One snowy evening in the mountains of North Carolina, I snuggled into bed on the second night of a Buddhist meditation retreat. I was exhausted, and lay alone in my tiny cabin, longing for nourishing sleep. It didn’t come. My body was strangely restless, and despite being cocooned in a mound of blankets, I was still cold.

The type of meditation I had been practicing was jhana, a deep state of absorption concentration said to be essential in the Buddha’s awakening. All day I had been concentrating on my breath and scanning my body for various sensations. I had 13 days ahead of me to work, with the goal of experiencing highly refined states of awareness — and perhaps something beyond.

As I lay there musing in the brisk darkness, I suddenly sensed a tightening inside me. It was as if I was being ever so gently wound. Then quickly, the pressure intensified, and I breathed in rapid-fire staccato and violently shook. I was a guitar string being tuned beyond its highest range. The string popped. A spike of fear slashed through my guts. And that’s when I split apart.

The next four hours were a hellscape of terror, panic and paranoia. There were almost no thoughts, only my body begging to escape my skin, convulsing like a fish fighting for life. The fear was a bottomless trench.

I knew nothing, except that something, everything, was terribly wrong. For minutes, I was completely immobilized. And even when I regained control, I was incapable of finding help. I wasn’t sure if I was real, or if the door to my cabin was real, or if anyone outside of it would be real.

I punched myself in the head at one point just to feel something solid. I couldn’t help myself because I couldn’t locate myself. Where was I? Who had I become?

Finally, after hours, the attack smoldered and I drifted off. It was the worst night of my life.

The next morning, while making coffee, I stared at the creamer for two minutes, paralyzed. Hours later, I stood motionless on a windswept bluff, observing myself from somewhere above my right shoulder, stuck like a broken-down car on the shoulder of the road.

I relayed my experiences that afternoon to the two teachers who were overseeing the retreat of about 40 meditators. They were both kind, compassionate, and welcoming, suggesting various ways that I might alter my meditation practice to alleviate my symptoms

The problem, I explained to them, was that I couldn’t stop being mindful or aware of everything that was going on within my mind and body, and the awareness felt like it was choking me to death. After a day of trying alternative meditation approaches, I left the retreat.

I was crushed and bewildered during the 90 minute Lyft ride to my sister’s house in Knoxville. There, I spent a week trying to recuperate in her basement, watching reality TV and wrestling on the floor with my tiny nephews. A week later I drove back home to New Orleans, but unfortunately the effects of the retreat didn’t stay behind.

What happened to me that night may sound exotic, bizarre, psychotic and unusual, but it’s actually more common and predictable than many people think. As meditation practices have exploded in popularity in the West, they have brought with them an array of adverse experiences far beyond the typically-billed benefits of lower stress, decreased anxiety and reduced pain. The terrain of fractured, disruptive and altered states of consciousness has often been explored in Buddhist teachings through the centuries, but when these practices made their journey into Western culture, a sufficient understanding of the downsides of meditation was lost in transit.

In fact, today mindfulness meditation is primarily used as an off-label treatment for mental health issues, a strange and tortuous journey for a technique that was for centuries practiced by Asian Buddhists for achieving liberation and therefore avoiding re-birth. This rebranding, which has mostly whitewashed negative experiences of meditation and framed it as in alignment with Western mental health goals, has created a booming business of retreat centers, courses, instructors, consultants and apps. According to a 2017 report by Marketdata Enterprises, the U.S. meditation market is predicted to grow to 2 billion dollars by 2022.

I knew most of this previous to my disastrous retreat.

As an instructor in Mindfulness-Based Stress Reduction (MBSR), I spent four years teaching meditation as a full-time job. A longtime meditator, I have logged roughly 4,000 hours of practice over 10 years, including more than 100 days on roughly a dozen silent meditation retreats. I’m extremely knowledgeable of both Buddhist and secular frameworks of meditation, have read countless books on the subject, and have taken instruction from numerous renowned Western meditation teachers.

Prior to this retreat, I was an unabashed evangelist for mindfulness. I credit meditation with precipitating numerous positive changes in my life. It made me less reactive, helped me form better relationships and assisted me in curbing my drinking. It opened me up to a deeper understanding of my mind and perhaps, most important, gave me a craft and a framework through which I found meaning and purpose in my life.

