Some of the terminology in this thread may be confusing if you have not read the book "Mastering the Core Teachings of the Buddha" ( MCTB ) by Daniel Ingram. A superficial knowledge of the terms used can be gained from reading parts of the book in the wiki or the acronym and terms thread:
http://www.dharmaoverground.org/discussion/-/message_boards/message/3906614
The full text of the book MCTB can be found here:
http://integrateddaniel.info/book/
A print version can also be purchased from the standard online stores.
A comprehensive table summary of the stages of insight can be found here.
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DISCLAIMER/WARNING:
This thread is provided for informational purposes regarding increased safety concerns and changes in practice to reduce danger. I took this thread down for 7 or 8 months or so due to the following reasons:
1. This isn't safe. The worse the illness is (or, at least, the worse the illness is when episodes are occurring) the less safe it is (particularly if psychosis/schizophrenia/psychotic features is/are involved). I have done as much as I can explaining methods to mitigate these safety problems, however, I cannot guarantee your safety even with these precautions. Please make sure to read the two links I have included as they represent the dangers very well.
2. I stated that the illness would be eliminated upon completion of all paths when in my case the mood disorder part disappeared but the psychosis part stayed and became more prominent (mild non-paranoid schizophrenia). On the other hand, I
have been able to successfully treat the symptoms with vitamins/drugs. Since my manias were atypical to begin with, this is unlikely to occur to people without schizophrenic-like manias (people who experience "classical" bipolar manias or to people who just experience hypomania - bipolar II). In any case, any statement of "cure" is likely overly optimistic and changes to the mental illness post 4th path are unpredictable and unknown as this is frontier territory. There is likely to be a change in the presentation of the illness, but that change is, so far, unpredictable..I have found that most long-term meditation sittings have a significant danger of becoming psychotomimetic in individuals predisposed to psychosis and/or mania inciting in individuals pre-disposed to mania (particularly at the A&P stage). Risk of psychosis occurs at all meditative stages..I have put forth ways to mitigate this problem, below, by drastically reducing sitting times and significantly altering the meditative technique. However, this is not a guarantee of safety.
The purpose of this post is to prevent people from practicing/meditating in the same way as a person would if they had no mental illness (since this, obviously, is even more dangerous). Please see the links for case history of dangers.********************************************************************************************************************************
I am creating this thread to refer people to a source of information regarding the issue of mental illness (bipolar disorder and its variants) and HOW TO practice if that is the case/situation.
Searching through this forum there has been much discussion about the dangers of dharma practice for those diagnosed with certain forms of mental illness (as well as for those who are not) and was the impetus for the big WARNING at the top of this forum. Given that some people, such as my former self, might try to go for it anyways, they might as well have a source of information here about how to practice, and succeed.
See below quote:
"Froth, disregarding my issues with meditation for the moment, what should be done when someone comes in complaining of depression and depersonalization and gets diagnosed instead with dark night and a glimpse of 'no-self'? There's a huge amount of overlap in symptoms when you compare conditions such as bipolar, schizophrenia, borderline personality disorder, etc with effects of meditation practice. And what about when these people are told to 'keep meditating', and 'go on a retreat for a week', and they end up in a psychiatric ward or dead? Who's there to pick up the pieces? I realize I misrepresented Daniel at the start of the thread. Beo also pointed this out. Sorry Dan. To me the degree of risk seems very high to not have it plastered in big letters at the top of the home page. That's what I want."
As someone who is a practitioner that has done/completed the stages of insight to a fairly high degree (still between 3rd/4th path - still cautious about claiming 4th) and had been "diagnosed" before starting practices with "bipolar w/ psychotic features," has been in psychiatric wards before starting any practices, been in psychiatric wards due to practices, and despite these challenges/difficulties has concluded that practice is still MOST definitely worth doing.
