The medical metaphor is used a lot in Buddhist studies. The Buddha is sometimes referred to as “the great physician” curing the dis-eases of the world. The Four Truths which are fundamental to Buddhism - dukkha, samudaya, nirodha and marga - are often explained (wrongly, in my view) as analogous to a medical prescripion. Among these medical metaphors we also find the idea of meditation sickness. I would like to take this notion seriously here and see what we can make of it.

Firstly, I think we should distinguish between meditation sicknesses, meditation obstacles and the corruption of meditation purpose. Meditation sicknesses are states that can come about as a result of meditation, generally meditation that has, in effect, been practised with an unsound motivation (though, necessarily, nobody has perfect motivation at the outset). Meditation obstacles, by contrast, are conditions that make it difficult to meditate in the first place.

Types of meditation sickness:
The following list includes the major and most common forms.
1. Unsustainable infatuation: The practitioner falls in love with the practice in an unsustainable way that in due course often leads to an equally sudden rejection or loss of faith.
2. Pursuit of visions and emotional high: The practitioner pursues the practice primarily in a quest for visionary or psychodelic experiences and is endlessly looking for such novelties.
3. Attachment to heavenly states: The practitioner makes some progress and attains to one of the higher dhyanas and becomes strongly attached to it, wanting only to dwell there.
4. Emptiness disease: The practitioner, having had an insight into emptiness loses all sense of purpose or direction. At an extreme this can become a kind of psychopathy.
5. Self-inflation: The practitioner believes him or herself to be enlightened and in possession of super-normal abilities in a way that leads to recklessness or abuse of others.
6. Reactivation of extreme ego states: Meditation can trigger neurotic or psychotic symptoms in persons already so predisposed.
7. Loss of connection with instinct: The practitioner may become so detached from bodily processes that he or she loses the ability to respond naturally to somatic messages.
8. Accidie: The practitioner becomes weary of spirit and can see no point in the practice or in any other activity.

Types of meditation obstacles:
There are any number, but the following are well represented in Buddhist teachings.
1. Worry and flurry: The person has an aggitated mind, preoccupied by a multiplicity of concerns that will not allow them the repose in which to settle to a contemplative exercise.
2. Over intellectualism: The person is too caught up in theory to be able to get down to actual practice.
3. The Five Hindrances: sensual desire, hatred, sloth, restlessness, and doubt.
4. The three poisons: sensuality, wrath and pride.
5. Presence of overpowering emotions: such a grief
6. Lack of suitable ambient conditions: Thus, in the texts,the meditator is advised to go to a secluded spot.

The obstacles can be considered to be things that good meditation practice might cure, whereas the diseases are things that faulty practice may bring about.

The Corruption of Purpose
I mentioned above that the sicknesses may be the result of pursuing meditation with inappropriate motivation and qualified this by adding that it is more or less inevitable that one has the wrong motivation at the start. I want to stress this point because the rectification of motivation is one of the prime objectives of Buddhism. If a person can attain to right intention they have done nearly everything that Buddha asks. Buddhist ethics are framed largely in terms of intention. The blind man who steps on insects is not at fault because he intended no harm and did not know he was inflicting any.

Meditation has become popular in recent years. This popularity owes a little to individuals becoming genuinely spiritually inspired, but a great deal more to others exploiting it as a path to physical and mental health benefits, as a form of personal effectiveness training or escape from the stress and melancholy induced by modern life. The development of utilitarian mindfulness practice falls into this category, and we have all heard that “it has nothing to do with religion”. However, if meditation does not have a fundamentally religious intention, it may well contribute to a spiritual sickness of one kind or another.


Unsustainable Infatuation
Sometimes, when a person “discovers” meditation, they take it on with a great initial enthusiasm. This enthusiasm may be powered by fantasies of what meditation is going to do for them. These imaginings may range from the utilitarian motivations just mentioned - reduce stress, bring unassailable happiness, solve personal problems, or cure depressive symptoms, etc - to various forms of self-enhancement including the idea that one is soon going to become a great Zen master, be enlightened, and have mental powers that will confound one’s rivals and generally make one immune to the slings and arrows of fate. These fantasies, being exaggerated, cannot be sustained indefinitely and when the evidence of non-attainment becomes unavoidable the person may sink into a kind of despair.