But 14 months ago, my meditation practice brought me to my knees.

In the months after the retreat, I suffered from symptoms diagnosed by a therapist as post-traumatic stress disorder. I frequently experienced involuntary convulsions and simple tasks like cooking a meal induced panic attacks. I was occasionally so overwhelmed by my bodily sensations that I was unable to speak, and sometimes had problems differentiating myself from my surroundings.

The tiniest moments of adversity, such as a traffic jam, felt like death. My body was a torture chamber, lighting me up with with panic, terror, despair, a mélange of agonizing sensations. I even carried around a green squishy ball, which I desperately clutched to prevent dissociative episodes, and I rarely left the house without Xanax in my pocket.

This terrain was fresh. I had never previously experienced a psychotic episode and have no history of mental illness besides occasional bouts of mild anxiety and depression. And I didn’t have a history of any major trauma prior to the retreat.

As I navigated life with meditation-induced PTSD, I also felt betrayed. While I had heard cursory mentions of difficulties during meditation, the primary framing had been positive. I remember clearly a senior teacher answering a student’s question of how much they should meditate.

“Well, how happy do you want to be?” he had quipped.

In fact, when I had reported convulsions and some shaking on earlier retreats, teachers never voiced concern. Most of the literature I had come across on the subject of negative experiences framed them as stages or signs that one is progressing toward awakened states. In my mind, there was never a reason to stop pursuing meditation. Over a decade, I didn’t meet a single teacher who described any situation where meditation could be damaging or should be ceased. So, I soldiered on.

But, unbeknownst to me, there was someone already sounding the alarm.

Willoughby Britton is a clinical psychologist, neuroscientist, and associate professor at Brown University. She’s also arguably the world’s expert in adverse effects of meditation.

I met her by happenstance, nine months before my disastrous retreat. She was leading a conference called “Do No Harm” in Los Angeles about adverse effects of meditation. I was there because it was the cheapest way for me to complete my teaching certification in Mindfulness-Based Stress Reduction, and had only minimal interest in the topic at the time. The attendees, maybe 300 or so, were the intelligentsia of the American mindfulness movement: therapists, meditation teachers, neuroscientists and doctors. Many of them were quite prominent. They had made their careers evangelizing for mindfulness meditation as a science of the mind, fully compatible, if not superior, to Western ideas about mental health.

The meat of Britton’s talks was the results of a 2017 paper she co-published with her husband, Jared Lindahl, called the Varieties of Contemplative Experience1. In it, they examined distressing and functionally impairing meditation experiences of 60 Western Buddhist meditators. They documented 59 types of adverse effects in their study, including involuntary convulsions, panic, anxiety, dissociation and perceptual hypersensitivity—a far cry from the mainstream branding of mindfulness meditation as a panacea for all our woes.

Their message wasn’t particularly well received. And why would it be? The livelihoods of many in the room — including mine — rested on the fact that mindfulness was going to be the saving grace of modern discontent. Britton and her co-presenters, Lindahl and the therapist David Treleaven, were bursting the bubble to the frustration of some in attendance.

Almost every mindfulness retreat, event, talk or discussion I had previously attended involved a fusion of neuroscience, psychology, testimonials, anecdotes, poetry and meditation, all of which was patched together and synthesized to fortify the pre-eminence of mindfulness as a healing approach.

But Britton and her co-presenters were savaging much of the science as sloppy, pointing out considerable misunderstandings and weaknesses in the current body of research, challenging whether secular mindfulness programs were actually secular, and generally extinguishing a lot of the feel-good vibes one expects to imbibe at such a gathering.

At one point, a prominent author of mindfulness books stood and unleashed a roughly 10-minute rejoinder to Britton’s work. His tone grew increasingly condescending as he rambled on, promoting his own conferences and bemoaning how it was our mistaken sense of self that was leading to mass human suffering and climate change.

The author’s monologue ended with him citing the poem, “The Guest House,” by Rumi, as a model for how people might handle distressing meditation experiences. The poem, often used by meditation teachers, suggests that we should welcome in all our emotions, feelings, experiences — good or bad — the same way we might welcome a guest into our home.

Previous to his outburst, Britton had described meditators who had lost the ability to feel their bodies, lost emotions for their children and, in one particularly troublesome occasion, lost the ability to recognize the meaning of a red light.