I feel there are some very signficant differences in practice that need to be taken for someone in these situations, but it is still very possible to be brought to the highest degrees of realization/awakening as well as the EVENTUAL likely elimination or alleviation - whether medications needs/chooses to be continued or not) of the diagnosed illness (to which I will offer various theoretical reasons as well as my own personal experience). However, the degree to which the "illness" will be absent will depend on the degree of progress.
(EDIT: While there may be changes to the illness post 4th path, they are unpredictable. See the new disclaimer at the top of the post).However, the practice requires a significant deviation from what is done on retreats/at the dharmaoverground/in mctb/or any other intensive meditative practice center. FOR SOMEONE WITH MAJOR MENTAL ILLNESS: DO NOT DO EXACTLY WHAT IS WRITTEN IN MCTB/MAHASI SYADAW PROGRESS OF INSIGHT. DO NOT GO ON A RETREAT!
For a history of these issues see the following posts (which in and themselves contain more than enough descriptive information to show just how dangerous these practices can become if the advice in this article is not followed).
http://www.dharmaoverground.org/web/guest/discussion/-/message_boards/message/3142129url=http://www.dharmaoverground.org/web/guest/discussion/-/message_boards/message/1032824Also check out a relatively old discussion started by Daniel on Bipolar Disorder and the stages of insight:
http://dharmaoverground.org/web/guest/discussion/-/message_boards/message/105357;jsessionid=FACEC1C4B8678147CC1F41742896E409?doAsUserId=U4FYRpmIICQ%3DAdmittedly these posts, despite their dramatic intensity, only contain a very small fraction of my experiences during several acute states of psychosis both as a result of too much intensive meditation after starting practices and before knowing what the dharma was.
The fact that I came out alive and thriving has to do with several factors: The ability to bounce back very very quickly (due to an understanding of dharma (or Buddhism) - whereas before knowing dharma I would never recover at all), products of my personality that involve a non-violent disposition, psychosis that retreats inward rather than outward (meaning it, for the most part, despite intensity, didn't involve interfering too much with other people and had little bleed-through). Little bleed-through both in temporal terms (I wasn't "traumatized" by any of it), and in interpersonal terms (I mostly kept to myself during these times).
The goal here isn't to get people to have these qualtiies, but to become awakened with no resultant manic/psychotic episodes at all - by approaching practice in an entirely different manner.
My working hypothesis for someone with bipolar disorder/schizoaffective is that mania/psychosis would be the only danger of practice, and clinical depression would not be a danger unless one STOPPED practice. Though passages through the dark nights may mimic some outward signs of depressed behavior, the internal experience would not be the same as clinical depression if one keeps practicing.
Therefore, clinical depression is not mentioned much in this article as I have not experienced clinical depresssion since starting a meditation practice and at this point can't imagine ever experiencing it again though my memory banks have in them some very severe instances of it before encountering the dharma. However, this does not mean that I never experienced moments of "depression/sorrow" (not clinical depression) during practice, just that these moments were very brief and passed quickly without lingering around and turning into a clinical syndrome.
I'm going to detail a practice starting from the beginning:
Before starting practice descriptions I will talk about an important philosophical point:
There are two extreme types of mentally ill individuals:
-The mentally ill individual that completely denies the psychiatric system to their detriment.-The mentally ill individual that completely embraces the psychiatric system to their detriment.I would recommend staying out of both of these extremes.
In the second category people say I AM A BIPOLAR TYPE II RAPID-CYCLING WITH DISASSOCIATIVE/DEREALIZATION TENDENCIES AND MELANCHOLIC FEATURES. Do not do this. Do not use phrases like this. This is the self/ego (no such inherent entity exists btw) looking for something to cling to, even if it is deviant/pathological/and very harmful. This is similar to the university student who proclaims to everyone: I AM AN INTERNATIONAL STUDIES MAJOR WITH AN EMPHASIS IN MIDDLE EASTERN AFFAIRS AND A MINOR IN MUSIC AND ANTHROPOLOGY.