More generally we can say that this is a case of the meditator being in flight from the suffering in life. The infatuation is a form of samudaya - an energy that arises in reaction to such suffering. Samudaya can be a stepping stone to spiritual progress - a wake-up call - but more commonly it leads us into patterns that ultimately only multiply the original state of affliction. These are detailed in the textual descriptions of the Second Truth as resorting to sensual distraction, to self-enhancement, or to destructive behaviour. Thus, in this case, the neophyte meditator thinks to gain a sensual benefit and self-enhancement but ends up in despair.

This kind of disappointment is a first instance of meditation sickness - an unfortunate state induced by undertaking the path of meditation with a misguided motive.

Pursuit of Visions and Emotional High
While some are seeking utilitarian benefits, others are looking for “high” experiences. The current wave of popularity of mindfulness is largely driven by utilitarian concerns. However, the wave of popularity that meditation enjoyed in the 1960s and 70s was substantially driven by the idea that meditation could give one experiences even better than psychodelic drugs. Sometimes it does. Then, just as with such drugs, it is possible to become addicted to obtaining such states. This can become an obsession. This is clearly not just a problem of the 60s and 70s in the West since there are many admonitions in Buddhist writings against talking too openly about such experiences. This must be because ancient masters also perceived the danger of people being drawn into the practice for such purposes. If a culture grows up in which people start swapping stories of the particular highs that they have experienced, then new practitioners will be led to think that getting such experiences is the purpose and that having them is evidence of progress.

Ecstatic states are sometimes experienced during meditation, but the purpose of religious contemplation is not that of obtaining such highs. They are an incidental. If one becomes addicted to them, it can become a distraction that corrupts one’s purpose and wastes a lot of time and energy. The vision quest can be a stepping stone, but if one falls in love with the stepping stone one will remain isolated in the middle of the river and eventually, when the flood comes, one will be washed away.

This kind of obsession is a second instance of meditation sickness.

Attachment to Heavenly States
Just as meditation may lead to sensual or emotional highs, at a deeper level it may lead the practitioner into the experience of heavenly states. The difference between a heavenly state and a high is that the high lasts a few hours at most whereas heavenly states can take over one’s whole life. The person who has fallen into a heavenly state may drift around blissed-out not just when performing a meditational exercise, but all day long. Such people may appear to be terribly spiritual. Nothing breaks through their bliss. To them everybody is wonderful and life is wonderful and everything that they encounter is wonderful. Such a person is generally completely unproductive, like a sleep-walker. In fact, they are in a kind of sleep - a pleasant dream that goes on and on. They often have a slightly sleepy or floating manner. They can be pleasant to be with for a limited period of time because their attitude toward one will be something like: “Oh darling, you are so wonderful. You have such a lovely halo,” but if you ask them to do something they will be too preoccupied with listening to angels to be able to cooperate.

This kind of ethereality is a third kind of meditation sickness. In this case it may not be so much a case of wrong initial motivation as of being high-jacked along the way.

Emptiness Disease
Many meditators seek and some obtain insight into emptiness, shunyata. This can also be called “non-duality”. This can seem like a kind of final revelation. Such people may now believe themselves to be enlightened. They have a watertight way of thinking about everything. All distinctions are void. There is only oneness. This compelling notion seems to cut through every dilemma. It is a kind of Parmenidean vision that transcends time and space. It is intoxicating. Now nothing matters. All moral dilemmas are invalid because there is no separation between good and bad, right and wrong or any other dualistic dichotomy.

Emptiness disease in the spiritual context is not the same as people mean when in common speech they talk of feeling empty. That is more similar to accidie which we shall come to below. Here emptiness disease is an attachment to an experience of oneness that initially seems intoxicating, but which has the effect of rendering everything in life pointless. In its milder form it shows as an attachment to a clever intellectualism, but in more developed form it results in a supreme indifference. Such people can appear to be terribly wise and have an answer to everything, but it is not an answer that is ultimately satisfying.

