Illustrations by Jialun Deng

On a cloudless afternoon in March 2017, Megan Vogt drove her truck toward a Delaware town between the coastal plain and the foothills of the Appalachians. She was on her way to a silent retreat at Dhamma Pubbananda, a meditation center specializing in a practice called vipassana, which its website describes as a “universal remedy for universal ills” that provides “total liberation from all defilements, all impurities, all suffering.” Those who attend Dhamma Pubbananda’s retreats pledge to observe strict rules (no reading, no dancing, no praying) and to stay for the whole ten days, as it is “both disadvantageous and inadvisable to leave . . . upon finding the discipline too difficult.” Megan knew that she’d have to forfeit her cell phone and observe a mandatory “noble silence,” so she called her mother one last time. “I love you, I love you, I love you,” she said. “I’ll talk to you in ten days.”

On the first day of the retreat, Megan, a cheerful twenty-five-year-old with blue eyes and shoulder-length hair dyed a cardinal red, woke at four o’clock in the morning to the chiming of a bell. For a cumulative ten hours and forty-five minutes, she sat cross-legged on a rug, her spine erect, and tried to focus on her breath. During breaks, she walked among the beech trees and orange lilies on the center’s thirteen acres. That evening, everyone gathered in the meditation hall and an instructor inserted a videotape into an old VCR. On the screen was an elderly man with soft, hooded eyes, sitting cross-legged on the floor. Satya Narayan Goenka, a Burmese businessman turned guru, had taken up meditation in the Fifties, hoping to alleviate his chronic migraines, and was so happy with the results that he went on to establish a global network of more than one hundred vipassana centers. Goenka died in 2013, but students on his retreats still receive much of their instruction from grainy recordings of the master himself.

“The first day is over,” Goenka said. “You have nine more left to work.” His voice was gravelly, his demeanor almost soporific. “To get the best result of your stay here, you have to work very hard,” he said. “Diligently, ardently, patiently, but persistently, continuously.” He spoke of the difficulties students would encounter in the coming days. “The body starts revolting. ‘I don’t like it.’ The mind starts revolting. ‘I don’t like it.’ So you feel very uncomfortable.” He called the untrained mind “a bundle of knots, Gordian knots”—an engine of tension and agitation. “Everyone will realize how insane one is.” He looked into the camera with an air of sympathy. “This technique will help you,” he said. “You must go to the source of your misery.”

At the time, Megan’s life was in flux—she had just gone through a breakup and decided to move to Utah, where she planned to work on an organic farm. Ten days of meditation sounded restorative, a way of turning the page to a new chapter. She found the early days of the retreat physically challenging in the ordinary sense: she had aching knees, a sore lower back, hunger pangs. But it was nothing she wasn’t used to from her time as an AmeriCorps volunteer, maintaining hiking trails out West, or the months she’d spent camping in national parks.

On the morning of the seventh day, Megan went outside to meditate alone under a tree. She had by now logged more than sixty hours of meditation. She wasn’t sure how long she sat there. “Time had slowed down,” she later wrote. The ferns and grasses were vibrating; they were made of vibrations, just as she was. Megan felt an exquisite serenity unlike any she had ever known. Tears came to her eyes. “I was so happy. I finally knew my place in the world. I was a child of the earth and I needed to share my joy.”

But hours later, Megan’s bliss dissipated. She became tired, then drained. She lay down on her bed and could not marshal the energy to get back up. The next meditation session was starting. She felt heavy, responsible for everything that was wrong in the world. Maybe I’m holy, she thought. Maybe I was put here to heal everyone. She forced herself upright and set her feet down on the floor.

Walking into the meditation hall, Megan looked at the rows of silent meditators, their eyes closed or staring vacantly at the wall. A surge of “immense fear” coursed through her body and she found herself panicking, unable to move. “I just zoned out into space,” she wrote later. “I can’t remember where I am. Who I am. What I’m doing here.” Then a torrent of dark thoughts came rushing in: Is it the end of the world? Am I dying? Why can’t I function or move? I can hear the Buddha now. He is telling me to meditate. I can’t, I’m so confused. Is this a test? Am I supposed to yell out “I accept Jesus as my Lord and Savior?” What am I supposed to do? I am so confused.

Meditation, which began as a practice among Buddhist renunciants living in monasteries, hermitages, and caves in the fifth century bc, is now a part of mainstream American culture. Countless books, magazine articles, YouTube videos, apps, and corporate wellness programs celebrate its benefits to our cognitive, emotional, and physical well-being. The market for meditation products and services in the United States is valued at $1.2 billion. In 2017, by one conservative estimate, some 15 percent of American adults engaged in “mental exercise to reach a heightened level of spiritual awareness or mindfulness.” Arianna Huffington captured the pop-psych view of meditation and mindfulness in an interview during the promotional tour for Thrive, her 2014 self-help book: “The list of all the conditions that these practices impact for the better—depression, anxiety, heart disease, memory, aging, creativity—sounds like a label on snake oil from the nineteenth century,” she said. “Except this cure-all is real, and there are no toxic side effects.”

