Yoga as a Treatment Approach for Psychological Disorders--Allison Kenney

 

Yoga as a Treatment Approach for Psychological Disorders

CSOCS 3452 Yoga: Theory, Culture and Practice

Professor Laura Douglass 

by Allison Kenney

 

           

            Yoga is becoming  much more widely practiced and understood for its physical benefits throughout the country. As yoga gains popularity scientists are further researching its benefits to the human body. Yoga has been seen to cure diseases such as diabetes, asthma and heart disease. It is considered an option as a complement to treatment for cancer patients, or those recovering survivors of cancer. While typically considered a practice to achieve greater physical strength and health, especially from the western perspective, yoga is now gaining popularity as a possible option in the treatment of psychological disorders, as a result of its therapeutic success.  From 1996 to 2006 diagnosed cases of mental disorder rose by about 60% among adults ages 18-64 (Novotney, 2010). This significant rise in mental disease is alarming and calls for an exploration of new treatment approaches and alternative healing practices. Yoga provides a much less toxic approach to healing than the traditional route of talk therapy with medication. In a nation where overmedication is abundant, we must look to natural alternatives to heal. Including yoga as a component of treatment has become a feasible option for a wide array of mental disorders. This is partly because of the recent, but delayed, acknowledgement of yoga’s power on the mind. Yoga is being acknowledged for its meditative and healing qualities in the treatment of patients with eating disorders, post-traumatic stress disorder, depression, etc.

GABA levels

            According to a study at McLean hospital, yoga increases GABA levels in the brain. GABA is a neurotransmitter which inhibits nerve transmission in the brain crucial in the role of calming nervous activity. It controls the release of dopamine, epinephrine and norepiphrine. Low levels of GABA are associated with depression and mental disease (Streeter, 2007). Two groups of study participants were asked to participate in different activities—one group read for sixty minutes and the other group participated in yoga for sixty minutes. The participants GABA levels were monitored using MRI technology both before and after their participation in the given activity. Those who participated in the yoga practice for an hour showed a 27% (average) increase in GABA levels. (Streeter, 2007). This study supports the theory that yoga could provide relief to patients struggling with anxiety, depression, self-harm, etc. From a Western perspective, finding scientific proof to support this theory is practically essential to the integration of yoga in a medical setting. Findings like these help “demonstrate the psychotherapeutic value of Yogic practices” (Bhusan,1994). Yoga’s direct positive effect on the brain’s chemistry is clear evidence of its potential for healing those suffering with mental disorder, anxiety, and depression.

Eating Disorders and Yoga

            Women make up 90-95% of the population of Americans with eating disorders (Boudette, 2006) . In a society where media places so much value on external appearance of the body, the body becomes an entity separate from the mind. “This is not surprising given societal prejudice in favor of lean, muscular bodies, and social sanctions against bodies that fall short of this ideal.” (Berman, 2000) There are cultural expectations placed upon the woman whose body  does not fit the expectations of society, and she finds herself constantly wanting to  change herself rather than working internally towards accepting and loving herself. This attitude of wanting to change and improve the body produces a perception of the body as an object, something separate from the self that desires to change it. Lester talks about this “Cartesian duality of mind and body which infuses Western culture and is continually produced and socially embodied in its institutions.” (Lester, 1997). Restricting food intake (disordered eating), bingeing and purging are common behaviors used by women to alter their bodies to fit the expectations placed upon them by society.  This culturally ingrained split often  leads to the development of eating disorders .

Practice as Therapeutic Intervention

            Through asanas (poses) and pranayama (breathing) the student is engaged in the practice and learns to focus on internal sensations of the body. Women with eating disorders become so disconnected with their bodies and their internal feelings, explaining how  they ignore natural internal signals such as hunger. The goal of integrating yoga as a therapeutic practice for patients with eating disorders is that they become more aware of the feeling of their body rather than the appearance. The word Yoga means “union”, (Dittman, 2008) and the ultimate goal is that through this newfound awareness the body can start to become one with the mind. Firstly, recognizing the sensations of the body, and then respecting those sensations, rather than pushing the body is opposite of the normal tendency of a person with an eating disorder, which allows them to nurture a new relationship with the body through the practice of yoga