EDIT: While these types of psychological reasons do factor into illness severity, mental illness is still significantly a biological issue, and simply avoiding these types of behaviors will not cure anyone of their illness, though it may significantly reduce some symptoms and interpersonal problems.People in the denial category range from someone with complete awareness of their problem, but is totally in love with their problems, to someone who completely denies all issues, keeps abruptly stopping their medications, and is totally out of control.
Don't be either of these extremes, nor is this article meant for someone in either of these extremes until they can let go of these behaviors. If you've already started down the path of medications and are significantly down that road, KEEP TAKING THE MEDICATIONS, but don't get too deeply involved in either of these extremes.
If you have a major mental illness AND YOU ARE NOT IN EITHER OF THE ABOVE TWO EXTREMES, then due to your experiences with lots of fleeting and constantly changing altered states you likely comprehend the statement in MCTB about the below:
In fact, not everyone is even willing to attempt to follow this advice, particularly those who buy into the dangerous paradigm that “whatever I feel right now is real” in the sense that their feelings at that moment must be the only possible valid perspective on their current situation and are thus completely justified along with their reactions to those feelings. There are those who simply don’t believe that such a wondrous and holy thing as insight practices could produce such profound difficulties. There are also those who do not believe in the maps or that the maps could possibly apply to their own very special and unique life. Lastly, there are a few whose pride and insecurity issues will not allow them to admit that they might be affected by the Dark Night in this way.
I would warn such people to STAY OUT OF THE DARK NIGHT until they come to a place where they might be able to approximate at least some aspects of the above-mentioned resolution or apply the basics of the theory behind it. That means that if you are not willing to at least try to make and live by some version of my recommended resolution, you should not do insight practices and should not cross the A&P Event.
Though, unfortunately, I'm pretty certain almost everyone with bipolar disorder has at some point crossed the A&P event. Though I have no specific research evidence for this, nor does anyone else for that matter.
If you have several suicide attempts, or have significant suicidal tendencies (many people do not have these and they are somewhat independent of seeming severity of illness), then insight practices for the forseeable future are definitely not for you and only the most basic and light forms of meditation should be done.
If you have had a "manic/hypomanic/depressive" episode, but have not yet started taking medications then read this article http://www.theroadback.org/nevertaken.aspx as well as all the writings about the stages and progression of insight. Research nutritional/vitamin approaches as supplements to medication if already started or as mono-therapy. See http://doctoryourself.com and information written further below.
Keep taking all prescribed medications as directed if you are already significantly involved in the psychiatric system and/or have had several psychiatric hospitalizations.
Training the Puppy stage:
The mind is likely a total mess, despite very likely already being involved in the first cycle of insight, someone with bipolar disorder should not do any insight practices before "training their puppy." The problem is the person is tangled up into a giant mess of insights occurring without any mindfulness/precision/practice coupled with obsessions/fixations/frustrated cravings (which I recommend some effort to pursue in daily life, but only if actually possible) and a mind that is generally far more of a mess than most "normal" people while at the same time likely crossed the A&P at some point in the past where they had a moment of "cosmic unity" or what-not and then it degenerated from there with future episodes and being somewhat misguided by worldly psychiatrists/psychotherapy/medication they are now "in the psychiatric system" and tangled into a mess of confusion.
The person may already be struggling with some delusions that may occur episodically. Generally, these delusions are related to the struggle with duality (take the ubiquitious "delusion of
reference" or "voices talking to
me" .
List of below symptoms of bipolar disorder/schizoaffective which in the past I have delineated as having experienced (with the exception of planning/attempting suicide - which I have not experienced):
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Symptoms of Bipolar Disorder.