Since the body and physical conditions do not yield to this kind of ultimate logic, the person may start to live a double life. They become blind to many aspects of their own real life, being too taken up by the transcendent enthusiasm to notice their own contradictions. If confronted with them, they will just dismiss the matter as illusory dualism.

This kind of false superiority is a fourth kind of meditation sickness.

This condition can be linked to either of the previous two or can occur independently. As a result of whatever experiences the pertson has had he or she comes to believe that they have attained to a superior condition in which karmic consequence no longer applies in their case. They have transcended karma. A Zen story tells how such a condition can lead to a hundred rebirths as a fox. Like the Emptiness Disease, this is basically a form of self-deception, but can be compelling to the sufferer. There have been notable instances of spiritual leaders going off the rails and abusing their disciples in various ways while still themselves believing that they were being God’s gift to the world.

Sometimes self-inflation can take a more specific form, well documented in the writings of C G Jung where, as he would put it, the personality becomes inflated by an archetype. The person starts to act as though they themselves embody and incarnate a particular archetypal energy. This might be the saviour, the earth mother, the eternal child, the trickster, or whatever. The person is now, as it were, living directly off a particular instinctive energy without any filtering by anxiety born of experience. Such people can be charismatic and compelling to others. They may readily draw a following of people who enjoy the vibrant energy that surrounds such a person. Some meditation practices involve the practitioner in self-identifying with a deity. If such identification becomes “real” for the practitioner, inflation of this kind can sometimes occur.

It is worth noting that this kind of meditation disease is not the same as charlatanry. The person is genuine in his or her self-belief, even though it may be misguided. The charlatan is somebody who deliberately contrives to pretend to a position whereas the self-inflated person is not consciously tricking anybody.

Reactivated Ego Extremes
Any pre-existing ego state can be reactivated or even amplified or exacerbated by meditation practice. In modern thinking such states can be broadly divided into mild (neurotic) and severe (psychotic). This is not the place to give a full tabulation of such conditions. Simply put, neuroses are conditions characterised by unnecessary or inappropriate fear, worry or depletion of energy whereas psychotic ones are states of more severe detachment from ordinary reality. The former can include obsessions, phobias, anxiety states and melancholy. The latter may include paranoia, megalomania, hearing voices, hallucinations, ideas of reference, mania, so-called endogenous depression and other conditions in which the person lives to a substantial degree in a self-generated illusory world. All such states can be considered to be exaggerated ego responses and, only excluding those who are totally spiritually enlightened, everybody has some such elements in some degree.

When such conditions are acute meditation is counter-indicated. Thus a person who has recently suffered a major bereavement should be weeping, not meditating. In many cases, however, it is impossible to discern the underlying condition. A person may present as completely “normal” yet be carrying within all manner of hang-ups. The discipline and sensory deprivation of many meditation practices may trigger old patterns. Such ego structures are essentially defenses against internalised passions and meditation is a process that accesses and investigates such internal formations, bringing to the surface content that may have been repressed in the past.

Reactivated extreme ego states are a sixth category of meditation sickness..

Loss of contact with instinctive signals
Meditation may increase conscious awareness of bodily signs and signals but increased consciousness may interfere with a more natural connection. It is a common mistake in spirituality to over-value consciousness as though it were the goal of practice. At certain times and phases, one needs conscious awareness and it can be an important stage in learning, but it should not be taken as a goal in and of itself. In excess, it can be counter-productive. Most bodily processes work best without conscious interference. One’s heart, liver, stomach and so on all function perfectly well without instructions from the conscious mind. A central element of consciousness is doubt and an excess of awareness problematises processes that should proceed naturally. A condition can thus arise in which the person loses a natural, unthinking connection with hunger, thirst, the impulse to sleep, feelings of heat and cold and so on. Such detachment from the body can, in some ways, be a spiritual gain, but it can easily also become a handicap. Zen stories that depict enlightenment as a state in which “When hungry, eat, when tired, sleep,” are seeking to guard against this pitfall.