            Robin Boudette explains the multitude of common goals in recovery that can be met through the practice of yoga: “I help identify goals in recovery that may transfer to taking a yoga class, such as: cultivating self-acceptance, respecting personal boundaries, challenging resistance, or tolerating discomfort.” (Boudette, 169). By identifying these goals, yoga teachers can modify the practice of yoga to specifically accommodate their patient’s treatment objectives. This being said, many yoga classes are not suitable for patients with eating disorders. Classes that bring too much focus to the physical aspect of yoga and less on the meditative aspect can actually be counterproductive in the treatment of a patient. “People with eating disorders suffer from a form of addiction, and their orientation is toward perfection.” (Berman, 2000). This tendency towards perfection may at first complicate the yogic practice of a patient suffering from an eating disorder. Patients with eating disorders may also find that relaxation provokes a feeling of anxiety because they feel that they are losing control. Yoga is about being content with where one is within the present moment, not pushing oneself harder to achieve. “..Early recognition of forcing vs. releasing into a posture is fostered. This recognition begins a process of listening to the body rather than willfully molding it into an external or internal image.” (Berman, 2000).

            Through asanas and pranayama the student is engaged in the practice and learns to focus on internal sensations of the body. Traditional treatment for eating disorders arguably focuses too much on the mind, and neglects the body which is so fundamental to the disease itself.  Women with eating disorders become so disconnected with their bodies and their internal feelings, explaining how  they ignore natural internal signals such as hunger. The goal of integrating yoga as a therapeutic practice for patients with eating disorders is that they become more aware of the feeling of their body rather than the appearance. Through this newfound awareness the body can start to become one with the mind. “postural yoga uses the body as a vehicle for self-discovery, through observation and attention.” (Dittman, 2008).  Firstly, recognizing the sensations of the body, and then respecting those sensations, rather than pushing the body is opposite of the normal tendency of a person with an eating disorder, which allows them to nurture a new relationship with the body through the practice of yoga.   As Swami Satyananda says : “yoga is a science of consciousness.” (Satyananda Saraswati, 1980) this consciousness is essential to overcoming this separation of mind and body, which is at the root of most eating disorders.

Yoga in the treatment of PTSD

            Yoga has also been very successfully used as a component of therapy for sufferers of Post-traumatic stress disorder. This disorder is caused by some kind of traumatic event. The sufferer experiences debilitating flashbacks and memories of the event(s). People who experience PTSD are often veterans of war, survivors of abuse, etc. (Wills, 2007).  Post-traumatic stress disorder is an extreme disconnection. Sufferers generally experience disassociation. Using yoga is a means of focusing internally on the sensations of the body, taking away the focus on flashbacks and anxiety, as well as keeping the person in the present moment. Practicing yoga also allows some PTSD patients to experience relaxation,  a sensation not easily experienced by those affected by PTSD.  Van Der Kolk as quoted by Denise Wills says “The memory of the trauma is imprinted on the human organism. I don’t think you can overcome it unless you learn to have a friendly relationship with your body.” (Wills, 2007) Much like yoga’s therapeutic uses for eating disorder treatment, the goal is to re-establish a connection with the body that is based on a healthy foundation of biofeedback.

            Ritu Sharma (as quoted by Amy Novotney) explains, "When people experience trauma, they may experience not only a sense of emotional disregulation, but also a feeling of being physically immobilized," (Novotney, 2009 ) it is this very physical aspect of PTSD that suggests traditional talk therapy may not be enough to help . Yoga could very well act as this link to connect traditional therapy with a more physical approach to treatment.  Multiple studies have been performed on the effects of yoga on patients affected by PTSD with similar results of reported improvement in quality of life and lessened occurrences of symptoms. (Wills, 2007).

            While these patients need a connection of mind and body, the treatment that is designed for these disorders must meet these needs. By addressing only the mind and the psychology, the therapist and patient only address one facet of the issue.

Conclusion

            While yoga is not a “fix” for any mental disease, it is a beneficial therapeutic component for many. It is partly due to the fact that the idea of “fixing” and “curing” is not something necessarily believed in a Yogic perspective. From a Yogic perspective you are as you are and there is no curing, fixing, or changing necessary. It is practiced with the belief that everything you need is already inside of you. This contradiction in Eastern and Western perspectives can be frustrating to a patient suffering from mental disease practicing yoga. As Americans there is an expected solution to a problem.  However the continual practice of yoga allows a shift in this culturally inherent perspective. Yoga works in synchrony with the body in ways that traditional psychotherapy does not address. Richard Gevirtz, PhD as quoted by Novotney says “Psychologists have painted themselves in the corner by only doing talk therapy. There's much more that can be accomplished if you integrate it with other sorts of modalities, such as biofeedback, relaxation training or yoga.” (Novotney, 2009) Traditional psychotherapy reflect a very western approach, where the “mind” is viewed as the problem, and thus it is the sole focus of therapy. Perhaps yoga’s therapeutic success is due to the inclusion of both the body and mind, which fundamentally exists as one at the root of most mental disease.

