“Jill” is 32 and works as a lawyer in the southwest. She wrote to me explaining that during her meditation she sometimes feels a panic attack coming on and has disturbing mental images. She cannot control it and does not know what she is doing wrong. When we talk for the first time I ask her when it began. “It started a few months after my therapist taught me mindfulness…”
Third wave Cognitive-Behavioral Therapy (CBT) is the marriage of modern psychology and ancient buddhist meditation. It has grown rapidly in the past decade, and many psychologists and meditation teachers are enthusiastic about the development, seeing it as a blend of the very best of eastern wisdom with western psychological science. Third wave CBT goes under a variety of names such as Mindfulness-Based CBT (MBCBT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR). There are also less structured approaches and informal sitting groups springing up in clinics across the country. It is the rare hospital or clinic that does not have a meditation group these days. This has resulted in a historically unique situation. Psychologists, medical doctors, social workers and counselors are rapidly becoming the vanguard of meditation in the west, introducing people who may have never meditated to the practice.
All these approaches have the common elements of CBT (recognizing and challenging maladaptive thoughts) and a version of meditation that goes under the moniker “mindfulness meditation” or sometimes just “mindfulness.” A review of the treatment manuals for DBT, ACT, MBSR and MBCBT suggest that “mindfulness meditation” is something close to a “soft-vipassana.” The person doing meditation in these treatment protocols is instructed to watch thoughts and feelings come and go on their own without judgment. This leads to the insight that one does not need to believe in, or act on, thoughts or feelings. This is perfect for CBT, which emphasizes the importance of thoughts and beliefs as the drivers of mood disorders. I call mindfulness meditation a “soft” version of vipassana because it stops short of instructing the person to see that everything in awareness is coming and going and is not owned. It also does not emphasize the kind of intense or rapid momentary concentration that marks some vipassana techniques. Instead, clinical mindfulness focuses on relaxation and gentleness (but not samadhi) and points the person to watch thinking and emotional reactions. I would argue that these differences are a very good thing because, despite popular opinion, traditional vipassana would be terrible medicine for a person who is emotionally distraught, unstable, and unable to cope.
That last sentence may be a bit shocking to some. If you are like most people, you associate meditation, all types of meditation, with happiness, relaxation, and maybe even bliss. The idea that it could produce difficulty is not only counter intuitive, it is anathema to how meditation is presented in the west. If anything difficult does occur during the meditation the meditator is likely to feel that they are doing something wrong. If he or she goes to a meditation teacher the advice will likely be to just “let it go,” “drop it,” or my favorite, “thank your mind for it.” This is patronizing. It gives the false impression that if anything distressing does occur during meditation, the problem is one of technique or reactivity on behalf of the meditator. In reality difficult experiences in meditation, ones that are remarkably similar to the symptoms of many mood disorders, are so normal that the most ancient surviving meditation manuals in Buddhism go into great detail about them, categorizing them into six distinct types that occur in a specific order. Far from being a sign of poor meditation, they are actually described as a sign of deepening insight. In other words, the most ancient manuals not only affirm that difficult experiences occur during serious meditation, they posit that these experiences are supposed to happen. They are a definite sign of one’s movement along what the famous Burmese meditation master Mahasi Sayadaw coined The Progress of Insight, and are known as the “dukkha nanas” or “insights into suffering.” This might sound bad, but the good news is that these more distressing insights only occur when one is well on the way and down the path. Meditators usually have to go through a lot of sitting time, develop strong concentration, and become very equanimous before they can enter into the later insights. For this reason it is unlikely that a soft-vipassana approach can get one very far beyond the initial insights and into the dukkha nanas. So in a clinical setting if you stick to the instructions and don’t overdo it, nothing unsettling is likely to occur. I do not believe mindfulness meditation is intentionally designed for this, but if it was it would be a damn clever modification of traditional vipassana.
Despite the limits of mindfulness meditation, there is a problem. A small number of people in clinical settings are unexpectedly good at meditation. With the barest instruction, some people are able to launch themselves deep into the rabbit hole of insights that vipassana is intended to produce. It is an experience that can be troubling and even destabilizing, particularly if one has no idea that it is coming. As third wave CBT has boomed in the past decade these people have become a significant minority in the meditation community. Introduced to meditation through therapy, they find themselves on an emotional ride to which they never agreed, encountering upheavals and difficult truths at the very moment in their lives when they are least able to handle them. That is bad enough, but much worse is that many of the well-intentioned clinicians who teach these techniques have no idea that anything troubling could occur.