The person who has excessively sought conscious control of bodily processes through yogic or meditational exercises may arrive at a state in which their embodied existence has become endlessly problematic to them. Such a person may easily ruin their physical health by adopting an outlandish diet, disregarding the response of their own body, may deprive themselves of sleep to a degree that induces other physical or psychological symptoms and generally may become a psychological wreck. Typically such people are resistant to any sane advice because they judge that the person who advises healthy living is still a slave to the body and in an inferior spiritual condition to themselves.

Confusion or destruction of the body’s natural “wiring” is thus a seventh kind of meditation sickness.

Accidie (from the Greek akēdia) is a state of jadedness or carelessness. This is a meditation sickness that can afflict practitioners of long standing. They may have made some progress in their spiritual life, but arrived at a staleness. Nothing seems to matter anymore. Why practice? Why bother to do anything? There seems no answer. This may afflict the person who lives in solitude. It can also affect the person who lives in a monastery, who goes through the motions of monastic life but for whom it has all become meaningless. This kind of apathy can be regarded as a deficiency of love. Spiritual disciplines may seek to reduce passion and eros but when this goes too far, accidie is the result.
One sometimes sees a similar condition in refugees or people who have been uprooted from or lost connection with the people and conditions that gave their life meaning and purpose. In this latter case the connections of meaning have been broken by traumatic circumstance. In the case of accidie they have been ruptured by the erosion of meaning brought about by deconstructive meditations. Meditations that deconstruct worldly circumstance can be valuable in revealing impermanence and showing the connection between physical being and the natural elements, but carried to excess they leave the practitioner in a state of helpless anomie.

Accidie is a meditation sickness.


It would be satisfying to be able to produce a corresponding list with remedies for each of the above conditions. This, however, is not appropriate because in general those suffering from such states do not see themselves as having a problem and do not seek a remedy. The condition may be recognised by others and sometimes they might be able to intervene in helpful ways, but most of these maladies are, as one might say, dead ends.

Calling them illnesses or sicknesses is only a metaphor. They have in common with medical conditions that they can lay a person low and interfere with ordinary life but they are not spread by germs or viruses and cannot be cured by the administration of a medicine.

The table below shows some of the structure and correspondences of these conditions. However, it is generally of no use to tell a person that they are suffering from such-and-such a condition, are deficient in this or that and need to rectify the situation. The person will dismiss such information and it may even serve to alienate them and make them more resistant to change. A longer, more oblique or subtle approach is needed. This is all clear from the parable of the prodigal son in the Lotus Sutra,

If we can talk of a cure at all then it must be, in every case, some skilful combination of wisdom and compassion. This is because, when we examine the ailments closely, we see that they each involve some combination of, firstly, alienation from reality and, secondly, misunderstanding. The former is a deficiency of love and the latter of wisdom. One or other of these deficiencies generally predominates. If the guide remains humble, patient, empathic and intrepid, well-grounded and full of fellow-feeling, then he or she will provide a loving example and this will create good conditions, but such humility and patience begins with the awareness that we all suffer from all of these problems in some degree. They are considered “sicknesses” when they run to an extreme, but we all are prey to similar delusions at times.

Unsustainable infatuation Mistaking the purpose Patience Wisdom
Search for highs Mistaking the purpose     Inspiration     Compassion
Heavenly states Mistaking the goal Fortitude Wisdom
Emptiness disease Mistaking the goal Empathy Compassion
Self-inflation Ego excess Humility Wisdom
Old ego states Ego excess Faith Compassion
Loss of instinctive connection     Eros deficiency Grounding Wisdom
Accidie Eros deficiency Love Compassion

The above table provides a rough outline of correspondences. In reality nothing is so neat or organised. People are complex. It is never the case that a person is fulfilled in all qualities except one in which they are totally deficient. In reality they have innumerable qualities each in some degree, none fully developed but none totally absent. Consequently, there are rarely simple solutions. Each person is on a path and they may have become stuck for a time, but it is like a stick floating down a river. It may get caught in a backwater, but sooner or later something will change and it will be back in the flow. As in this analogy, the thing that moves a person on is not necessarily something that appears benign at first sight. The winter flood may carry the stick down stream. In the same way, it may be some crisis in life that overwhelms the practitioner's delusion and forces him or her back into the current.