 

References

            Berman, Marcie. "Yoga and Eating Disorders." Yoga World: International Newsletter for Yoga Teachers & Students Oct-dec.15 (2000): 8-10. Alternative Health Watch. Web.

           

            Boudette, Robin. "Question& Answer: Yoga In The Treatment of Disordered Eating and Body Image Disturbance." Eating Disorders 14.2 (2006): 167-70. Routledge, 2006. Web. 1 May 2012.

            Brown, Richard P. "Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part II--Clinical Application and Guidelines." The Journal of Alternative and Complementary Medicine 11 (2005): 711-17.

            Dittmann, Katherine Anne, "Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga" (2008). Master's Theses. Paper 3515. http://scholarworks.sjsu.edu/etd_theses/3515

            Lester, Rebecca J. The (dis)embodied Self in Anorexia Nervosa. Thesis. University of California at San Diego, 1997. Elsevier Science, 1997. Web.

            Majchrzak, Tammy L. "Yoga for Mental Health." Positive Health (2007): 42-44. Print.

            Novotney, Amy. "Yoga as a Practice Tool." Yoga as a Practice Tool. APA, Nov. 2009. Web. 11 May 2012. <http://www.apa.org/monitor/2009/11/yoga.aspx>.

            Streeter, Cc. Yoga Asana Sessions Increase Brain GABA Levels: A Pilot Study. Rep. U.S. National Library of Medicine, 13 May 2007. Web. 26 Apr. 2012. <http://www.ncbi.nlm.nih.gov/pubmed/17532734?dopt=Abstract>. Web.

            Satyananda, Saraswati. Yoga, from Shore to Shore: A Collection of Lectures. Monghyr, India: Bihar School of Yoga, 1980. Print.

            Wills, Denise K. "Heal Life's Traumas." Editorial. Yoga Journal June 2007: 41-44. EBSCO. Web. 2 May 2012.

           

Yoga Therapy and Raja Yoga to Reduce Stress and Related Disorders

CSOCS 3452 Yoga: Theory, Culture and Practice

Lesley College

Professor Laura Douglass

Elyse Simon

May 9, 2012

Yoga Therapy and Raja Yoga to Reduce Stress and Related Disorders

            Stress is a necessary part of the human condition, it can be a healthy response to danger and protect us from threat. Distress arises when one feels shortcoming in the ability to psychologically, physically or emotionally manage an overwhelming situation.  An imbalance of order in these systems of the body affects the nervous and endocrine systems (Gupta, 2002).   The symptoms are exhibited as rapid heartbeat, anxious thoughts, excessive stomach acid and result from unhealthy reactivity over a prolonged period of time. Disorders may develop and then manifest into stress-related diseases such as high blood pressure, sleep disorders, stomach conditions, heart problems and even cancer.  Raja yoga practices originating from ancient Hindu traditions offer a way to generate harmony and tolerate the effects of stress on these systems of the body and mind.  This practice focuses on mental attitude, spirituality, and morality as pathways to healing.

            I teach the Mindfulness-Based Stress Reduction Program (MBSR) four times weekly and hold practices for students using mindfulness to complement physical activity, psychotherapy and medical treatments. When we first began the Yoga Theories, Culture and Practice class, it was the unknown Raja yoga that piqued my interest for further inquiry. In particular, I wanted to explore the similarities and differences between Raja yoga and mindfulness with a goal of integrating both modalities for the alleviation of stress. MBSR is based on the dharma teachings of Buddhism, nevertheless a difference in Raja Yoga is the nourishment of spirituality. Raja Yoga’s basis of ethical codes and energy connection to the presence within of a higher power is intentionally not brought into a medical setting in the practice of MBSR.

 I have observed that students most often come to the practice of mindfulness when they feel that stress is controlling their minds and they notice it as tension in the body. The cognitive study of mindfulness resonates with students,  it is an embodied practice of creating space between thoughts and reactions, that makes it relevant in daily life. 

            The idea that opinions, attitudes and emotions affect our physical and mental wellness has been explored since ancient times.  Different cultures have contrasting opinions about the spiritual aspects of yoga which lead to varying levels of acceptance of this practice.  Schure, Christopher and Christopher (2008) recognize the practice of yoga can open an individual up to “exploring one’s belief system and expanded knowledge” (p.49) to a new perspective on being alive.  The Western modern scientific view on the alleviation of stress looks to combat physical indications of the body such as tension, anxiety and worry. In contrast, the Eastern yogic perspective on stress views the core problem existing within the body, mind, and spirit. 

