While the strong metaphysical linkage between Eastern religiosity, its psycho-spiritual practices, and health may offer important new perspectives on the relationship between religiosity and health, there are a number of practical difficulties associated with studying the epidemiology of non-Western forms of spirituality. These include:

• differing criteria of religiosity
• new confounding variables relating to language, culture, ethnicity, diet and environment
• an absence of validated and reliable measures
• accurate data regarding the background population may be unavailable.

Given these considerable limitations, the study of a Western sub-population that has adopted a well-defined aspect of Eastern religiosity may be particularly useful as it allows comparison with well-developed, validated databases and commentary while avoiding a number of the confounders mentioned above. Studies such as this may provide important conceptual bridges by which researchers can extend their understandings of the relationship between religiosity and health in non-Western groups using a common set of empirical scientific tools.

Dr Ramesh Manocha

Within the yoga tradition, meditation is defined as an experiential state of awareness specifically involving control over all aspects of mental activity. Feuerstein (2006) explains that “the initial purpose of meditation is to intercept the flux of ordinary mental activity.” He translates Patanjali’s explanation from the Yoga Sutras (aphorism 1.2) as follows: “Yoga is the control of the fluctuations of the mind” (p98).

In this paradigm the highly developed meditator is not only less stressed and more relaxed but also experiences beneficial effects on health and psyche, having activated a previously latent potential for positive psychology and optimized wellbeing.

The mental complexities with which one gradually becomes encumbered as one progresses through life can be loosely termed as “mind” and they increase in strength as one becomes more involved in the mundane. Yogic systems in fact identify the mind as not only the source of “illusion” that prevents perception of reality, but also as the ultimate source of disease. According to the yogic tradition the true aim of life is to resolve these complexities and therefore progress toward a more profound understanding of one’s self. Feuerstein translates the passage of the Yoga Bhishya (1.1) in which the five fundamental behaviour patterns of the mind are described as follows:

1. mudha – dullness;
2. kshipta – restlessness;
3. vikshipta – being intermittently distracted;
4. ekagra – being focused
5. niruddha – a state of control.

The order in which these states are cited is important; indicating a hierarchy in which the controlled mind is the most preferable. The Guru is traditionally seen as someone who, having mastered his own mind and soul, sets out to help others do the same.

Dr Ramesh Manocha

The Jadad scoring system is a widely used method of rating RCTs for basic methodological rigour. However it seems to be inadequately structured to meaningfully discern the methodological standard of meditation trials. For instance, while all trials might be randomised, only a minority described randomisation methods and few use the term “double blind”.

The blinding process in meditation trials is complex since it involves blinding of participants, raters, instructors, statisticians and other investigators.

It also demands that the comparator intervention is properly able to control for non-specific effects. Many trials feature some of these steps and others actually feature them all. And yet the Jadad score only applies one point for this crucial but complex and multifaceted factor. Similarly, very few trials described drop-outs.

The Jadad score of the studies in my review mostly ranged between 0 and 2. Trials with high scores did not seem to be much better designed than trials with lower scores. Thus the Jadad system does not usefully differentiate between trials with a methodology of a sufficient standard to discern effects specific to meditation, and those that do not have such a methodology. Despite evaluating other methodological rating systems none were appropriately orientated to be useful in discerning meditation research.

Dr Ramesh Manocha

Of great interest is that the yoga tradition does not just describe philosophical, moral, metaphysical associations between mind, behaviour and health but actually describes the mechanism by which they are interconnected. This is the system of chakras (energy plexuses) and nadis (energy channels). Described since ancient times, the physical body is said to be energized via a complex network of 72,000 nadis and their associated chakras, not unlike the ancient Western understandings of the four “humors”—blood, bile, phlegm and pneuma. Yogic exercises and disciplines are directed at manipulating the subtle energetic system in order to bring about shifts in energy flux which not only impact on physical function, but also on cognitive style, mood and consciousness.

States of enlightened consciousness, whether they be described as self-realization, moksha or sahaja can be characterized by the awakening of an energy called kundalini. This energy is said to lie dormant at or near the base of the spine. At the time of awakening it rises through the spine to enter the brain and then exit via the crown of the head. The kundalini has been described variously and has been compared to many other psycho-cultural and archetypal symbols. For a useful diagramme, see Subbarayappa, 1997.

The ancient subtle-energetic mechanics of the chakra system may offer important clues in the quest to comprehensively describe and integrate the otherwise rather disparate psycho-physiological pathways that are coming to be recognized in modern science.

Dr Ramesh Manocha

The popularity of meditation in the West has grown in parallel with the mainstreaming of alternative health and the New Age movement and is now fuelled by a potent combination of traditional anecdote, selective misreadings of the scientific database and marketing hyperbole. Popularity with consumers may well be encouraged by apparent acceptance amongst health professionals.

The scientific evidence clearly shows that prevalent definitions of meditation do not have much of an effect beyond that of simple rest. This is primarily because the original understandings of meditation and its relationship to mental silence have not been successfully translated into the West.

