In my previous post, I examined whether yoga is safe from a physiological perspective (I think its purported safety is inconclusive), and concluded that although it seems assuring that there has not been a substantial number of yoga-related adverse events reported in the medical literature, this could be due to under-reporting of such events, and therefore, more studies are needed to establish its safety.

In the study published by Cramer H, Krucoff C, and Dobos G. of the 76 unique cases of yoga-related adverse events that has been reported in the medical literature between 1969 to 2012, there was 1 case that involved a psychotic episode, and another that involved a manic episode.

I was unable to obtain further information on the manic episode (because a paid subscription to the journal is required), but further information on the psychotic episode was available in a letter published in the American Journal of Psychiatry.

The psychotic epside involved a 33-year-old man who became psychotic while participating in a Bikram yoga instructors’ training seminar that lasted several days. The man, though, had a history of brief hallucinogen-induced psychosis 10 years before this event.

In the days leading up to the episode, the man felt dehydrated, ate poorly, and slept only 2–3 hours per night. He then developed auditory and visual hallucinations (he reported seeing owls speaking to him, “cat-like slits” in people’s eyes, and a cross on his own forehead), paranoia, and a disturbing sense that there was “a battle for control of [his] mind” and that he had “betrayed God.”

He was subsequently treated with aripiprazole (an antipsychotic), and had robust improvement in his psychosis after 1 week, and complete recovery by 1 month.

“This case demonstrates that while yoga may have physical and psychological health benefits, it is not devoid of side effects. Intensive forms of yoga such as Bikram may in particular have a liability for psychotic decompensation among those individuals who are more psychosis-prone because of stress, sleep and sensory deprivation, and dissociative experiences that can arise from meditation,” noted the authors, in their letter to the American Journal of Psychiatry.

Apparently, this is not the first peer-reviewed paper that has observed a connection between yoga and mental illness. In the paper ‘The Physio-Kundalini Syndrome and Mental Illness’ that was published in 1993 in the Journal of Transpersonal Psychology, the author (Bruce Greyson) cited Yogi Gopi Krishna, who claimed ‘countless’ cases of spontaneous yoga-related kundalini-awakening that led to insanity or less severe mental illness: “Apart from psychosis. there are also many people in whom the awakening of kundalini leads to neurosis and other psychic d1sordcrs. They lead an unbalanced hfe without cross1ng the border mto the territory of the incurably insane.”

In Hinduism, the Kundalini refers to the dormant spiritual power or energy that resides at the base of the tail bone. The base of the tail bone is believed to be the location of 1 of 7 energy centres (known as ‘chakras’) in the body.

The Kundalini is represented as a coil, or a snake, which will rise with the practice of yoga, and will pass through and activate 5 other energy centers, until reaching the last one (which is located on the top of the head), and at that point, full enlightenment happens.

In physical terms, the Kundalini experience is commonly reported as a feeling of electric current running along the spine (Wikipedia). Some people experience intense involuntary, jerking movements (known as ‘kriyas’) of the body.

Unfortunately for others, their experience of Kundalini awakening is so disturbing that they require psyhiatric attention. Specifically, they may experience symptoms resembling schizophrenia — they hear internal voices (which resembles auditory hallucinations in schizophrenia), or become locked into unusual positions/postures (which resembles catatonic rigidity in schizophrenia), or have intense mood swings for no reason (which resembles the schizophrenic symptom of inappropriate affect), or experience thoughts speeding up or slowing down in kundalini awakening (which resemble the formal thought disorder of schizophrenia).

It is not clear why some individual experience psychosis (that is, a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality) during Kundalini awakening, while others don’t.  In the paper published in the Journal of Transpersonal Psychology, the author (Bruce Greyson) noted: “Some authors have asserted that kundalini awakening, or inappropriate treatment of it, is a frequent cause of psychosis; while others maintained that mental illness occurs only in individuals predisposed to it or already suffering from borderline or narcissistic pathology prior to a kundalini awakening.” Nonetheless, according to Greyson, “symptoms of the physio-kundalini syndrome (i.e. physiological symptoms associated with kundalini awakening) are reported far more often by individuals known to have experienced kundalini awakening than by psychiatric, and particularly psychotic, patients“.

In summary, there appears to be a connection between yoga and some symptoms of mental illness. This connection, however, is not entirely clear; for example, it may be that some who require psychiatric help already have an underlying mental condition that is exacerbated by yoga. Nonetheless, it has been noted that psychiatric (and, in particular, psychotic) patients are far less likely to report specific mental disturbances associated with kundalini awakening, than individuals who practice yoga that had previously claimed to have a kundalini awakening. Hence, the connection between yoga and some symptoms of mental illness cannot be rejected.