“It might be wise to look through the keyhole before letting in whoever or whatever is on the outside,” she snapped back.

I spent my last day in Los Angeles riding on a Segway, buying legal marijuana and staring at some turtles in an on-campus pond at UCLA. I was unsettled yet intrigued by Britton’s message. Some of the adverse experiences she had described were similar to challenges I had faced. But, at this point I was a decade into my intensive mindfulness meditation practice. I was too deep to get out.

Why did I start meditating? The short answer is that in 2009 I started a fist fight in a French Quarter bar over some jambalaya, a steamy kiss, and a stray comment I didn’t take fondly. The evening ended hours later after I broke a window with my fist, misplaced my shirt, and guzzled about 16 bottles of Miller High Life. My girlfriend was not happy. I wasn’t happy. Something had to change.

That speck in time represented a constant battle I had waged over the prior decade with anger and other negative emotions. I drank too much. I occasionally smashed printers that jammed. I had volatile relationships with women. My mind wandered uncontrollably.

I was drifting into my mid-20s doing things that had felt defensible at 19, but didn’t feel OK any longer. I wanted a calmer, tranquil mind, so I found a Zen center and started dropping in for weekly meditation practice. The effect was profound and immediate. Everything slowed down in the aftermath. There was peace, space, and bliss. It was like a drug. And I immediately wanted more.

In 2011, I sat my first meditation retreat in the Vipassana tradition of S.N Goenka. I spent ten days in silence, focusing on my breath and body for 10 to 12 hours a day. It was grueling, but toward the end of the retreat I had a life-changing experience.

While meditating alone in my room, I went into full-body convulsions and observed with perfect equanimity a cannonball of grief, despair and horrific pain emerge from my gut, up into my chest and then out of my mouth. At the zenith, a cascade of images emerged from the darkness of my closed eyes, and I unleashed a blood-curdling scream while bursting into tears. It was as if I had purged a lifetime of negative emotions.

In the aftermath, I floated for months in a state free of discontent. I also began experiencing memories that felt foreign — like they weren’t mine — could observe myself sleeping, and was able to quell even the slightest bit of agitation by simply focusing my attention on it.

I felt like I had a superpower. My drinking ebbed, my anger was tempered and I was able to concentrate at a much higher level at my job. A few months later, I exited a toxic relationship and quickly made a new set of new friends. I was flourishing in numerous directions and had meditation to thank for it.

A year later, I returned for another retreat. And over the next decade, I attended meditation retreats across the country, read voluminous books on Buddhism, and even moved from New Orleans to the San Francisco Bay Area to deepen my meditation practice. I often joked that the only thing that stopped me from becoming a monk was having to sew my own robes. But, it’s mostly the truth.

As the years went by, I became a full believer in much of Buddhist doctrine, especially the idea that all suffering is the product of craving or desire. It seemed self-evident to me that if I could cultivate a non-reactive state, I could live free of discontent.

I was also impressed by the arguments made by many meditation teachers that meditation was a completely secular endeavor, which could be done without any connection to religion. It was essentially, they argued, exercise for the mind.

Yet, somewhere six or seven years into my practice, whatever progress I was making petered out. I was experiencing a growing sense of bodily agitation and began self-medicating with drugs and alcohol. Looking back, it was also during this time period that I had my first dissociative experiences, in which elements of my sense of self became separated in a way that impaired my ability to function.

It seemed like the more I meditated the worse I felt. I was desperate to find a framework to understand what was happening and hunted through meditation books for references to extended periods of distress. On my shelf, I found a book that I had owned for a while but never read. It was called “Mastering the Core Teachings of the Buddha.” The cover picture was the silhouette of a sitting meditator with hot-pink squiggly lines shooting out in all directions. The author, an Alabama emergency room physician, proclaimed himself to be fully awakened. He referred to himself as The Arahat Daniel M. Ingram.

It would be impossible to fully synthesize Ingram’s 620-page tome, so I’ll stick with what was most salient for me. At the core of Ingram’s book was a Buddhist model that described meditation progress in 16 stages, each with a consistent set of characteristics. Two of the stages jumped out at me.

One was “The Arising and Passing” state, sometimes called A & P. According to Ingram, this state includes, “powerful physical shaking and releases, explosions of consciousness like a fireworks display or a tornado, visions, and especially vortices of powerful fine “electrical” vibrations blasting up or down the spinal column and/or between the ears.”