Many of the developers of these approaches received their training in meditation through Zen, which eschews the more old fashioned stage-models of insight, and therefore does not formally recognize the predictable difficulties that arise (though every Zen teacher I’ve met is cognizant of them and is well-prepared to handle them). Additionally, for reasons too complex to go into here, traditional vipassana teachers in the west have elected to present the practice without much emphasis on the traditional stages of insight. And so, without intending to, they often leave the simplistic impression that there are no difficulties associated with insight, and that more meditation equals more happiness. The inspired psychologists who learn from these teachers come away greatly impressed with meditation, but with little to no knowledge of the dukkha nanas. They return to their clinics, offices and hospitals and find novel ways to integrate meditation into the treatments of unstable people. Most of these people get great benefit. Some have a different experience, one that is unsettling. And while many meditators may object to this characterization, pointing out that their own experience of dukkha nanas was not so difficult, I would argue that most people who go through it with little trouble are not in the midst of therapy or suicidal.
People who have had this unexpected experience are growing in numbers and are starting to share with each other and with more traditional meditators. They have come to call the dukkha nanas the “dark night” after the Christian experience (some teachers believe they may be in the same mystical family if not the same thing). They are sharing and seeking advice on internet forums and in settings such as the Cheetah House and Dark Night Project where they feel they will not be told to simply “drop it” but will be supported in gaining understanding. They are an unseen, and as yet unrecognized, growing minority of western meditators. Many have no sangha, no formal teacher, no texts or canon, no philosophy or anything resembling “faith.” They are frequently alone, searching the Internet for anyone like themselves, trying to sift through the overwhelmingly positive pitch for meditation for some nugget of information that can illuminate their experience. Like refugees with no home, they do not understand what is happening to them or why, and they often do not know what to do or where to go for help.
This issue is not abstract for me and perhaps my own experience will shed light on why I care so much. Two years ago I received the green light from my teacher to begin teaching insight meditation. I put up a website, told those who knew me what I was up to, and waited to see who would be interested. While I made an effort to write in my own voice, which can be irreverent, what I presented was right down the middle vipassana. However, I did do one thing that was unusual and for which I am very grateful. I went against the common practice of downplaying the insight stages and instead put them front-and-center on the site. I did this because my teacher was clear about them with me, so I followed suit and was candid about them in my teaching. I made sure to include a rich description of the dukkha nanas and cautions to those who may be about to plunge into them. Unbeknownst to me this one gesture of understanding came to define my experience of teaching for the next two years, as the great majority of people who contacted me, and continue to contact me, are in the dark night. Most got into it through formal practice (amazingly, it doesn’t seem to matter much which technique or tradition). But I was alarmed when it seemed that a significant number, perhaps a third, learned to meditate from their therapist or from a group in a clinical setting. Sometimes they were actively suicidal at the time they learned to meditate. Interestingly, the majority never discussed their negative experiences while they were in therapy. Like the therapists themselves, they wanted to believe that meditation was helping, and so they dismissed what was occurring or blamed it on the thing that brought them to therapy in the first place.
As a psychologist this is more than a bit embarrassing, it is troubling. It is one of the ethical principles of psychology that no intervention is done without fully explaining the risks and benefits of the treatment. If an intervention could possibly cause distress, even mild distress, psychologists are ethically obligated to inform the person of this possibility and gain their informed consent before proceeding. Psychologists are not doing this when it comes to mindfulness meditation, chiefly because they do not know there are risks. But more and more people who have participated in it know that there are. This is not a situation created by malice, but by ignorance. Psychologists simply were not told this could ever happen, and were given the impression that the results of meditation were exclusively happiness, calm, and increased wellbeing. They are not to be blamed for this situation, as they have merely borrowed a problem that already existed in the way meditation was being taught to students in the west. It is a problem that continues and in some ways defines what “mainstream” meditation teaching is in the west.
While this is not psychology’s fault, it is only a matter of time before the consequences lay squarely on the shoulders of psychologists who teach mindfulness meditation. Sooner or later, those who teach it will learn about the progress of insight and the dark night. Either from writings like this or from patients themselves. When they do they will face an ethical dilemma about whether to continue teaching meditation in clinical settings. While meditation teachers can essentially “get away” with not telling people about the dark night, psychologists do not have this luxury. Ethically, we are obligated to acknowledge the risks and be cautious. This is not happening yet, but it is my sincere hope that those enamored of third wave CBT will examine not only the manuals and the studies, but look deeply into the descriptions of insight in the pali cannon. Even better, talk with meditators who have experienced a dark night, researchers who study it, or best of all dive into it and see what it is like. Psychologists might benefit most from going beyond mindfulness meditation, breaking loose of the manual, and seeing how far this practice can go. Then there might be more respect for the powerful, and sometimes life-shaking, changes that vipassana can create in the heart and mind. It is my hope that psychology will soon lose its infatuation with meditation, and begin to evaluate it as a tool for change in a more mature light, seeing both the promise and the dilemmas. Until this happens I expect the community of mindfulness meditation refugees to grow.