Sunday, June 16, 2019

'I Do Not Exist' - Pathological Loss of Self after a Buddhist Retreat

Eve is plagued by a waking nightmare.

‘I do not exist. All you see is a shell with no being inside, a mask covering nothingness. I am no one and no thing. I am the unborn, the non-existent.’

– from Pickering (2019).

Dr. Judith Pickering is a psychotherapist and Jungian Analyst in Sydney, Australia. Her patient ‘Eve’ is an “anonymous, fictionalised amalgam of patients suffering disorders of self.”   Eve had a psychotic episode while attending a Tibetan Buddhist retreat.
“She felt that she was no more than an amoeba-like semblance of pre-life with no form, no substance, no past, no future, no sense of on-going being.”

Eve's fractured sense of self preceded the retreat. In fact, she was drawn to Buddhist philosophy precisely because of its negation of self. In the doctrine of non-being (anātman), “there is no unchanging, permanent self, soul, or essence in living beings.” The tenet of emptiness (śūnyatā) that “all things are empty [or void] of intrinsic existence” was problematic as well. When applied and interpreted incorrectly, śūnyatā and anātman can resemble or precipitate disorders of the self.

Dr. Pickering noted:
‘Eve’ is representative of a number of patients suffering both derealisation and depersonalisation. They doubt the existence of the outer world (derealisation) and fear that they do not exist. In place of a sense of self, they have but an empty core inside (depersonalisation).

How do you find your way back to your self after that? Will the psychotic episode respond to neuroleptics or mood stabilizers?

The current article takes a decidedly different approach from this blog's usual themes of neuroimaging, cognitive neuroscience, and psychopharmacology. Spirituality, dreams, and the unconscious play an important role in Jungian psychology. Pickering mentions the Object Relations School, Attachment Theory, Field Theory, The Relational School, the Conversational Model, Intersubjectivity Theory and Infant Research. She cites Winnicott, Bowlby, and Bion (not Blanke & Arzy 2005, Kas et al. 2014, or Seth et al. 2012).

Why did I read this paper? Sometimes it's useful to consider the value of alternate perspectives. Now we can examine the potential hazards of teaching overly Westernized conceptions of Buddhist philosophy.1 

When Westerners Attend Large Buddhist Retreats

Eve’s existential predicament exemplifies a more general area of concern found in situations involving Western practitioners of Buddhism, whether in traditional settings in Asia, or Western settings ostensibly adapted to the Western mind. Have there been problems of translation in regard to Buddhist teachings on anātman (non-self) as implying the self is completely non-existent, and interpretations of śūnyatā (emptiness) as meaning all reality is non-existent, or void?
. . .

This relates to another issue concerning situations where Westerners attend large Buddhist retreats in which personalised psycho-spiritual care may be lacking. Traditionally, a Buddhist master would know the student well and carefully select appropriate teachings and practices according to a disciple’s psychological, physical and spiritual predispositions, proficiency and maturity. For example, teaching emptiness or śūnyatā to someone who is not ready can be extremely harmful. As well as being detrimental for the student, it puts the teacher at risk of a major ethical infringement...

I found Dr. Pickering's discussion of Nameless Dread to be especially compelling.

Nameless Dread

I open the door to a white, frozen mask. I know immediately that Eve has disappeared again into what she calls ‘the void’. She sits down like an automaton, stares in stony silence at the wall as if staring into space. I do not exist for her, she is totally isolated in her own realm of non-existence.

The sense of deadly despair pervades the room. I feel myself fading into nothingness, this realm of absence, unmitigated, bleakness and blankness.We sit in silence, sometimes for session after session. I wonder what on earth do I have to offer her? Nothing, it seems.

ADDENDUM (June 18 2019): A reader alerted me to a tragic story two years ago in Pennsylvania, where a young woman ultimately died by suicide after experiencing a psychotic episode during an intensive 10-day meditation retreat. The article noted:
"One of the documented but rare adverse side effects from intense meditation retreats can be depersonalization disorder. People need to have an especially strong ego, or sense of self, to be able to withstand the strictness and severity of the retreats."

Case reports of extreme adverse events are rare, but a 2017 study documented "meditation-related challenges" in Western Buddhists. The authors conducted detailed qualitative interviews in 60 people who engaged in a variety of Buddhist meditation practices (Lindahl et al., 2017). Thematic analysis revealed a taxonomy of 59 experiences across seven domains (I've appended a table at the end of the post). The authors found a wide range of responses: "The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring." The paper is open access, and Brown University issued an excellent press release.


1 This is especially important given the appropriation of semi-spiritual versions of yoga and mindfulness, culminating in inanities such as tech bro eating disorders.


Blanke O, Arzy S. (2005). The out-of-body experience: disturbed self-processing at the temporo-parietal junction. Neuroscientist 11:16-24.

Kas A, Lavault S, Habert MO, Arnulf I. (2014) Feeling unreal: a functional imaging study in patients with Kleine-Levin syndrome. Brain 137: 2077-2087.

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.

Pickering J. (2019). 'I Do Not Exist': Pathologies of Self Among Western Buddhists. J Relig Health 58(3):748-769.

Seth AK, Suzuki K, Critchley HD. (2012). An interoceptive predictive coding model of conscious presence. Front Psychol. 2:395.

Further Reading

Derealization / Dying

Feeling Mighty Unreal: Derealization in Kleine-Levin Syndrome

A Detached Sense of Self Associated with Altered Neural Responses to Mirror Touch

Phenomenology coding structure (Table 4, Lindahl et al., 2017).

- click table for a larger view -

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At June 17, 2019 10:16 AM, Anonymous derda123 said...