That description was eerily similar to what I experienced on my first retreat.

Ingram went on to say that after the A & P, meditators have crossed a threshold or “point of no return.” They are now destined to plunge into what he describes as “The Dark Night,” a series of stages such as dissolution, misery, disgust, and fear.

According to Ingram, one must continue to meditate through these awful experiences until reaching a deeper state of awakening. He makes it clear that the consequences of stopping are severe.

“If they give up in the stages of the Dark Night (or any time after the A&P), the qualities of the Dark Night will almost certainly continue to haunt them in their daily life, sapping their energy and motivation, and perhaps even causing feelings of unease, depression, paranoia, and even suicidal thoughts. Thus, the wise meditator is very, very highly encouraged to try to maintain practice despite potential difficulties, to avoid getting stuck in these stages.”

As bizarre as it may seem, it’s impossible to describe how relieving this diagnosis was to me. Ingram’s book validated my experiences in a way that no meditation teacher or therapist had done. With this diagnosis in tow, the upshot of my current condition was clear to me. I was halfway to awakening. I had to make it there or I would continue to suffer. I no longer had a choice.

The second time I encountered Willoughby Britton was three weeks after my disastrous meditation retreat. I was desperate for help. My body was in constant physical agony. I was struggling to make eye contact with my wife. Driving a car was becoming challenging. My left shoulder felt electrified and was uncontrollably convulsing. I was scared and didn’t know what to do.

Britton runs an organization called Cheetah House, through which she counsels meditators in distress. She’s also had adverse experiences herself. We met over Skype. I was despondent as I described my symptoms to her and she meticulously took notes. Then, Britton told me something that infuriated me. It made me want to knock someone’s teeth out. She said that many of the leading figures in the world of mindfulness meditation have had experiences like mine, but they just don’t talk about them. It’s an open secret of sorts.

“What kind of fucking person could go through something like this and not warn other people!” I yelled. When I did this, I gestured frenetically with my right hand, like I was karate chopping the air in front of me. It was the first time in years I had dropped my Buddhist pretense and allowed myself to be truly angry.

I told Britton everything that happened at the retreat and also in the months before. I explained, that motivated by Ingram’s book and similar texts, I had been meditating two hours a day if not longer. I described how on numerous occasions all my thoughts disintegrated and I bathed for extended periods of time in states of deep, non-conceptual bliss. I thought awakening was right around the corner and now feel broken and betrayed, I said.

Britton explained to me that it’s likely that my meditation practice, specifically the constant attention directed toward the sensations of the body, may have increased the activation and size of a part of the brain called the insula cortex.

“Activation of the insula cortex is related to systemic arousal,” she said. “If you keep amping up your body awareness, there is a point where it becomes too much and the body tries to limit excessive arousal by shutting down the limbic system. That’s why you have an oscillation between intense fear and dissociation.”

She suggested I try a trauma therapy called Somatic Experiencing and invited me to her support group for meditators who have experienced acute distress. Their stories were validating yet heartbreaking: a steady stream of individuals using meditation in a search for relief from suffering and instead finding greater anguish.

While some were veterans of numerous meditation retreats, others simply dabbled with a meditation application. One woman, a clinical mental health worker, ended up in a psychiatric facility after her doctor recommended she participate in a 10-day meditation retreat. Numerous participants developed problems after using Sam Harris’s popular Waking Up app.

One might wonder if these wounded meditators had preexisting conditions that triggered these experiences. Most of us don’t, a finding similar to Britton and Lindahl’s study, which reported that 57% of practitioners suffering adverse effects didn’t have a trauma history and 42% had no psychiatric issues at all prior to meditation practice.

What we do share is a feeling that’s common among those who have had traumatic experiences: neglect, shame and a sense of being unheard by those in power. Case in point, the words and work of the neuroscientist Richard Davidson.

Davidson’s and journalist Daniel Goleman’s 2017 book, “The Science of Meditation”, spent almost 300 pages documenting the positive effects of meditation. When it came to negative effects, the authors dedicated two pages.

In a 2019 Vice article, Davidson suggested that those who have meditation-related difficulties simply aren’t meditating correctly.