            Raja yoga in particular supports a shift in beliefs and attitudes with disciplines including asana, pranayama, and yoga nidra (mental deep relaxation) for adapting a balanced mental outlook (Saraswati, 1979). Asana is the continuation of bringing into sthiram (balance) and harmony the assimilation of asanam (body position) and sukham (peaceful mind). The practice of pranayama, following asana practice, refers to “prana” vital force, “ayama” extension and expansion.  The pranayama approach is for purifying and clearing out energy that has been restricted and interferes with “pranic flow” (Vivekanada, 2005, p.173). Pratyahara practiced last in Raja yoga nidra or shavasana involves a stillness and awareness of different body parts for integration and balance.

                        Raja yoga, similar to mindfulness, focuses on the interplay between our internal experiences and communication with others. It also encourages changes in thought patterns, lifestyle attitudes and moral direction to clear the mind. Douglass and Tiwari (2006) point out from a Yogic perspective, “spirituality is the foundation of mental health, and mental health is the foundation for physical health” (p.25), for this reason, it is our thinking that motivates us to action.

Stress Reactivity

            Chronic stress has been shown to affect the health of an individual’s psychological and physical well-being (Schure, Christopher, & Christopher, 2008).  Health disorders arising from chronic stress include “heart disease, anxiety, depression, hypertension, substance abuse, and gastrointestinal disorders” (Schure, Christopher, & Christopher, 2008, p.48). Stress is a generalized response to environmental stimuli, in which the body is readied for physical reaction “such as fight or flight” (Schure, Christopher, & Christopher, 2008, p.48).  Distress arises from an individual’s inability to engage in flight or fight and release of the initial stress. Distress can be caused both in the brain and the body. Stress affects the balance of muscular, mental and emotional in the autonomic nervous system and in the endocrine system (Gupta, 2002).

            According to Saraswati (1979, paras. 4-7) there are four phases of stress:

1.               Psychic –This is about psychological changes, affecting the central nervous system in the individual due to distress. Symptoms of this first phase include: trouble sleeping, anxiety, irritation, and concern with irrational worries.  

2.               Psychosomatic – In this phase, the psychological distress becomes apparent in the body, like rapid heartbeat and increased blood pressure.

3.               Somatic –In this phase, distress starts affecting the organs, depending on the individual’s genetic pre-disposition as well as the environment.  Bodily systems, such as the thyroid, cardiopulmonary, and digestive, may show elevated levels of activity, that include high blood pressure, churning stomach acids, and rapid heart rate.

4.               Organic – At this point, the disorder turns into disease and “fully settles down into a particular organ” (Saraswati, 1977, para. 7). This creates long-term swelling in the organs and the start of permanent damage.

Yoga Therapy

            Yoga therapy is used in mind-body medicine as a means to comprehend the body in relation to the mind (Chaoul & Cohen, 2010). The National Institute of Mental Health (NIMH) report that practicing yoga, primarily as exercise, could result in a variety of beneficial ways “to mental and physical health” (Milligan, 2006, p.181).  Cikitsa, which means "to oppose or act against disease" (Douglass & Tiwari 2006, p.21), is an inclusive way of life with a focus on the development of ethical behaviors practiced with Raja Yoga.

            Schure, Christopher, and Christopher (2008) ask: “What is therapy, anyway? How do we heal ourselves and what can we provide for one another that can help?”  (p.54). It is the freedom from our typical confining patterns of thoughts and bodily awareness that motivates a shift through the means of a yoga practice (Ravindra, 2006). In particular, Yoga therapy can help address stress by catching bodily symptoms of stress with awareness before it moves from the somatic into the organic phase to become disease.  

            Yoga and meditative therapy programs for disorders caused by stress are most effective when coupled with psychotherapy (Saraswati, 1979). Milligan (2006) researched yoga for managing stress with university students and the counseling centers noticed that many found yoga therapy a more pleasing alternative than dealing with the more conventional counseling. 

Gupta (2002) describes the natural disposition of the mind in psychology as incited, active and in constant motion. Psychotherapy and yoga both require a client to extend thoughts about the interconnection between mind and body (Chapman, 2010).