The current lack of clarity about definition is used by the New Age industry and entrepreneurs to perpetuate a misunderstanding of a form of meditation that is basically no more effective than sitting quietly, listening to music or walking in the park. In contrast the traditional understanding of meditation as mental silence does appear to generate scientifically verifiable effects and is therefore likely to be if considerable value to health professional and indeed modern consumers. Sahaja Yoga meditation is an example of such an approach to meditation.

Dr Ramesh Manocha

In light of the number of studies reporting adverse effects from meditation broad based surveys need to be conducted, and given that studies such as Kaldor’s (2002) suggest that up to 10% of the population may have tried meditation at some time, a direct-to-public cross sectional survey may be sufficiently effective in quantifying adverse effect rates. Also important are controlled observational studies with a specific focus on detecting, characterising and quantifying adverse reactions. Moreover, meditation should not be the only modality assessed but instead, the opportunity should be taken to assess the effects of all related quasi therapeutic practices including hypnosis, faith healing and Qigong, Reiki and other new age practices. Combining the outcomes from these different data gathering strategies on a wide variety of contemplative and new age practices will not only help us understand adverse effects associated with meditation but also provide a perspective with regard to related practices. Such information will hopefully help to explain why a practice traditionally described as beneficial seems to be associated with a consistent reporting rate of adverse events.

Dr Ramesh Manocha

In 2000 Pirrotta et al. published the results of a widely publicised survey of family physicians in Australia. Remarkably it reported that almost 80% of respondents had recommended meditation to patients at some time in the course of their practice, yet less than 35% had any formal training or education in the field. This reflects, on the one hand, the growing legitimacy of what was once regarded as a fringe concept and on the other, a lack of quality education on the topic. The medical community’s manifest interest in meditation is often construed by consumers as tacit endorsement of the practice.

Meditation arose from an ancient spiritual tradition centred in India. It has achieved substantial popularity in Western societies as a therapeutic tool as well as a method of self development. In both the East and West it is widely perceived to have potent, specific effects on both the body and mind. In Australia, a survey of a randomly selected but representative sample drawn from the state of Western Australia (n = 1,033) found that 11% of respondents had practiced meditation at least once. This reflects trends in other countries. In the United States for instance, a survey administered to 31,000 representative adults, conducted in 2002 as part of the National Health Interview Survey (NHIS) of the Centers for Disease Control and Prevention (CDC), showed that 8% of respondents had practiced meditation at some time.

Dr Ramesh Manocha.

Dr Ramesh Manocha carried out a randomised controlled trial to assess the impact Sahaja Yoga meditation (SYM) has on attention deficit hyperactivity disorder (ADHD) symptoms.

The results of this trial program indicate that SYM has potential as an adjunctive therapy for children with ADHD when offered via a family treatment approach and in combination with existing medical treatment. Although results were limited by the small number of children for whom complete data was available, the consistency of the findings, which drew on different measures of child outcomes, different groups of children and both parent and child respondents, along with the significance of the results, points to the positive potential of this approach.

Core symptoms of ADHD were improved. Parent ratings on the Connors Parent-Teacher Questionnaire, which assesses attention, hyperactivity and impulsivity, were significantly reduced over the course of the program. Children also reported that they felt calmer, less panicky, and more relaxed. Parents reported that the children’s approach to school and homework had improved during the SYM program, while the children themselves said that they were more able to concentrate at school. Improved sleep was another positive outcome reported by parents and children.

Evidence for the effectiveness of the SYM intervention, over other possible contributors was provided by the group of “wait-list” children whose baseline ADHD scores remained the same over two pre-treatment assessment points. It consequently dropped significantly over the 6-week SYM program.

Two cases are described in a report by Xu (1994). The first involved a 22 year-old man who sought treatment for lumbago and experienced the onset of adverse effects while undertaking self-teaching of the Wu Qin Xi form of Qigong. He experienced anxiety, physical pain, psychosis and suicidal thoughts. Some relief was experienced as a result of treatment by a Qigong master, but symptoms recurred. These included hearing the “voices of evil spirits”, uncontrollable behaviour and attempted suicide. Some months later he developed similar symptoms when his family would not allow him to do his Qigong exercises. He attempted suicide and was admitted to a psychiatric institution. After ECT treatment he was discharged and was subsequently stable. The second case involved a 44 year old male who developed delusional psychosis after practicing He Xiang Zhuang (a form of Qigong) for a cervical disorder.

I propose that one of the main reasons for the paucity of convincing evidence with regard to meditation is because Western scientists have failed to apprehend the key idea that underlies the meditation tradition: meditation is traditionally defined in Eastern cultures as the experience of mental silence. Modern Western understandings of meditation vary, but probably the most common understanding is that it is a method for eliciting reduction in physiological arousal. The notion that meditation involves a state of consciousness “beyond thought” seems all but absent from modern Western scientific literature on meditation.

Dr Ramesh Manocha.