With the second source of Ch'an sickness ─ psychological problems ─ the person is probably overanxious about getting results. He or she may be desperate immediately to achieve enlightenment or acquire supernormal powers. Mental sickness of this nature comes from vexations. Problems usually stem from obsessive greed, hatred, pride, or doubt. Everyone encounters these feelings and desires, but in most of us it does not get out of hand. Such obsessions can lead to Ch'an sickness unless there is proper guidance.

The third kind of Ch'an sickness comes from karmic obstructions. Everything may be fine when people do not practice, but when they practice with intensity, things start going wrong. They might suffer headaches, a tightening in the chest, or fearful hallucinations. Such Ch'an sickness comes from previous bad karma. Medical or psychological care will not help. It is best that they stop meditating intensely. Meditation need not be given up altogether, but approached more casually. They should also recite repentance verses before and after meditation. If a person can do repentance practice with sincerity, then the sickness may gradually disappear. Repentance, however, is not enough; they must also make vows. Repentance is for past bad actions. Making vows is for the future. One should vow not to practice solely for one's own benefit, but for the benefit of all sentient beings.

The fourth source of Ch'an sickness is extremely rare. People who are disturbed by outside influences usually have bodies and personalities that are desirable as mediums or channels for outside entities. They are vulnerable even if they do not meditate, but when they meditate, they may be even more vulnerable. Spirits may attach themselves to people and direct their thinking and actions as if they were puppets. Discontinuing practice would likely have no affect upon the spirit's influence.