            A mind-body connection is observed when efforts with concentration on the mind have consequences on physical movement and disciplines on the body result in responsive thoughts (Watts, 2000). Mental thoughts respond in the automatic nervous system to stress with symptoms such as rapid heartbeat, increased blood pressure and digestive disturbances. The breath can be used to influence a calm state when a stressful reaction arises in thoughts and tensions occur (Watts, 2000). Physically lactic acid collects when stresses in the muscles of the body. The asana poses practiced with Raja Yoga help to diminish soreness, boost the circulatory system, and rid the body of unneeded wastes. Yoga reduces stress in the physical body by stimulating endocrine gland secretions, increasing endurance and revitalizes concentration in the body (Gupta, 2002).

            Flexibility in behavior, attitude and postures from our conditioned patterns depends on our stretching boundaries and limits through an attained practice of yoga (Chapman, 2010). Transformation is the benefit of yoga therapy when a client can come to observe inner mental dialogues with clarity, and liberating negative patterns of thinking (Ogden, 2006, p.25).  Stability is another key accomplishment in yoga whether the concentration is mental or physical. The benefits to integrative yoga and meditative therapies, as compared to medical treatments claim to be more enduring with lasting ramifications, however require more physical and psychological effort on the part of the patient (Watts, 2000). The challenge in yoga is not to be met with conflict, instead in harmonious modes of unity between mind and body.

            The treatment of stress with integrative yoga and meditation practices combined with medication and psychotherapy as a whole approach have shown results in bringing blood pressure down and reducing the risk of heart attack (Watts, 2000).  More recent research indicates the influence of stress- related issues on “cancer progression, recovery and survival” (Chaoul & Cohen, 2010, p.146).  Yoga therapy to complement medical treatment for stress not only improves physical well-being, it affects” mental functioning, increases the immune system and the activity of the endocrine system” (Chaoul & Cohen, 2010, p.151).

            Yoga, having originated in the East, integrates the idea of energy into healing treatment referred to as, “mind-body-energy medicine” (Schure et al., 2008, p.50). In the West, "energy medicine" is not considered scientific –based enough to be combined with traditional medical care. (Chaoul & Cohen, 2010, p.144). Raja Yoga principles include the science of yoga, which describe wheels of energy that flow within seven main tunnels of the body named in Sanskrit chakras (Vivekanada, 2005, p.37).

                         

Raja Yoga

 Raja Yoga assists us to control the “afflictions of the mind such as ignorance, ego, attraction, aversion and attachment to life” (Sarawati, 1984, para. 19). Ethical practice in Raja Yoga, known as yama and niyama, is focused on harmonizing the tension that exists between our internal and external experiences. Stress is addressed with Raja Yoga in two ways. One emphasizes changing internal attitudes; the other focuses on modifying ways of living. These changes in attitude and lifestyle come from three practices: the first is asakti (attachment); second is anasakti (non-attachment); and the third is vairagya (detachment) (Ravindra, 2006).  asakti causes stress, when the ego is involved in wanting what one cannot have. Neurotic characteristics, such as excessive worry and need for praise arise from the dissatisfaction that asakti engenders.  The Western individualistic view, common in America, emphasizes happiness through feeding the ego with possessions. A rationalized belief that I will become less whole when detached from a long-standing idea or person creates constant effort and tension and causes mental and physical stress.

            The “lifestyle principles” in Raja Yoga are contemplation about self for an awareness of  personality characteristics such as stamina, challenges, desires and wants (Vivekanada, 2005, p.173).  The people we surround ourselves with, the ways we nourish our bodies and what we listen to with all our senses influence our levels of stress. Raja Yoga describes the ethics of

yamas (self-restraints) that focus on harmonizing the tension with social interactions. The first,

ahimsa  (non-violence) is seen often displayed as anger towards oneself and others. Raja practice involves an awareness of: “thoughts, emotions, desires, feelings, motivation, ambitions, words and deeds” (Vivekanada, 2005, p.176). When stress is noticed, begin to work with it by examining how it is displayed in the mind and body, allow it to become a lesson, and then commit to not replicating in the same way. The feelings of guilt are feelings of anger directed at yourself.  Raja Yoga ahimsa (self-restraint) directs concentration away from the ego and towards non-harm of other human beings and animals. The non-violent self-restraint works with stress in decreasing reactivity to others negative behavior and communication. Whether others knowingly or unknowingly act with harm, the charged feeling from the threat can be diminished. This can bring a sense of liberation from aversion and aggression with disciplined practice.

