Dear DhO,

As many of you probably already know, one of my main projects these days it the EPRC which is mainly about how the clinical mainstream can better understand the deep end of human experience, stuff here we often call things insight stages, jhanas, awakening, kriyas, energy stuff, powers, entities, etc. — all the highs, lows, weirds and plateaus of the path. 

So, I thought I would start a thread dedicated to what people on the DhO wished that the clinical mainstream, doctors, APPs (PAs, NPs), psychologists, clinical social workers, etc. all knew about this such that they could best understand, normalize, and support good outcomes, reduce harm, and be thoroughly competent in what we routinely discuss and consider normal here on the DhO. 

Put another way, were we building a fellowship level educational curriculum, meaning post-doctoral level, meaning the highest level of detailed academic knowledge, what would that curriculum include, at a minimum, in terms of topics, modules, terms, concepts, etc.? Said another way, in an ideal world, what would the clinical mainstream know to be totally awesome about this stuff?

I mean not just the obvious stuff, like not automatically diagnosing the A&P to DN as bipolar and putting you on meds and saying you are broken for life, but also the positive psychology stuff, like jhanas potentially making one more mentally resilient, or the possible range of benefits of awakening, or the healing and reality enhancements that can come from the powers on a good day, etc.

Questions such as when to try meds vs non-medication approaches for various challenges, how to establish a therapeutic relationship, what would be considered mininum knowledge for a physician to have a detailed and high-level about the risks and benefits of an intensive meditation retreat, or of psychedelics, or of intensive kundalini yoga, etc.

Please feel free to be elaborate, to add your personal stories to lend weight to why this might be important for people to know, as well as potentially adding in downstream benefits, as in, "If doctors knew this stuff was real, perhaps my family wouldn't think I was nuts..."

Thanks in advance for any help you can lend!

Long live the DhO,

Daniel
 

I wish people across all ranges of professions reminded themselves on a daily basis, even if they didn't have the insight to fully grok it, that their worldview may not be perfect and very likely is not. That it does not necessarily serve anyone to assume this is the case even though it may be a largely serviceable worldview in many instances. I wish once a day everyone on planet earth reminded themselves that "I do not know what anything is"

That everything they've heard about mindfulness is fucking bullshit and sometimes meditation can have weird effects and on a long enough timeline serious meditators will likely have to encounter all manner of extraordinarily challenging situations and that's normal and generally just another part of the process. Being a daily meditator doesn't necessarily mean "Oh well you meditate shouldn't that make you more relaxed". 

The potential "ontological" and cognitive benefits of awakening. As far as I've made it, I think better, I learn faster, I'm much more creative, much more spontaneous, way less likely to get bogged down in limiting beliefs, way more likely to rapidly iterate towards better understandings of things. This is such a massive cognitive benefit it suprises me how little it's talked about. Meditation either made me more intelligent or significantly better equipped me to actualize my existing intelligence. We're talking orders of magnitude more capable, functional, etc... no fucking nootropics required. 

I think we would make more progress on the frontiers of science if more frontier scientists were awakened. Just a suspicion of mine. 

One thing I'll say is I know people who have been recommended meditation by a therapist or councillor where I'm kind of of the mind, knowing these people well, that a serious dark night would be potentially hugely destabilizing for them and definitely not what they're after and I wouldn't personally recommend meditation to these people unless I'd seen some evidence they had a good support network, a life that can fit serious meditation practice and strong trauma/emotional coping mechanisms.

Also shrinks recommending meditation(mindfulness) when they have zero experience with it themselves is weird. 

​​​​​​​Then the converse of this, people should know, that a lot of our limitations in life and difficulties are due to neurosis' that can be largely cured by serious meditation practice. 

AND ANOTHER THING:

Learn to pick up on and respect it when people are using embodied language. 

When you go to a doctor these days they don't give a shit what intuitions you have about what's wrong or whatever. Generally it's a very different experience when you go to see a physio, they really respect that you have an awareness of your body and can do your own research whereas the last 5-6 doctors I've seen have all gotten kind of snooty and uppity about this and i know the same is true for most of my friends. I'm an insightful fucking activated human being, I live in this body everyday, I am paying waaaaaaay too much money for you to be an asshole to me because you think your worldview is superior. It's 2025, we've got google and high powered AI's what exactly is your job? yknow... GP's in particular need a course on human well being. 

I don't know anyone these days who has a good relationship with their GP and I remember growing up, the old school local doctors, highly respected and insightful members of society you know... Nowadays all of my friends have GP horror stories. People refuse to go see them because they'll just be treated like shit and charged for it. So round up all GP's and stick them in a hut in the jungle for a few years. Let em learn a little health and well being. 
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 I think there's lots of value in studying the intersection between no-self and executive function issues.

