anxiety, depression, trauma, intrusive thoughts, schizophrenia etc etc but I truly despair at people with complex mental health issues being blithely encouraged to practice meditation.

Without proper care, rather than helping, it’s likely that meditation will actually exacerbate the existing mental health condition.

People with active mental health conditions need access to qualified and informed meditation teachers, which in this case means someone who is both experienced in meditation and also who has a good knowledge about various mental health conditions. It is especially very dangerous for an uninformed meditation teacher to give advice to people struggling with an acute episode, and in many cases would be considered a breach of their duty of care, with potential legal consequences. Always get professional help.

Most people will go through a mental health issue at some stage in their life. There are many conditions all with very different symptoms. We can’t just have a one size fits all approach to mental health and meditation. Also, sometimes meditation will be fine for some folks, but at other times it will be problematic for them, though they might be fine to practice meditation later, depending on what is going on with their condition.

Some mental health issues are generally not suited to prolonged periods of seated meditation, where they are left sitting with their thoughts - such as anxiety, intrusive or obsessive thoughts, or acute episodes of PTSD, suicidal thoughts or self harm. So, for example, someone who is experiencing severe anxiety should avoid long periods of silent seated meditation, but might be okay doing some calming walking meditation, or some chanting, or controlled breathing practices. It’s important to recognise that there are often bodily symptoms to thing such as PTSD and anxiety and that these also need to be acknowledged and managed.

Other people’s symptoms will be triggered by silence, social isolation and solitude of a retreat or monastery environment, especially those with some types of schizophrenia, including paranoia, persecution, or delusional patterns. For these folks, sometimes silence and solitude means they lose touch with our shared experience of reality and deluded views take over, and they may start to have paranoid thought patterns, hear voices or experience visual disturbances. These folks might not be suited to long intensive retreats but might be able to do short stays where they are more involved in community.

Some general advice for people with mental health issues:

  • Be upfront about your condition if going to a retreat centre or monastery
  • Indicate on your application form if it is an active condition or was historic, and list your current medications and your specialist’s contact details
  • Have a chat with your specialist before undertaking meditation practices or retreats and ask what particular practices might adversely affect your condition
  • Have a mental health care plan in place to make sure your treatment wishes are followed in case of an episode
  • Don’t go off medication on retreat
  • Have regular chats with the teacher
  • Practice for shorter periods and less intensively
  • Watch for breakthrough symptoms / pro-drome symptoms
  • Be prepared to stop meditating if it is not going well
  • Have some alternative practices to do if meditation does not work out for you
  • Remember that meditation might not be the answer for you right now but might be ok in the future.

Some suggestions for Teachers and organisations:

  • Undertake mental health first aid training for teachers and staff to better understand conditions and to watch for warning signs of acute episodes and how to handle them
  • Do a suicide prevention or intervention course.
  • Develop connections with mental health emergency services and professionals in your local area
  • Keep contact details and mental health first aid resources in the retreat centre office
  • De-stigmatise mental health issues by having conversations in your community and in Dhamma talks
  • Be welcoming of people with mental health issues (don’t reject folks just because they have mental health issues, that would be discrimination and illegal)
  • When you ask about people’s mental health issues in application forms ensure that applicants are informed that the information will be treated confidentially and will not adversely affect their application.
  • Have a dedicated mental health contact person at the retreat centre and let participants know they can contact them at any time
  • Be prepared to make accommodations for people with mental health issues just as we make allowances for people with differently abled bodies. Allow people to move postures when they want, or leave the hall whenever they need, to do less intensive practice, to do walking meditation instead, come at any time for an interview or chat etc
  • If someone has a mental health care plan, make sure you follow it
  • Don’t call the police if there is an acute situation, call the emergency mental health team. Learn how to de-escalate difficult situations skillfully. Only involve police as a very last resort
  • Remember that meditation is not a cure-all. Don’t encourage people who are experiencing symptoms to “just observe l” it “just sit with it”.
  • Never treat people going through a crisis with condescension, or disempower them or treat them as any less of a human. Always centre their needs and make sure they have agency and dignity.

Anyway these are just some ideas that popped into my head, largely informed by my research using the resources below, as well as training and personal experiences in monasteries and leading retreats. I'm sure there's many more useful ideas that folks might contribute.

I have done mental health first aid training and suicide prevention and intervention training and these experiences were extremely valuable. Importantly I learnt that many of the usual approaches one might take to things are actually the WRONG approach. So it’s worth doing such training.