            Satya (truthfulness) is the yama that helps one stay authentic to the truth. Being dishonest perpetuates stress and the concern that the lie will be found out. If you speak and have thoughts that are genuine, others can rely on you to be truthful (Vivekanada, 2005, p. 177). Stress occurs when there is a concern that one is being deceived – can be trusted with the truth? When we think in misleading ways, by avoiding or making excuses, it distorts how we think about something and it becomes unclear and confusing. Satya (truthfulness) arises from a centered place of powerful energy and self-confidence that one is being honest with others and themselves. Satya allows this truthful energy to flow naturally and with ease as it is practiced (p. 178). The practitioner of raja yoga eliminates dishonest thinking to elevate a level of consciousness where negative thinking will not taint our thought patterns. This purifies our stream of consciousness by replacing disillusioned thoughts with sincere ones (p. 178). Stress can be seen when one builds a reality out of lies, and the lies inevitably crumble and one is left with the truth, which is unavoidable. Stress is created when one’s energy is focused on covering up their deceit and they do not realize that it might be time well spent looking at facing the truth.

            The next yama that focuses on truthfulness with others is asteya (honesty). When there is a desire for something that someone else has, stress can arise from how one will negotiate with another for that possession. It can also arise when one wants an outcome while working with another and the end result cannot be controlled for the benefit of one’s plan (Vivekanada, 2005, p. 179).

            In one’s everyday life, the more one wants from others, the more complicated it becomes to figure out how one will possess what is desired. The raja yoga lifestyle describes living in a transparent way that does not require absorbing the energy from another by feeling the need to manipulate a situation (Vivekanada, 2005). When people look to others to feed their desires, their energy can be depleting. The practice of yoga shifts a need to take this energy from others and allows an individual to feel livelier within themselves. Raja yoga develops an energy where you can see clearly that everything you need, you have, and you do not need objects and other people to fill up a hole that might feel missing (Vivekanada, 2005, p.180).

            Stress can be alleviated when one becomes clear on the difference between what we need and what we desire. This can lead to a sense of security that we have what we need and may not need just what is desired (Vivekanada, 2005). Once one recognizes that one has all they need, it can lead to more generosity in sharing those possessions we do not need, but that others might. Generosity comes from the awareness that rather than gathering unneeded possessions, energy can be directed towards giving to others in need (p. 180). This attitude of generosity can reduce stress because it takes away focus from the ego and puts it on helping humanity instead of acquiring more.

             Aparigraha (non-attachment) is the lifestyle principle that one looks to evolve with raja yoga.   Attachment to patterns of thinking and to other people may become a problem when our desires begin to feel obsessive or addictive. These aspects in life have to do with our ego (Vivekanada, 2005, p. 181) varying from preferred emotions, actions, beliefs and habits of thoughts and possessions. Brahmacharya (continence) means using discernment to simplify complicated relationships with others. The longing to be connected sexually may create compulsive behaviors and stressful emotions (p.182).  A committed and supportive relationship based on trust, on the other hand, can help to alleviate stress.

            The difficulty in this mental state is that stress can be brought about by holding this clutter of emotions in our minds. Stress occurs, when we don’t acquire what we feel should be ours, we may become dissatisfied and aggressive. Another kind of stress can arise if, on the other hand, we do acquire what we wanted and feel afraid that it will be taken away. A large component of stress is a feeling of threat. This threat can be noticed in the way we react to something being taken away or held back from our reach. Watts (2000) describes a form of yoga on the mental state, similar to Raja Yoga and combining psychology and science as “the somatic focus of consciousness” (p. 71). When we bring conscious attention to our emotional reactions we can shift the charged, desperate clinging to things and others.  We can sit with emotions even stressful ones by first, becoming aware and then, learning to respond without being reactive or defensive (Schure, et al., 2008).

            There are several other virtues of living they are in Raja Yoga niyamas (personal codes) (Vivekanada, 2005, p.184). Niyamas create harmony with our internal perception, similar to yamas, for social harmony with others. Shaucha (cleanliness) this is a yoga practice to purify the mind of negative thoughts and emotions with meditation and focus on paying attention. When the mind is organized it can better absorb positive influences and attitudes. Santosha (contentment) is the result of the lifestyle adjustments coming together to result in feelings of an overall sense of peace. This sense of calm can be maintained even when stressful situations arise. An aliveness, confidence and capacity to handle difficulties develop from this serenity.

Tapas (austerity) is a result of living simply, where we cope with stressful challenges and see them as lessons (Vivekanada, 2005, p.186). Sitting in silent meditation, strengthening stamina and willpower are practices for meeting stress with the confidence to handle it calmly. We can work with determination to remove the additional element of worry from stress reactivity.