Unfortunately, Huffington was wrong. Although there is data supporting the positive effects of meditation, the scientific literature is murkier than some champions of the practice would like to believe, and the possibility of negative outcomes cannot be so easily dismissed. As early as 1976, Arnold Lazarus, one of the forefathers of cognitive behavioral therapy, raised concerns about transcendental meditation, the mantra-based practice then in vogue. “When used indiscriminately,” he warned, “the procedure can precipitate serious psychiatric problems such as depression, agitation, and even schizophrenic decompensation.” Lazarus had by then treated a number of “agitated, restive” patients whose symptoms seemed to worsen after meditating. He came to believe that the practice, while beneficial for many, was likely harmful to some.

One case study, from 2007, documented a twenty-four-year-old male patient who had slipped into “a short-lasting acute psychotic state” during “an unguided and intense” meditation session. He was referred to clinicians following the onset of “an acute sensation of being mentally split.” He saw vivid colors, hallucinated, and was overcome with severe anxiety. At the height of the episode, he was tormented by “delusional convictions that he had caused the end of the world” and talked of suicide. The man had experienced one previous hypomanic episode and had a history of untreated depression. The authors posited that “meditation can act as a stressor in vulnerable patients.”

Even as academic interest in meditation has mounted, with hundreds of new papers published every year, the question of adverse effects has received little attention. Most studies don’t monitor for negative reactions, relying instead on participants to report them spontaneously. But the research that does exist is not reassuring. More than fifty published studies have documented meditation-induced mental health problems, including mania, dissociation, and psychosis. In 2012, leading meditation researchers in the United Kingdom published a set of guidelines for meditation instructors, noting “risks for participants,” including depression, traumatic flashbacks, and increased suicidal ideation. Four years later, the U.S. National Institutes of Health cautioned that “meditation could cause or worsen symptoms in people with certain psychiatric problems.” Jeffrey Lieberman, the former head of the American Psychiatric Association, told me he’d seen this in his own practice. “The clinical phenomenon is real,” he said. “There’s no question about it.”

Exactly who is vulnerable to these negative effects remains a subject of debate. Some clinicians suspect that meditation can trigger such reactions only in individuals with underlying psychiatric conditions. Vinod Srihari, of the Yale School of Medicine, explained that genetics and environmental factors can come together to kindle the onset of psychosis. “For people already at risk for a psychotic disorder, to have a first break on an extended meditation retreat makes sense logically.” Lieberman posits that most cases likely involve a latent psychiatric condition that is activated by sustained or intensive meditation. These mental health crises, he believes, tend to occur in the context of a retreat, when people are meditating for hours at a time. “For most people, meditation is an either innocuous or potentially beneficial activity,” Lieberman said, “but in a small number of individuals it has the potential for psychological destabilization.”

But an alternate view has been around for decades and has recently been gaining traction. Some clinicians believe that meditation can cause psychological problems in people without underlying conditions, and that even forty minutes of meditation per day can pose risks. In 1975, The Journal of Nervous and Mental Disease published the case study of a thirty-eight-year-old woman, Mrs. M., who had no history of trauma or psychotic episodes but had begun to experience “altered reality testing and behavior” soon after taking up transcendental meditation. She was meditating for twenty minutes, twice a day. The authors, psychiatrists at the University of California, Davis, wrote that

an altered state of consciousness within days after beginning TM, and the occurrence of the “waking fantasies” shortly thereafter, leave little doubt of some causal relationship between the use of TM and the subsequent psychosis-like experience.

They concluded, “We would expect the occurrence of powerfully compelling fantasies in some portion of normal individuals utilizing depressive procedures of any form,” including meditation.

Precisely what happened after Megan’s unraveling in the meditation hall is unclear. By one account, she went outside and tried to tear down a fence. By another, she broke into uncontrollable laughter. What is certain is that one of the teachers, a middle-aged woman named Yanny Hin, realized that something was wrong. Hin found a volunteer in the kitchen, Jodi Beck, and asked her whether she’d mind attending to Megan. Beck tried having a conversation with Megan but couldn’t follow her train of thought—something about God “getting back at her” for something she’d done. Megan kept asking, “Is Jesus punishing me?” Beck told me. “She didn’t understand what was happening to her.”

As she ranted, Megan mentioned that she had stopped taking her medication. She had been on the lowest therapeutic dose of Zoloft for mild anxiety since her early twenties. Before admitting Megan to the retreat, the center’s administrators required that her doctor complete a form certifying that she was in good health. One of the questions read: “If the patient has difficulty during the course would you be available to him/her?” Megan’s provider checked yes. Hin instructed Beck to administer Megan’s pills for the remainder of the retreat, but the center did not attempt to contact Megan’s doctor.

Megan spent much of the next three days in her room, trying to concentrate on sensations in her body. Beck sat by her side. “She always had the option to leave,” Beck said. “She wanted to stay. She doubled down. She was trying so hard.” According to Beck, Megan told Hin that she felt like she was going crazy. Hin instructed Megan to focus on her breath. During one meeting, Megan had trouble sitting up, so Hin had her lie down. When Megan clenched her fists, Hin told her to focus on the feeling in her hands. “Yanny had no sense of this being anything that she couldn’t teach her way out of,” Beck told me. When Megan got agitated, “the instruction was always the same: close your eyes, go back to meditating.” (Yanny Hin declined to be interviewed for this story.)