When Yoga Causes Psychosis

Over the years, I have read many bizarre case reports and letters in various psychiatric and psychological journals. This one takes the grand prize: "Psychotic Episode Associated With Bikram Yoga" from the current issue over the American Journal of Psychiatry. In it, a Los Angeles doc reports on a 33-year-old man who experienced psychosis apparently related to Bikram yoga (aka "hot yoga").

The author of the letter offers some medical and historical context:

"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. Castillo (5) reported that the meditative trance experiences among Indian yogis are often characterized by dissociation, hallucinations, and beliefs in possessing supernatural powers. While such experiences are typically labeled pathological by Western clinicians, they can be identified as part of spiritual awakening in Eastern meditative traditions (2, 5). Distinguishing between pathological and culturally sanctioned experiences can therefore be a clinical challenge requiring open-mindedness and sensitivity. In our patient, his experiences were recognized as pathological within the cultural framework in which he practiced yoga, and psychiatric hospitalization and antipsychotic treatment resulted in symptomatic improvement. Clinicians should screen patients for alternative therapies, including yoga, caution patients who are prone to either mania or psychosis against stress and sleep deprivation, and consider the cultural contexts of yoga-induced psychosis in order to fully help their patients in healing."

I guess the upshot of this is that if you are prone to psychosis--and, gosh, who isn't?--and are down for hot yoga, then perhaps you ought to move to India where you'll be greeted as a yogi and not someone "needing" to be committed to a psych unit.

Fascinating letter on so many levels. I mean when has any of us read a doc recommending that patients be screened for yoga background? I can hear the intake nurse at the unit: "Alcohol use? Marijuana? Street drugs? Yoga?"

OK, all joking aside, I'm not surprised that yoga might induce psychosis in some people, since intense religious and transcendental experiences have long been walking the razor's edge between enlightenment and insanity. Need evidence of that? Check out the life histories of about half of the Catholic saints, or this little old poem by my pal S.T. Coleridge:

"In Xanadu did Kubla Khan A stately pleasure-dome decree : Where Alph, the sacred river, ran Through caverns measureless to man Down to a sunless sea."

The rest is here.