Section II: Depression
i. DSM-IV definition
ii. Depressed Mood
iii. Lack of Interest or Pleasure
iv. Lack/Gain of Appetite
v. Insomnia/Hypersomnia
vi. Psychomotor Retardation/Agitation
vii. Fatigue and Loss of Energy
viii. Worthlessness/Guilt
ix. Inability to Think/Concentrate/Decide
x. Death and Dying/Suicidal Ideation/Planning and Attempting Suicide
xi. Lack of Bereavement
xii. Indulging in Depression
Section III: Mania
i. DSM-IV definition
ii. Grandiosity and Inflated Self-Esteem
iii. Decreased Need for Sleep
iv. Increased Talkativeness/Pressured Speech
v. Racing Thoughts/Flight of Ideas
vi. Distractibility/Attention Easily Drawn to Unimportant/Irrelevant Stimuli
vii. Goal-directed activity/Psychomotor agitation
viii. Pleasure seeking without thought of consequence
ix. Indulging in Mania
Additional Symptoms
i. Mixed States/Episodes (Mania + Depression)
ii. Hypomania
iii. Psychotic Features (Hallucinations/delusions) iv. Depersonalization and Derealization
v. Obsessive/Intrusive thoughts
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These symptoms are exagerrations of the five hindrances. However, it is a specific variant/pattern that is related to cycling.
Hindrances
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Sense Desire
Ill-will
Sloth and Torpor
Restlessness
Doubt
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-Also note that all of the above bipolar symptoms are all symptoms that can occur during dark night/three characteristics and A&P cycles (which in and of themselves occur due to alteration in hindrance levels due to insight meditation). Alteration of hindrance levels is occurring due to the struggle with duality (having a false belief in an inherently existing self/observer/controller/"I").
This is why I say the mind of a "diagnosed" bipolar individual is a total mess and thus the person must start at the very basics with the faith/goal of reaching access concentration and staying there with every sit. Personally, this took me 1.5-2 years of sitting practice before reaching this level.
How to do this:
Put the attention on the breath. "Where" the breath is located is irrelevant, put it wherever you find the breath and when it wanders bring it back. I used the nostrils mostly during this period, but it can also be the belly. The mind will wander incessantly, but keep practicing and don't give up! Try counting breaths (1-8 and then restart). When you can keep attention on the breath for several minutes without attention wandering - then that is "access concentration."
From here the first and second jhana will eventually be reached. However, I caution such individuals with major mental illness from developing the third and fourth jhanas as this sort of practice is going to require a less developed level of concentration. Why? Because despite now being able to suppress your hindrances and a seeming "recovery," your "illness" is still latent and active.
Developing too much concentration now will lead to hallucinations/problems with psychosis after starting insight practices. People with bipolar disorder are people who are already prone to too much concentration without adequate development in mindfulness/non-duality/effort. However, this "concentration" has been habitually misdirected into some obsession/fixation or other.
Once access concrentration/jhana is attained, that concentration will remain just as strong, and thus prone to out of control hallucinatory states when starting insight practices. This is coupled with a propensity for strange desires for things as they are not and a desire to indulge in such things.
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-At this point you've learned to access jhana, can sit at access concentration at a whim, have stopped all episodes by learning to suppress hindrances, are still taking meds, you've researched nutrition/vitaminsand put that into practice, and the doctor has reported that you are "very stable" and you've been strangely stable for the first time in quite some time. (certain vitamins can suppress symptoms far beyond what psychiatrists likely think is possible, but it is still a "suppression" and not a cure, as the symptoms will come back when vitamins are stopped). Though vitamins will likely have a regenerative effect that may lessen symptoms over time. Drugs do not have this effect.
Now you are ready to begin the progress of insight. If you're familiar with the three characteristics, you have been ignoring them in your practice right? You've just been doing basic mindfulness/meditation that the media talks about, not getting too heavily concentrated or getting too deep into jhana -Good, all is well.
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PROGRESS OF INSIGHT STAGE-Whereas in the previous stage you were likely able to sit as long as you wanted, you no longer have that luxury. If you have major mental illness (bipolar/schizoaffective/psychotic features) then you should not sit "on cushion" for more than 3 hours a day or go on a retreat (despite the fact that you feel fine and are stable at this point).