“I think that many of the people who are having difficulty and who are reporting that their problems are exacerbated by meditation are not meditating correctly, to put it simply and coarsely,” he said, “Some might even say that they’re not meditating. That they think they’re meditating, but they’re not really meditating.”2

His notion, contradicted by historical and contemporary accounts, is a fusion of victim-blaming and fundamental attribution error. Unable to entertain the possibility of deficiencies in the mechanism, he blames the meditator.

In fact, in Britton’s study, 60% of the participants reporting distressing experiences were meditation teachers, rebutting Davidson’s argument that experienced meditators don’t end up in difficult territory.

While blaming meditators for their negative experience is an unfortunately common tactic from the mindfulness intelligentsia, another strategy is to pretend that adverse effects don’t occur.

Spirit Rock Meditation Center, widely viewed as the mecca of American Buddhism, hosts scores of silent meditation retreats each year. On its website, there are reminders not to bring scented soap due to allergies, articles touting the benefits of meditation, and even a recipe for the gluten-free almond cupcakes served in the center’s acclaimed kitchen. Yet there’s not a single word about a fact every prospective meditator deserves to know: meditation can harm you3.

Vipassana International, the meditation organization that Britton says triggers the most adverse effects, flat-out denies meditation ever goes bad. With 13 retreat centers in the United States and 207 across the globe, Vipassana International likely serves more meditators than any other organization in the world. On its website, it specifically answers the question of whether or not Vipassana meditation can “make you mentally unbalanced.”

The answer given: “No, Vipassana teaches you to be aware and equanimous, that is, balanced, despite all the ups and downs of life.”4

That answer likely feels cruel to the family of Megan Vogt. Vogt, a 25-year-old Pennsylvania woman with no history of mental illness besides anxiety, committed suicide in 2017 in the aftermath of a 10-day Vipassana retreat. According to media reports, she left the retreat in a psychosis, barely recognizable to her family. On the way home from the retreat center, she tried to commit suicide by jumping out of her car and eventually spent time in a psychiatric ward.

Ten weeks later, she jumped off a bridge to her death.

Before her death, Vogt sent two emails to the retreat center about her challenges, at one point writing that she thought her distress was “a sign that I need to give up my life for a more pure one.”

The responses she received weren’t more than a line or two, saying her message had been forwarded to a teacher, who never reached out.5

What happened to me last year in that chilly cabin in North Carolina? That’s a question I’ve been wrestling with since I left the retreat. As my knowledge of meditation-related distress has increased, it has not made things simpler to understand. In sifting through a patchwork of spiritual, psychological and biological frameworks, I have had to mix and match and to trust less in the words of experts and more in my intuition. It’s been, like much in life, an inside job.

One thing is clear: I have significantly healed over the last 15 months due to a combination of medication, therapy and support groups. However, vestiges of my symptoms do still remain.

The framework that aided most in my recovery is the work of Willoughby Britton, without whom I would be in unimaginably dire straits.6 Britton has had to mop up after the meditation industrial complex and help the people deemed by the Richard Davidson’s of the world as failed meditators or by other spiritual teachers as being congenitally unwell.

She has created an impressive body of work that shows how certain mechanisms of meditation can trigger a traumatic stress response. This approach rejects spiritual interpretations of these experiences for those grounded in neuroscience and physiology. Most heartening is that it’s not simply theoretical, but involves practical steps to heal.

The most powerful, for me, has been a trauma therapy called Somatic Experiencing, founded by the psychologist Peter Levine. Levine argues that humans often inhibit their biological defensive responses, such as fight, flight and freeze, trapping them in the body. Using this model, it’s possible that my meditation practice unleashed a stockpile of latent defensive responses, which emerged so rapidly that my body could not integrate them. One psychological element of my experiences was that I did glimpse some hidden pockets of self-loathing, which could have been a trigger for this response.

I cannot rule out that possibility that, at the same time, I had some sort of “spiritual emergency,” a term coined by the therapist Stanislav Groff and used to describe non-ordinary states of consciousness that are often mistaken for mental illness. Groff’s work and that of his colleagues was helpful in normalizing my experience, but it didn’t provide a coherent framework for healing.

Lastly, it’s easy to make the work of Daniel Ingram and similar meditation teachers a scapegoat for this type of suffering, as his suggestion to meditate through the Dark Night had a catastrophic effect on me and is often cited by distressed meditators as a contributing factor to adverse effects. In fact, stopping meditation was crucial to my recovery. That being said, Ingram has provided a valuable service in describing in-depth the often bizarre and dangerous territory of intensive meditation, which has been whitewashed from our contemporary mindfulness culture.