Lastly these days, folks who have a diagnosis are usually pretty keyed in to their condition and good at self care. But it’s the undiagnosed folks or unrecognised underlying conditions triggered by meditation that are likely to create the biggest challenges in retreat environments, both for the individual and the organisers.


There are several good resources out there, check them out!

  • Meditating in safety
    Set up by a Buddhist and a psychologist. User friendly and simple.

https://meditatinginsafety.org.uk/


You might want to check out two figures leading this field:

  • Dr Willoughby Britton - the academic behind the Meditation Safety Toolbox above and involved with Cheetah House

  • Dr David Treleaven, also involved with Cheetah House and who wrote a book called Trauma Sensitive Mindfulness.

Hope this helps!

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I’ve been treated for schizophrenia since just after I finished high school in 1996. I had a career as a software engineer and ordained as an anagarika at Bodhinyana in 2006. My application letter included information about my illness.

Shortly after, during the rains retreat, I had a psychotic episode that required me changing medications from Risperidone to Clozapine. The latter is a more effective drug but with potentially very serious side effects. Changing medications required about a 2 month stay on the psychiatric ward of a public hospital. Once I was discharged in January 2007 I ordained again as an anagarika and now have 14 rains as a fully ordained monk.

Once a month I get a blood test and visit the public outpatient clinic in Gosnells. I’m pretty much their star patient and my 4 month trip to Sri Lanka in 2014 made it into their best practices for Clozapine patients travelling overseas.

As guest monk at Bodhinyana I’ve seen many cases of mental illness where visitors struggled. At least one young man ordained but had a really hard time and eventually disrobed. My advice is to take things very slowly and to make sure you discuss your situation with your health care providers.

Mega-metta,

Ajahn J.R.

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Anumodana sadhu sadhu sadhu for the monastics replies :orange_heart:

It meets my feeling what good spiritual friends would do if one finds oneself going out of mind.

When I read the moderators posting I felt a deja vu to feelings and thoughts I had when everything collapsed. And to sum it up I repeat an earlier sentence: Organised religion can’t help you, not even what I thought was the right one for me, so I ended up hating everything about it.

My advice is to remember that you have to watch out for yourself. Don’t trust a teacher, retreat manager, or monk with your health. They are not psychiatrists. They do not understand mental illness or medication at a deep level. If you think things are going poorly or the meditation is making things worse, you need to trust yourself and back off.

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Discussion of medication and personal experience regarding the expression of metta.

Just finished a 10 day metta retreat with Bhante Sujato, was an excellent experience for me. One question i did find myself asking was would the experience of metta (something im not particularly accomplished in) be hindered by my medication (i have bipolar 1 and take the mood stabliser Lithium). I think in my experience the answer to that is no. I had one strong experience of metta on the retreat and it was a kind of “aha” moment with shifting perspectives rather than a slow build up - which would be what i would expect if medication had been hindering metta expression below a certain physical threshold.

In conclusion im more willing to believe my difficulty in expressing metta is due to inexperience rather than my mood stabilising medication. Obviously this is one experience.

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Hi there Sean, I came across this podcast and thought it might be of interest to you, haven’t listened to all of it yet but so far it’s pretty good. hope all is well with you.

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Thanks Adrian good addition to the thread.

Guest has phd in neuropsychiatry and meditation teacher experience

Some things mentioned

  • Healthy ways to view a mental illness
  • Negative symptoms as motivation to seek spiritual meaning
  • Mindfulness to become aware of negative symptoms and finding “choice” in the situation
  • Should people with mental illness meditate? (yes its about finding the right method for the time, metta globally a good practice)
  • “meditation is not something that replaces anything it adds to life” - response to medication question
  • spiritual practices other than meditation that are helpful (communities)
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Wow you summarized it really well :anjal:

It was a great conversation I thought.

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thanks :slight_smile: im hoping future seekers will have an easy time looking for stuff.

yeah she was a good guest kept it rather simple and straight forward. guess ill keep trying to get metta to work lol

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Sorry I’m a bit late to the game, but one of my teachers, Ayya Sudhamma, alerted me to this thread and thought I should share my essay on being bipolar and Buddhist: The Bipolar Buddhist.

If you have issues with depression, I’ve also written up my experiences with depression and Buddhist practice: Buddhist Approaches to Depression. That one is currently in draft form (you might see some suggested edits that I am still working on) but you might find it helpful if you have issues with depression.

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