Sit longer than this at your own risk. I have derived this number off my own experience varying sitting times, and feel it is a good number for still making progress/keeping up momentum without going overboard. In reality, after you have path, you won't even have to sit for this long and there will only be sporadic periods where you will feel "compelled" to sit for long periods of time to keep up momentum.
Resist all temptation to sit "on cushion" for longer than 3 hours / day during these periods (that doesn't mean you can't make progress off cushion).
People with bipolar disorder don't actually have to "sit on cushion" as long as everyone else to make just as much progress. Why? Because you have more "acceleration" that has already been building up over the years and that is the problem. It's the difference between pushing down the accelerator on a ferrari vs. a ford focus (don't let that go to ego, it's just an analogy). You're going to have to push the accelerator down much more carefully and slowly to avoid wiping out.
Get a feel for what is most comfortable in the range of 1-3 hours/insight practice per day.
-Practice "light noting" OUT LOUD. Do NOT note in your head! I can't emphasize this enough. It will create a mess of spaghetti that will become tangled and may lead to mania at certain later stages such as review. Don't note every second or you will become too concentrated and thus risk lapsing into mania/psychosis. Note every 30seconds - every few minutes out loud/whisper only. If you really feel it necessary to do mental noting or find yourself doing it anyways, then switch to noting with mental pictures instead of words. However, only do this if you're able to condition things so that this is not also causing auditory mental sensations that try to interpret or read the pictures.
Maintain awareness of the three characteristics of phenomena, starting with impermanence. Focus more on the characteristics of phenomena than on noting, but still note. Important point: The three characteristics are intrinsic to phenomena and are not observed from an observer observing them. To say: "I see a sensation, and that sensation is impermanent because I'm looking at it is wrong." This particular kind of wrong view can show up when looking at visual sensations or mental sensations, so avoid those in early paths to avoid manic/psychotic responses. Notice the sensations like the ones on your fingertips and notice how they come and go. That's all.
-When going about your day note in a whisper.
-Do lots of walking meditation and note in a whisper.
-Take up basic yoga and/or basic tai chi.
-Join a gym, lift weights, run, swim
Ground yourself in bodily sensations. De-emphasize the three characteristics of mental phenomena and focus on breath, tingles in body, etc. Same goes for visual sensations. Don't mess with mental/visual sensations until attaining higher paths.
*When in equinamity be weary of review phases. All my most acute psychotic episodes that required hospitalization happened during review phases after obtaining path. Though having over-done it before this, there were definite indicators of psychosis beforehand.
Do the same for 2nd path (as 2nd path is the same as 1st)
Sitting meditation (on cushion) really needs to be taken cautiously and carefully as over-doing it on cushion will lead to problems off cushion. The problem is that you might not know you over-did it until you get up and go about your day realizing that you actually did, then it is too late as the acceleration from that sitting may lead to mania!
-That is why you should not sit for more than 3 hours a day, and should BUILD UP to that number. Start with 30 minutes /day (or even 10 or 20 minutes) for a week, then move to an hour, etc. You will, in due course, having followed all the precautions get stream entry without too much fuss. I estimate in a manner of a few months (or perhaps a year or several years which would also be sufficient).
.
[Personal note: After pushing myself way too hard and developing too strong of concentration (much harder, and unnecessarily, than I'm advocating here), I actually began to "hear voices." If this happens, keep non-duality in mind, and remember they are NOT talking to "you" as there is no independent entity here to talk to. Keep an intellectual knowledge of this available and take it moment by moment. Try taking Niacin-immediate release nicotinic acid (see doctoryourself.com), as this seems to help mask them. If you are hearing them, then this, particularly, is what led to psychosis (states of confusion - like doing hallucinogenic drugs) when hitting reviews when the mind was too powerful for its own good and couldn't handle the dualism from the voices.