While I've achieved significant academic success, I'm also a life-long procrastinator, and from one angle my life is a continuous succession of nail-biters. My procrastination gave me a horrible, continuous case of self-hatred for a long while. It was ruining my life. The conventional wisdom about exerting willpower and constructing a white-knuckle identity just didn't work. But practicing my way to stream entry, and especially third path, has cut right through this self-hatred and perrenial struggle.

I still procrastinate, definitely, but it's no longer hell. I don't worry about exerting willpower, which is a huge relief. I allow myself to actually rest now. Before, there'd always be some process trying to pressure the mind to catch up and go faster, even in the off hours. By delegating time management to the body, I'm no longer chased around at all hours by my bottomless greed for productivity.

I think we'll look back on our present executive function interventions as pretty paltry. For one program I know of, it's mostly about organization tricks that are somewhat helpful but don't solve the main problem, which is the mismatch between the patient's intentions and behavior.

If the relevant professionals understood the severe limitations (or, you could say, non-existence) of willpower, that'd be a step in the right direction. Rather than selling patients on the expectation that they can sculpt their behavior through mental strain, there should be a frank discussion about the limits of the personal will. Maybe we should tell people that it's important to set the right intentions, and that we should adopt some executive function best-practices if we can, but that we cannot dictate our behavior. These programs could emphasize on acceptance practices, or maybe even outright insight practice in some cases. The mental move of trying to force behavior should be explicitly discouraged. 

For the right people, this sort of messaging can stop their emotional churning, freeing up energy for life or work. 

Edit: Procrastination is, to a large degree, in the eye of the beholder. By letting go of your expectations, a moment that used to be full-freakout panic about the ticking clock can be transformed into a moment of restorative peace. When the body pauses and rests, this can be understood as a necessary, inexorable, totally uncontrollable, healthy thing, rather than a cue to start generating a bunch of useless artificial tension in the cranium. One should feel safe to rest in this moment with all their being. With practice, the issue of when to get to work, and even working itself, can be fully offloaded to the body.

​​​​​​​(Long live the DhO!) 

Curriculum-wise, I don't think reading and lectures will help much here. I would like to see a material portion of the curriculum devoted to spending time at retreat centers and talking to/learning from those who have run them. I think case studies would be great, and in-person stories told by people who have had and survived serious issues related to their spiritual practice. Unless medical professionals can get a deep, emotional, empathetic, and experiential dose of these things, the lessons/learnings won't stick very well. These professionals should also begin a serious meditation practice if they haven't already.

​​​​​​​JMHO

I was going to mention Insight and Bipolarity, but I think it might be a bit more nuanced take, because I think I was actually bipolar. The relationship between insight stages and bipolar disorder is complicated, not just because one can be mistaken for the other, I actually think, based on my own story, that one can trigger the other.

More precisely, I think that my first A&P triggered not just the dukha nanas, but actual bipolar disorder. The timeline was roughly like this:

- A bunch of LSD trips in August-September '08 triggered my first A&P
- First dissolution event in December '08
- First visit to dukha nanas throughout '09, but also: a cyclic, predictable pattern of euphoria, which lasted for 1-2 weeks followed by depression, which lasted 2-4 months. Definitely correlated with insight stages, but keep reading.
- Stream entry december 30, 2009 (big thanks to Tarin Greco for guiding me on that solo retreat)
- Then, for the next 4.5 years, until roughly March 2014: the euphoria-depression cycles continue. They are still correlated with insight stages, but also, sometimes insight stages are noticed to happen out of sync of euphoria-depression cycles.
- Various kinds of experimentation with AF, including PCEs, etc. Euphoria-depression cycles continue.
- Sometime in March 2014, I understand something about the process of booting up euphoria, I understand that there is something I'm doing with my head that starts up the process, like a kind of pressing on the accelerator. This understanding would not be possible without all the training in vipassana. This training gave me the skill to notice and make sense of subtle bodily and mental phenomena. I further understand that I can stop pressing the accelerator.
- over 2-3 week period, the euphoric period tries to start up again, about 5-10 times. Each time, I get the same sense that I'm pressing the accelerator, and manage to not let it go far. The euphoria doesn't build up, doesn't get established.
- Eventually, it's a new skill. I had one or two more euphoria-starts that year, which also were let go. And there was never again a euphoric period, and never again a depressive period, in my life. Excitement, yes. Sadness, yes. Insight stages, yes. Euphoria-depression, no. We're talking more than 10 years now. My baseline mood is extremely stable, much more than it was even before bipolar disorder started, and it stays that way completely automatically.