            Raja Yoga is a spiritual practice.  Ishwara pranidhana “cultivation of faith” (Vivekanada, 2005, p.187), results in the feeling that a higher power is working through one’s self. (Ravindra, 2006).  A steady spiritual practice extends our thinking from persistently ruminating around the same stressful thoughts. Liberation from these stressful thoughts that loop over- and- over again in the mind allow for an engagement in more peaceful and steady thought patterns. 

           

Conclusion

            In my opinion, Raja Yoga’s lifestyle principles, virtues and moral codes can shift attitudes and behaviors in an effective way to deal with stress.  The motives behind the actions we choose to engagement in reflect our attitudes towards ourselves and others.

An agitated mind encourages behaviors that are disagreeable and these attitudes go in reverse, where disagreeable behaviors encourage agitation in the mind. There is psychological tension when a struggle develops between an action we take, and one we actually thought we should not have taken, maybe without realizing.  We can recognize with Raja yoga the negative patterns and replace them with new healthier habits.  Moral and ethical issues, as well as spirituality beliefs reflect an Eastern yogic perspective somewhat rejected culturally in the field of traditional medicine in the US. The purposeful absence of religion in the teachings of MBSR, I have not experienced with a lack in spirituality. The success of integrative therapies becoming accepted within mainstream medicine, particularly in America, depends on         the credibility and relevance to the end user.

            I agree with the ancient perspective of Raja Yoga, which views stress stemming from internal core issues rather than external causes. The healthy attitudes and purposeful lifestyle described in Raja Yoga lift the spirit of a human being for energy to flow freely, which had previously been blocked by stressful ways of life.  It is not the stress that causes the problems it is our relationship to the stress. A situation that is stressful to one person may not be perceived as stressful to someone else. I see a need for more research on the prevention of stress and the use of yoga therapy before stress itself becomes masked by other diseases. Controlling stress before it develops into disease involves a patient participation alongside the medication to treat the symptoms. The patient who actively participates in their own care with yoga therapy and meditation appears to more effectively be seeing and treating the actual cause of stress.

References

Chapman, P. (2010). Learning to stand on your head: How yoga demonstrates the psychosomatic value of perspective, flexibility and strength.  Psychodynamic Practice (16) 3, p. 305-312.

Chaoul, A .M. & Cohen, L. (2010). Rethinking yoga and the application of yoga in modern medicine.  Crosscurrants (6)145, p.144-167.

Douglass, L.S. & Tiwari, S. R. (2006).  Integrating yoga cikitsa in the west challenges and future directions.  International Journal of Yoga Therapy(16) 21, p. 21-32.

Gupta, A.K. (2002).  Yoga and stress.  Retrieved from http://www.yogamag.net/archives/2002/ajan02/stress.shtml.         

Hickey, W. S. (2010).  Meditation as medicine: A critique . Crosscurrents, p.168-184.

Milligan,C.K. (2006). Yoga for stress management program as a complementary alternative counseling resource in a university counseling center.  Journal of College Counseling (9)8,  p.181-188.

Pain, C., Kekuni, M., Ogden P. (2006) Trauma and the body: A Sensorimotor approach to psychotherapy (1^st Ed). New York & London: W.W. Norton & Company.

Saraswati, Swami Karmananda. (1979). Stress-related diseases. Retrieved from http://www.yogamag.net/archives/1979/ajan79/strdis.shtml

Saraswati, Swami Karmananda. (1991). Stress and modern man.  Retrieved from http://www.yogamag.net/archives/1991/esep91/modman.shtml

Schure, Christopher, & Christopher (2008) Mind-body medicine and the art of self-care: Teaching mindfulness to counseling students through yoga, meditation, and qigong. Journal of Counseling & Development (86) 47, p. 47-56.

Smith, A J., Greer, Sheets, T. & Watson, S.(2011). Is there more to yoga than exercise? Alternative Therapies 17(3), p.22-29.

Vivekanada, R. (2005). Practical Yoga Psychology. Bihar, India: Yoga Publication Trust.

Vivekanada , S. (2007). Raja Yoga. Scribd.com.

            Retrieved from http://www.scribd.com/doc/3009555/Vivekananda-Raja-Yoga

Watts, F. (2000). Psychological research questions about yoga. Mental health, Religion & Culture 3(1), p.71-82.

Whicher, I. (1998). Yoga and freedom: A reconsideration of Patanjali’s classical yoga

            Deputy Director of the Dharam Hinduja Philosophy East & West (48), 2 1998

            272-322.