Perhaps the biggest lesson of this experience was the danger in all-encompassing frameworks, those in which a group of powerful people make truth claims about the “nature of reality” or something similar based upon their own experiences. There are few places where this is more actively happening than the convergence between Western science and Eastern religion, where neuroscientists, psychologists and monks have converged to create a new religion that the scholar David McMahan calls “Buddhist Modernism.”7

These days I rarely meditate, but the quality of mindfulness is a constant in my life. I use it when I need it, but I can turn it off and on. It’s a tool that I can access but doesn’t control me.

A few months ago, I began dabbling with teaching mindfulness again, which may seem surprising. However, I believe that these practices, with the correct framework, dosage, and education, can be a valuable tool for improving mental health. I have seen it repeatedly in my classes. And, perhaps, more important, I feel that I could do something for my students that wasn’t ever done for me: tell the truth.

In one of her papers, perhaps the one most valuable for me, Britton theorized that the effects of mindfulness might follow an inverted U-shaped curve, where at some point therapeutic returns not only diminish but mindfulness could have negative side effects.8

That fits my story like a glove.

I began meditating in search for a decrease in stress and anxiety. I got that, and then somehow became swept away in a new-age super religion without even knowing it. There are parts of this essay that embarrass me. But, when you’re vulnerable and looking for answers, you take what is available. For me, that was the enlightenment pill, and I almost choked on it.

Many who have these types of experiences don’t talk about them publicly. It’s not because they’re not powerful, smart, and strong. It’s because they’re scared that their stories will be greeted with defensiveness, snark and possibly even attacks. I’ve been tempted to do the same.

But lately, I have begun counseling other meditators in distress, and I see the fear in their eyes. It reminds me that I have some work to do before I let this wound close. It’s this essay, the act of speaking out, of rendering my story in a public way, that I need to complete to put this chapter of life behind me. I can’t bear the idea of pushing these experiences under the rug or simplifying them like so many other meditation teachers have done.

If you’re a meditation teacher or hold a powerful position in the mindfulness industry, perhaps take a moment to question what sort of legacy you want to leave. Transparency, honesty and humility are often the core values of religion, but are typically abandoned the moment a sacred idea is critiqued.

Is it the fate of the Western mindfulness movement to follow this trend? Is there some wiggle room around the idea that more awareness is always better? Is there potential for a pause in our desperate attempt to prove that we’ve found a magic bullet for all our ills?

Can we be honest about the negative effects of this practice so people know what they’re getting? Isn’t that an ethical responsibility of being a meditation teacher, no different than how a doctor advises patients of possible side effects?

For me, meditation will always stay close to my heart. There’s something so curious and bizarre about being human that I find it irresistible to occasionally poke around the edges. I’ve shed a lot of baggage over the last 15 months. At the core was the loss of my faith: a faith that had protected me, supported me, answered questions that felt unanswerable, empowered me in the innumerable ways that only faith can.

My faith did not crumble gradually — but collapsed like a Jenga game, leaving me to pick through the ruins and to wonder, with tremulous apprehension, if anything was salvageable. What I found was not the remnants of my Buddhism, but instead slivers of a past self buried under the weight of dogma long ago. There, entombed in the cobwebs of time, was a skeptic, a rebel, an explorer and a writer: a fierce collective primarily interested not in making the world easier or simpler, but in celebrating its insane vastness and complexity. It was something once surrendered as an offering. It is part of myself that I have now reclaimed.

This essay was originally published on Dan Lawton Substack newsletter. Thank you to Daniel for letting REALM republish this piece.


[1] Varieties of Contemplative Experience Study, PLOS

[2] Meditation Is a Powerful Tool and For Some it Goes Terribly Awry,Vice

[3] Gluten-Free Almond Cupcakes, Spirit Rock Meditation Center

[4] Questions and Answers About the Technique of Vipassana

[5] Lost in Thought, Harpers Magazine

[6] Cheetah House, Resources for Meditators in Distress

[7] The Making of Buddhist Modernism, David McMahan

[8] Can Mindfulness Be too Much of a Good Thing? The Value of A Middle Way, Science Direct