Eventually this untangled and I no longer consider myself to "hear" voices (EDIT: This actually isn't true, as they are still come and go and I have had to stop meditating, for the time being, since the risk of meditation becoming psychotomimetic is too high. I have been able to largely treat most of the schizophrenia symptoms with vitamins/niacin/prescribed tranquilizers).
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After stream entry:
-Learn the "3 gears"
-Practice using the phrase "How am I experiencing this moment of being alive"
-Repeat this process until you have 2nd path
-Repeat the process again until you have 3rd path.
-Resist all urges to sit more than 3 HOURS / DAY. The urge will likely be very high at times, resist it or you will fall into the trap where you will not know you over-did it until it is too late!
-Chance of mania/psychosis is directly proportional to time spent "on the cushion" and to no other activity of being aware throughout the day. Use cushion time to hit the accelerator, then coast on that momentum throughout the day without actually "sitting on cushion."
-Be weary of review phases. Do NOT go into them with too much momentum or it may lead to mania/psychosis. Have in-person people available in case of emergency if you think you're about to hit review. The mind is much too powerful for its own good in review.
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Post 3rd path/4th path:
-You can now note in your head.
-Keep going until you are utterly happy and at peace 24/7!
-Keep to the sitting length limit!
When emptiness of phenomena is apparent in all activities (at 3rd path):
-Experiment with slowly lowering dosage of medications and notice how this affects practice/mental phenomena. Do not do this until you are at this stage, as you would not have the insight level necessary to notice such effects anyways.
-Keep practicing "How am I experiencing this moment of being alive."
-Let go of all subtle mental obsessions/fixations
-Work on eliminating all higher fetters by noticing three characteristics at chakra points.
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You did it!
As you can see this appraoch has several important elements:
-De-emphasis of "on cushion" sitting time. MAX 3 hours/day. All "on cushion time" should only be used to "hit the accelerator" and the rest of practice should be practicing "awareness" throughout the day based on that down-hill momentum.
-Lack of emphasis on samatha jhanas/strong concentration.
-If mania/psychotic features are a danger, all concentration must be kept light. [EDIT: Before insight practices concentration practices are generally mania preventive, after starting insight practices the background vipassana/struggle with duality causes situations that are potentially mania inciting if the person has a tendency towards hallucinatory states - hallucinatory states are caused by very "strong" concentration. People with bipolar II(hypomania only) may not be as prone to this problem and for them very strong concentration may be beneficial for reducing "hypomania" (mania/hypomania = increased mental proliferation]
-Noting must be kept light in the sense that it should not be forceful or done once every second, or done mentally until 3rd path (Personally, I prefer not to note verbally in the head at all ever at any path. Visual pictures of words to note is preferable)
-An emphasis on the three characteristics of bodily sensations over mental and visual sensations until at least 3rd path. Though getting involved in some amount of mental activity is likely unavoidable before then. Though try to condition yourself to do at least 80% body sensations.
Nutrition/Supplements/Vitamins - Vitamins are rather harmless, but read books by Dr. Abram Hoffer (also see www.doctoryourself.com) for more information. Talk to your doctor or see an orthomolecular physician.
Learn to recognize cerebral food allergies. Certain foods, unique to the individual, are often off-setters of symptoms. It can be difficult to recognize that it is the foods that are causing the problem, so practice elimination diets or be very conscious of what you're eating to identify problematic foods. Certain foods like milk are very common instigators.
Here is a vitamin regimen that can minimize the toxic effects of neuroleptic medications and/or reduce the risk of psychosis occurring (the most important being the niacin/b vitamins and vitamin c).
Nicotinic acid (niacin) - 1.5-9 grams/day (immediate release only ~ start in mg amounts and increase dose gradually)
Vitamin C - 3-10 grams/day
Folic Acid
Omega-3 fatty acids
B-complex
Vitamin D3
Zinc
Selenium