So from this I concluded, with some confidence, that I actually was bipolar. It makes sense: my mom is bipolar, so my genetics prone to it. I can say that my descriptions of the cycles seemed very, very familiar to her. I was actually officially diagnosed as such by a psychiatrist, who prescribed antipsychotics for it, which I never took. And yet, I cured it.

So what I would really really like the medical profession, especially psychiatrists and psychologists to know is: bipolar disorder can be completely and totally cured. I'm guessing that this is also likely to be the case with depression. I also remember a poster here on the DhO who was diagnosed with schizophrenia and overcame it with the help of a lot of samatha. I sometimes fantasize about changing careers into that direction... who knows.

So I definitely think the relationship between the stages and Bipolar disorder should be investigated. I once described the path cycle to a therapist friend and they said "Are you sure you're not bipolar because it really just sounds like your bipolar" and they hinted that this elaborate phenomenological system I was describing was potentially just a prodcut of my mania. I don't hold that against them, I actually think it's a fairly cogent conclusion to come to. 

There's probably some real easy wins there in terms of research, funding, experiments etc. 

If the neurology of the A&P and Bipolar manic phase are not linked... well... By golly I will eat my hat. 

I know Frank Yang talks about meditation curing his bipolar disorder. 

I appreciate your engagement in this important matter!

Unfortunately I don’t have much to contribute, as I am an academic but not in the medical field or doing research on these matters. Also, I will not go into details on the content of possible experiences, as you literally wrote one of the “definitive books” on it and the forum is full of experienced people. Rather here some sociological framing and strategic remarks:

First, about the part on how to gain tolerance or empathy from professionals, which is more on a psychological or sociological level. There, I lean to the position of „Chris M“ above, that personal experience is key:

You can have read a lot and written some exams about medical conditions (mental or psychological), but lists of symptoms and conditions stay arbitrary and abstract, until the first reality check outside. Which is either
a) in first person, if you yourself alreadys had a panic attack, depressive episode, etc., or at least 
b) in second person, with the start of your first internship or practical training episode in a hospital, mental institution, etc. 
Both do confront you on an intuitive, non-intellectualized level with (1.) a particular set of conditions within (2.) a unique character of a (3.) physical person in front of you with that you have (4.) to interact with and possibly co-decide about their fate.

Everything else falls drastically short of personal experience in order to raise awareness and empathy: Even lively and colorful reports of single cases (like there are now more and more e. g. for near death experiences), that may be the best alternative to direct experience, stay superficial and not impressing on the long term for most people.

Second, about the framing of pushing such an “extra-curriculum” into already big piles of content in most studies, which is more on a strategic level of successful lobbying:

Any of the spiritual subcultures, be it in (hardcore) meditation (as here the primary focus), psychedelics, various sorts of shamanism, sects etc., are on their own too small (by participants and potential patients) to have a good case for an extra curriculum in the medical field. With perhaps the exception of the christian context, as christianity still is a mass phenomenon in the West, and many people have spiritual experiences there - but within the churches are a lot of internal pastoral care, so even with those numbers, not sufficiently patients might end up in the medical care field.

Thus, I would argue to put them all under one umbrella of “extreme spiritual experiences”. 
Despite their huge differences, they all can induce the same emergency cases of spiritual distress up to full mental crises and states of emergency. 
By that, they also would be in one bag with some already a bit more established topics, like “near death experiences” (e.g. Dr. Bruce Greyson), broader spirituality (e. g. Dr. Lisa Miller) etc., which makes it more likely that there is not so much opposition against implementation.

Third, it is important to focus only on cases, that were not caused negligent or for hedonistic reasons (street or party drugs), but either due to accidents (near death, sudden A&Ps) or following actions that had a positive motivation for one’s life (religious, spiritual or meditative practices). That is key to get those people out of the box of the usual cases with mostly devaluated social backgrounds.

Combining those three points, I would argue, that it is neither important nor feasible, that medical professionals (meaning, generalists, not experts on specific fields) will get to learn full catalogs of vague and broad symptoms of various psychedelics, meditation states, etc., (beyond as a digression on the last pages/slides of the lecture) but that it is enough and feasible, that by some sort of practical and direct experience, the curriculum highers the chances for a high quota of medical professionals develop a basic knowledge of and and principal empathy for any form of spiritual emergency state (with socially accepted, positive backgrounds).

I can imagine various ways, that differ in length, personal commitment and feasibility (legally and politically), that one should take into consideration in order to try to lobby that into any curriculum: 

A) Psychedelic experience (Psylos, Ayahusaca, LSD,)
–> Fast, easy, near 100% success – but less feasible concerning legal and political reasons

Meditation boot camp (practical training, let’s say 7 days).
–> relatively condensed but still a lot of time and costs, also perhaps only 50% success quota (because people will not be equally committed as the current volunteers in meditation retreats), not many legal or political problems.