Thank you very much for this interesting post. For someone who suffers/suffered from Derealization and also following a meditation habit this post contains a lot I can identify with and also with experiences I have discovered during meditation and therapy. The feeling of utter void and nothingness, a sort of 'evil infinity' is exactly how I would describe what I have encountered during my initial cannabis trip that triggered my DP/DR experience and also the subsequent DP/DR experience itself. With lot's of therapy, self-inquiry and meditation, more than a decade later, I have made contact the underlying experience from my very early childhood: A sense of being alone in a dark, vast, empty and hostile space, with no 'other' there to answer my calls, a terrifying experience. Luckily meditation (and a handful of these 10-day retreats) was for me a way to slowly approach these experiences, look at them, re-assess them and heal this inner part that made these experiences and did not spiral me down further. The article, and Eves experiences, resonated with me on many levels and puts in words what I have been experiencing as well (sans the ego-loss and not even remotely as extreme as the case of Eve). I have always been wondering what all this DP/DR is about, where and why it comes about. Slowly I gain to realize how this whole inner system of self and other, non-self and non-other seems to work. How deeply DP/DR is connected with connection to 'other' and the subsequent fear of actual contact, stemming from the deeply rooted experience and belief of non-contact. Still the philosophical dilemma of self vs. other does not feel solved entirely, from a psychoanalytical viewpoint, and the resolution that the author gives in the last paragraph does not make sense to me yet. The Buddhist approach seems at least somewhat satisfying. (I hope all of this makes sense to you ;-) just thought I wanted to share some of my experience this way).

At June 17, 2019 10:59 AM, Blogger The Neurocritic said...

I'm glad you appreciated the post. Thanks for sharing your experiences.

At June 17, 2019 11:12 AM, Anonymous Anonymous said...

Reminded me of this story:

A young girl returns from a 10-day meditation retreat, clearly disturbed, and commits suicide shortly after.

At June 17, 2019 10:43 PM, Blogger The Neurocritic said...

Thanks very much for the link. I hadn't heard about that tragic story.

At June 20, 2019 8:52 PM, Blogger Ray Davis said...

Of course, Western religion and philosophy have their own long, sad histories of blowing minds down & out. Among philosophers, Nietzsche may hold the numerical record, but the first example I thought of when I read your summary was Heinrich von Kleist's "Kant crisis." (My own hollow shell found its stable foundation through the sequence Kant-to-Nagarjuna-to-Nietzsche.)

At June 23, 2019 4:31 AM, Blogger Jayarava said...

On the other hand one might cite the example of Sally Clay who had a psychotic episode that started out as a spiritual visions and then descended into madness. She used Tibetan Buddhist practices to integrate the experience and regain her mental health. Her story was recounted in an essay titled Wounded Prophet (she hasn't kept ownership of the domain so this is a archive link).

At June 23, 2019 7:35 PM, Anonymous David J Littleboy said...

tl;dr: You are exactly right to look at Buddhism in America as an American phenomenon, and that any problems that occur need to be explained in terms of what actually goes on in Buddhism in America.

Anyway, having lived in Japan over 30 years, my impression is that anything and everything Americans think about Buddhism is completely unrelated to anything any Japanese, even Japanese monks and Japanese religious studies academics, would recognize as Buddhism. For the non-specialist Japanese, Buddhism looks and sounds a lot more like Catholicism than anything else. (If, for example one listens to what Buddhist monks say to the bereaved at funerals. Or observes the extent of the bling, pomp, and circumstance. I once generalized that such and such a sect wasn't into the bling thing, and was told in no uncertain terms that the amount of bling is related to the size and affluence of the community that supports the temple in question, not the sect. Japanese Buddhists love gold leaf on their stuff.)

FWIW, the main interaction between non-specialist Japanese and Buddhism is funerals, since the Buddhists here have a near monopoly on the funeral business. Also FWIW, Christianity doesn't do very well in Japan: official figures are in the 2 to 3% range, but I'd put the number of believers at well under 1%. The Japanese themselves joke that Japanese are born and grow up Shinto, marry Christian, and die Buddhist. And it's not all that wrong.

(Except in the literary community, where French literature is seen as being closest intellectually (in terms of literary theory and development) and quite a few major authors convert to/are deeply concerned with Catholicism.)

Also FWIW, the current right wing government here recently carried out a series of executions of death penalty case defendants that included the last of the convicted Aum Shinrikyo defendants (the leaders of the Buddhist cult that attacked the Tokyo subways with nerve gas). There was some discussion in the newspapers, including a rehash of the criticism of the academic religious studies types who had been defending the Aum Shinrikyo Buddhist cult against investigative reporters who argued that they were dangerous. The point being that being an academic specialist in something makes it hard for one to be adequately critical of that something. The idea of Buddhists using nerve gas doesn't compute for Americans, but it's the reality the Japanese face.

Anyway, since you've got the right idea, the above is just (opinionated!) background. Folks with different axes to grind than mine will disagree.

At June 24, 2019 9:38 AM, Blogger The Neurocritic said...

David - thanks for your insights. You lived in Japan for 30 years, you're entitled to be opinionated about American Buddhism!

At September 06, 2020 7:20 AM, Blogger Eric said...

Here we are the best example of the wrong buddhism interpretation.The problem is that often the buddhism teachings of emptiness in west and also often in Asia are wrong. Sunyata doesn't mean emptiness but also doesn't mean existence. It is actually existence but beyond perception which can be understood via training which goes beyond that duality. Already Vasubandhu and his Yogacara school ages ago cleared it up. The problem is with wrong translation and the intellectual pseudo buddhism. She needed psychiatrist first not buddhism.


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