Physiological Barriers to Meditation
Over the past 12 months I have had significant experience in working with meditation in ADHD patients.
While some patients have succeeded well, others have had significant difficulties, and most of them appear to be physical. Many patients have had issues with pain or drowsiness. Some patients have noted that they become increasingly agitated while meditating, or even 20 minutes afterwards. One individual reports that he can meditate effectively only lying on his back with his legs elevated on a chair, or propped up against a wall.
At the same time my physical examinations of my ADHD patients have sharpened, and I have found four predictable clusters of abnormalities in virtually all ADHD patients. These are somewhat interconnected, and most patients have more than one of the following 3 groups
Issues related to Orthostatic Intolerance, Dysautonomia or even overt Postural Orthostatic Tachycardia Syndrome
pale complexion- that resolves on lying flat
often sweaty and clammy
elevated resting pulse (more likely to be in the high 80s to the low 100s than in the low 70s)
marked elevation of pulse on standing and failure of pulse to stabilise in the expected time (usually standing pulse should settle a little faster than sitting pulse within about a minute in a healthy human- but some ADHD patients stabilise at 30-40 beats higher than sitting pulse, worsening with prolonged standing).
Problems with perception, balance and co-ordination:
dysgraphia, dyslexia, dysarthria
Poor sense of balance:
often a fear of heights
positive Romberg test (swaying while eyes closed)
impaired cerebellar and vestibular functioning characterised by:
(unstable heel toe gait- especially with eyes closed),
and positive Fukuda test (unable to march on the spot eyes closed without drifting)
Difficulties with eye tracking
Postural Abnormalities with associated spinal malalignments and gait abnormalities.
Chronic forward head posture (Upper Crossed Syndrome)
Sway Back (Lower Crossed Syndrome)
Multilevel spinal malalignments- especially upper cervical spine- (C0-1-2), lower cervical spine,
Sacroiliac Joints (with pelvic tilt, an externally rotated foot and flattened feet).
Orthopaedic complications of all the above.
A history of repeated deteriorations in function at times when the patient gets less physical movement.
Observation of the patient in meditation
Close observation in meditation will reveal
- Increasing pallor with prolonged meditation- with associated drowsiness and tendency to repeatedly nod off towards sleep and wake with a start.
- Failure to drop blood pressure and pulse when meditating (you need to do before and after observations)
- Inability to achieve anything approximating fully upright posture.
- Excessive complaints of pain in meditation.
- Great difficulties with mind wandering.
My assessment after a number of reviews is that the biggest barrier to meditation is orthostatic intolerance, and that when they stand or sit for a ling time these patients are actually developing a degree of cerebral ischaemia and a secondary stress response. This is worse if they are dehydrated or tired, and worse if they cannot achieve straight posture.
A few individuals actually start to wobble and sway as soon as their eyes are closed- indicating a more severe balance problem.
It is known that in the majority of ADHD patients a pair of SPECT scans (measuring cerebral blood flow) will demonstrate impaired perfusion of the frontal lobes when sitting doing a concentration task as compared to when lying down relaxing.
The impairment has been thought to be secondary to abnormal functioning of the dopaminergic circuits, but as far as I know nobody has ever realised that the concentration task is done sitting and the resting scan is done lying down.
Equally- physiological observations are not routinely taken when the patient is having the scan.
Based upon my own self observations (I have ADHD, but am a meditation teacher) and on multiple
patients I would propose the following hypotheses:
Intermittent relative cerebral ischaemia is responsible for the frontal lobe failure of inhibition.
Failure of the frontal lobe to inhibit Default mode network activity induces mind wandering and rumination. That rumination intrudes on daily life, by competing with the current necessary task for available “cerebral real estate resources”- inducing chronic, uncontrolled multitasking.
The associated stress response skews the subjects selected by the DMN towards those with a negative emotional valence.
These thoughts then exacerbate the stress response through triggering secondary “fear of fear responses”.
Repeated failure experiences and the feeling of being unable to manage one’s mind only worsen the situation.
The autonomically induced stress responses and stress responses secondary to balance instability massively increases right frontal lobe activity, with associated suppression of left frontal lobe activity and reduced ability to challenge negative thoughts (hence the frequent failure of CBT).
Balance and co-ordination issues increase the demand on working memory and increase the risk of losing track of whatever one is doing.
High cervical facet joint malalignments further worsen the situation by creating a mismatch between the proprioceptive information reaching the brain and the actual position of the body, and a mismatch between proprioceptive input and visual input- further compromising processing of sensory data.