In the story in the sutra, a young man leaves home and goes out into the world and loses his way and his fortune and becomes impoverished. Meanwhile, his father has become rich and successful. One day the son wanders into the town where the father now lives. He sees the father but does not recognise him. He immediately thinks that such a superior man would have no time for the like of himself and fears being captured and enslaved, so he runs away. However the father has seen and recognised the son. For years now the father has been missing the son, but he realises that the son is now frightened of him and unable to recognise the true situation. The father sends one of his men to befriend the son. The man does so and tells the son that there is a menial job going at the big house. The son starts to work in the father’s stables. The father then, from time to time, comes and works alongside him, reducing the son’s fear. Gradually the father advances the son, giving him new responsibilities. Eventually there comes a day when the father jdges that the true situation can be revealed, the son is acknowledged and there is general rejoicing.

We can see many important elements in this story. The “father” here is the spiritual guide and the “son” is the practitioner who has a meditation sickness. The father sees the son but the son does not recognise the father. In other words, the practitioner does not see the problem. The guide sees the problem but cannot do anything about it directly. He has to find a skilful means. The father ponders the matter and finds ways to involve the son based on the son’s existing knowledge and attitude. He gives him things to do that correspond with whatever motivation or felt need the son already does have. The son’s deficiency must be exploited in a way that ultimately leads to a cure. Involving the son provides opportunities for the father to get closer to him. The practitioner gradually comes to trust the guide more and in new ways. Initially, the practitioner may admire the guide from a distance, but tends to view him as belonging to a different species. The father comes down to the level of the son, working beside him. There is a touching moment in the diary of my teacher when she is working with other trainees in the monastery grounds gathering leaves into sacks when she notices that the man wearing the same working clothes working alongside her is the supreme abbot. This moment breaks through one of her stereotypes and releases her to think in new ways. It takes time, patience and care for the father to gradually coax the son into a new perspective. All this is somewhat like approaching a timid animal. The practitioner is not yet ready to understand the true nature of the compassion of the guide which is not based upon superiority but upon a deep family feeling.

Underpinning both love and wisdom there is always faith. It is an act of faith to love and it takes faith to face the truth of life and not run away. We can see the story as one in which the faith of the son is gradually restored and builds until it is strong enough to take on progressively more responsibility, overcome fear and draw closer to the father. The spiritual guide should be amply provided with these three qualities - faith, wisdom and love-compassion. However, even were one as equipped as Buddha himself, one could not heal every case immediately. There are times when a person can be moved along and there are times when they are stuck and nothing can be done until a change of conditions provides an opportunity. In such therapeutic work timing is a vital factor. When he is dying the Buddha says that those who were ready for it he has helped to cross over and those who were not yet ready must await another time. The great sage Honen, in one of his writings, lamants “Where was I at the time of Shakyamuni Buddha. I must, at that time, have just been one of the ignorant masses unable to benefit from the precious gift of the Dharma.”


Meditation sickness is different from obstacles to meditation. Obstacles can be overcome by actual meditation practice. Sicknesses are the result of meditation that has gone astray. The practitioner can be expected to fall sick in this sense from time to time and for periods along the way. A skilful guide or good spiritual friends may be able to help the person get back on track or it may be a matter of waiting for a change of life circumstance or divine intervention. However, in this dark age of the Dharma, we are the sick treating the sick, the blind leading the blind. The teacher is, as Chogyam Trumpa said, only a more advanced student, another mortal vulnerable to the same plague.

In this essay I have not addressed the question of obstacles as there is much written on the subject elsewhere. Nor have I spoken about different kinds of meditation and their specific advantages and characteristic pitfalls. Clearly different styles of practice attract different types of practitioner and each has its advantages and its risks. That is material for another essay another day.

The eight kinds of sickness sketched out here may give a rough and ready framework for thinking about the pitfalls of the path and, hopefully, this may help the practitioner to beware and the guide to be patient. Sometimes we are in the one role and sometimes in the other. We are all students and there are always other students to be helped along. If I help you with your homework, perhaps you will help me with mine.

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Thank you for this. Much to contemplate.


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