C) Witnessing sessions (of psychedelic psychotherapy or at least some daily reportings during a meditation retreat)
–> relatively low time effort (e. g. 1 day), legally and politically easy, relatively lively and can still be quite impressive. It would important to keep those always within a positive setting (so not negative settings, e. g. the drug help tent on a festival, where only really wasted people will show up).

D) interviews with practitioners
–> also time consuming, also too abstract and probably low impact, because artificial and controlled interview setting and only talking about it rather than experiencing something.

[That all of course additionally to any of the classical educational tools, that are fast, easy, non-problematic, but lacks any real impact for most people.]

--> I would say, Option C, witnessing controlled sessions or reportings, has the best combination of all the factors. Maybe, it would be worth to develop and lobby for such programs for students in the medial field?

I hope it is not too obvious or all besides the point – or both ; )

Not to derail the thread, but on the topic of bipolarity and insight stages, I feel like it may just be an unavoidable consequence of gaining access to the pleasure centres of the brain, that some degree of abuse of their mechanics occurs, wether that's a single episode or drawn out over years. Perhaps people prone to bipolarity have a similar degree of control or momentum as someone going through the insight stages, and that the unlearning of the pressing on the accelerator, as Bruno described it, requires dedicated time and attention.

Just one thing to add here: 

I think it should be avoided at all costs to label this whole field of emergent phemomena in any way as "extreme". 

In the same way that people working in the field of human health often express that the human body seems to be adapted to and thrives with significant levels of mobility, strength, respiratory capacity, etc., that might seem "extremely athletic" to a largely sedentary culture that is eating a heavily processed diet, it seems that jhanic capabilites, ditching the subject/object split etc. are normal expressions of what, for the sake of brevity, "attention physiology" can do and is adapted to do. 

All six major reward hormones as a result of getting into a garden variety flow state seems to me to say that the brain seems adapted to high levels of effortless concentration, for example. When I look at what Daniel P. Brown wrote about attention training in children and adolescents, it seems this field should be investigated as the normal range of what attention physiology can do and how to train/teach it under what circumstances, not as stuff that happens to fringe extremists. 

I have to think of Daniel Ingram saying on a podcast that 4th path was hard, but not as hard as getting an MD, but in other conversations refering to meditation practice as similar to extreme altitude mountaineering. I question whether the latter is all that helpful. We have to say "hardcore meditation" largely because of the MBSR industry. Before that, the "hardcore" stuff was just normal meditation. And it seems that it is another artifact of the MBSR thing that most people now have a very careless and irresponsible attitude towards their own attention physiology, since they have no idea what it can learn to do and that it is to be handled responsibly.  And so you get people crashing into silent retreats, thinking nothing of getting into high dose training that they often don't even understand.
So don't simplify it like the MBSR thing (Brandolini's law - Wikipedia), and don't mark it as extreme. Neither fosters responsible learning. 

There are all the documented risks, side effects, etc. Of ocurse. But this to me only means that this area is to be communicated and handled with the necessary knowledge and care from the very get go, in the same way that driving a car or becoming a parent or a doctor ideally is something that you don't just toy with. But neither would you consider these endeavors "extreme." Most of the things worth cultivating have risks and sideeffects and take time and a careful attention to detail to to cultivate, with a significant growth curve that is not only possible but often quite normal. So labeling a significant and quite normal growthcurve "extreme" just because we are, in relation to attention physiology, a largely sedentary culture on a diet of "highly processed mediation-like activities" - I think this only perpetuates a childlike and irresponsible attitude towards such matters. 

Normalize high levels of attention physiology training as normal, long term learning/skill development endeavors with significant growth curves as the normal scenario, to be handled with the neccessary care. 

Totally agree with pixel. It's weird how normal all this attentional stuff is that's revealed through meditation practice because it's just not  discussed in normative culture at all. 

If people had more training in this area would we be seeing so many of these UFO experiencers disclosing what are ostensibly A&P experiences. I'm overlysimplifying a topic I have very complex thoughts about but it seems to me the case that whatever else is going on 80% of these guys have a high powered A&P experience to report.

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Also, I want to say, now I'm no expert but, I often see lads with the head gear on in the lab getting the brain waves going and all that. Very cool. Might it also be worth investigating the heart, y'know like differences in the heart between an Arhat and a muggle. And are there ways to like look at physiological differences in the nervous system. I suppose there are. Big tubes with strange sensors and so on. 

​​​​​​​I think you may be able to measure enlightenment at the heart. That's probably crazy. I mean what the hell do I know. Just an idea. 

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​​​​​​​Some hallucinations are true (or true enough to be clinically useful)