These malalignments can be subtle and intermittent- but are demonstrable by a competent physical examination. The malalignments are visible on X Ray, but are rarely noticed by medically trained radiologists.
Careful consideration of the above phenomena will reveal a common factor, which I believe is highly significant in ADHD and in anxiety disorders, and probably in the evolution of metabolic syndrome as well.
Blood pressure and Circulation Homeostasis
Upright posture presents a major physiological challenge. When we stand upright we have to pump the blood uphill to our brains. Being liquid, however, blood gravitates to the lowest possible level. When we stand up- about 600ml of our circulating blood volume is lost to the veins around the intestines (the mesenteric circulation) and the veins in the legs.
That is what happens to the “average person”.
However- the “average person” is an anomaly.
All biological characteristics are distributed according to a bell curve- a normal distribution curve.
One of these characteristics is connective tissue elasticity.
According to Dr Chris O’Callaghan of the Austin Hospital in Melbourne, 20% of the population has sufficiently elastic connective tissues (including the walls of their blood vessels) to have significantly greater problems than most in regulating cerebral circulation.
He states that this population is
prone to issues of cerebral hypoxia and stress response on prolonged standing.
often unable to tolerate prolonged sitting or standing (often leading to social isolation).
worse off in hot weather, or when alcohol affected (vasodilation leaves more blood in the periphery and less available to the core)
much more likely to be an athlete, dancer, musician or artist (high creativity and sensitivity are predictable outcomes of the emotional turmoil generated by difficulty in self regulating the autonomic nervous system, as is a preference for fitness).
likely to intermarry with similar individuals
likely to pass on hyper elasticity through complex polygenic mechanisms.
Vulnerable to injury
symptomatically worse when unfit
Posture and meditation
Observation of the striking influence of postural mechanics on function and symptomatology have led to our hypothesis that posture affects and moderates every physiologic function from breathing to normal hormonal production. Spinal pain, headache, mood, blood pressure, pulse and lung capacity are amongst the functions most easily influenced by posture. The most significant effects of posture are upon respiration, oxygenation and sympathetic function. Ultimately it appears that homeostasis and autonomic regulation are intimately connected with posture.The corollary to these observations is that many symptoms, including pain, may be moderated or eliminated by improving posture.
Postural and Respiratory Modulation of Autonomic Function, Pain and Health.
John Lennon, BM, MM, C. Norman Shealy, MD, Roger K Cady, MD, William Matta, PhD, Richard Cox, PhD, and William F. Simpson, PhD
AJPM 1994;4:36-39 (American Journal of Pain Management).
It is actually a little more simple than that:
According to the neurologist Antonio Damasio, emotions effectively represent semiautomated programs that prepare our bodies for the action likely to be required, by altering our physiological homeostasis to one more appropriate for current conditions.
If we sit in a forward head posture we imitate the posture of fear or anger- and the interocepted sensory data then initiates the appropriate emotional program. The feedback from the alteration in homeostasis then reinforces the emotional state and furthermore skews our thoughts towards other occasions on which we have experienced that feeling state. In short, we start searching our back files for possible relevant data about the threat of which our body and brainstem are warning us.
However, if our spine is malaligned, adopting an appropriate upright posture (i.e. the Seven Point Posture of Vairocana) for more than a few minutes is very painful, and that pain will induce a stress response in all but the most advanced meditation practitioners.
In addition, poor cerebral perfusion pushes us towards a syncopal response- and that makes us slump.
There are additional positive features that are noteworthy in traditional meditation postures:
Cross legged postures compress the legs, improving core blood volume.
Sitting with the knees higher than the hips flattens the lumbar curve- increasing parasympathetic tone relative to sympathetic tone:
It is also of note that a posture such as that adopted for standing Qi Gong meditation has the following advantages:
upright spine (absence of forward head posture or sway back)
bent legs, with tensed muscles reducing venous stasis in the legs
abdominal breathing compressing the viscera on each in breath, improving venous return.
Doubtless there are more specific physiological advantages that the dedicated scholar can find- but this author has spent enough time with his head in books!
This article has become somewhat longer than I expected, and has also covered my understanding of the key physiological drivers of ADHD, but I wish to make one key point.
“Mindfulness” in the West has been hijacked by traditional Western Psychology. Western Psychology fails to grasp the pre-eminence of “bottom up” stimuli in the regulation of attention and emotion, and overemphasises the cognitive aspect of our being.
In the end, we are still animals, and we need to be mindful of that fact, and to learn to respect the messages our bodies are giving us.
All the traditional schools of meditation teaching place great emphasis on posture and balance. If we fail to follow these instructions, we are not really teaching mindfulness.