Death and the Dying Process: A Yogic Perspective

Death and the Dying Process: A Yogic Perspective
Julia Pike
Lesley University

                                                             INTRODUCTION
    When asked what the greatest wonder of the whole world was, King Yudhishthira of ancient India replied, “that we see people dying all around us and never think that we too will die.” (Brahmaprana, 2001, p. 337).  The temporality of mankind’s physical existence is experienced universally, and, at least in the Western world, it is typical for each individual to wrestle with the garden variety of paths to take and belief systems to follow as well as the implications of these decisions.  Many religious groups claim to have evidence of an afterlife, but without the ability to provide concrete evidence of such a realm, faith must come into play as a specific path of life is chosen.  In my paper, I will discuss several yogic perspectives on death, dying, and the afterlife, as well as the implications of these perspectives, particularly as they influence attitudes and the practice of yoga in life.  
    The Bhagavad Gita defines the purpose and implementation of yoga as being “detachment from all sensual engagements … Closing all the doors of the senses and fixing the mind on the heart and the life air at the top of the head” (1989, 8:12).  As this definition states, yoga is - in its true form - an ascetic discipline, intended to be used as a method of minimizing distractions, decreasing the gratification of carnal desires, and allowing individuals to remain present, focused, and mindful.  Rather than altering senses or experiences using external stimulants like rich or spicy foods, sex, extreme activities, or drugs, yogis are challenged to experience the full range of their emotions as they come about, without falling back on any type of escape.  Because of this calling to experience things authentically, yogis have a unique perspective and experience of death and the process of dying, which serves as an example of thought and behavior for others.  These guidelines of behavior and thought being followed by many yogis are stated or outlined in various ancient religious texts.
                                   SPIRITUAL EXPECTATIONS IN HINDUISM
    In the Bhagavad Gita, a foundational text of the Hindu faith, the expectations for beliefs and practices are discussed in snippets of conversation between Lord Krishna and Prince Arjuna, in which the significance and purposes of yoga and reincarnation, among other topics, are emphasized.  Especially notable is the question Arjuna asks Krishna in the eighth chapter: “how can those engaged in devotional service know you at the time of death?” (Bhagavad Gita, 1989, 8:2). By asking this, Arjuna is essentially requesting guidelines for remaining dedicated to Lord Krishna during the dying process.  To this Krishna replies, “one who, at the time of death, fixes his life air between the eyebrows and, by the strength of yoga, with an undeviating mind, engages himself in remembering the Supreme Lord in full devotion, will certainly attain to the Supreme Personality of Godhead.” (Bhagavad Gita, 1989, 8:10). According to the Bhagavad Gita then, dedication to the Supreme Lord and an “undeviating mind” are essential components in facing death.  
                                  VEDANTA AND THE CONCEPT OF SELF
    In the branch of Hinduism known as Vedanta, understanding of life and death is based in an understanding of the self’s purpose.  As human beings, our consciousness centers around the concept of “I”, because this is the identity we have been ascribed and socialized into protecting.  In a sense, this is the only identity we have to attach ourselves to.  In the words of Brahmaprana, “the “I” is the thread of continuity that runs throughout our lives from birth to death” (2001, p. 337).  According to this philosophy, however, our sense of “I” is not the reality of ourselves - rather, the “I” is only a “faint reflection of our true nature” (Brahmaprana, 2001, p. 337).  In this case, the idea of true nature refers to the Atman, or Higher self, which is “unborn and undying” (Brahmaprana, 2001, p. 337).  Our Atman works in conjunction with God, or Brahman, who is the existing reality, or pure consciousness (Brahmaprana, 2001, p. 337).  When we are born, we are ascribed a very physical identity, which grows over time and ultimately eclipses our higher self, because we choose to feed that concept of self (Brahmaprana, 2001).  Rather than self-identifying with a spiritual and eternal consciousness, we tend to see ourselves entirely in terms of our physical and mental capacities.  This breeds more attachment to the physical body and self, distancing any existing association with a spiritual and eternal identity.  
    In a Western culture that is particularly taken with consumption and materialism, we tend to identify ourselves by what Brahmaprana calls our “little ego”, claiming external objects and conditions as our main identities and focusing more on the mind and body than on the spirit (2001, p. 337).  Instead of identifying the self through spiritual characteristics, we identify ourselves by our political party, level of education, or geographical location, none of which pertain to our pure consciousness.  In order to transcend this “little ego” and begin to exist in the Atman, or Higher self, we are required to let go of the connection with the physical and material identity (Brahmaprana, 2001, p. 338).  In a culture that glorifies what is tangible, being in touch with this “pure consciousness” not only takes an element of self-awareness, but also a level of effort in order to achieve it.  Through the practice of yoga, though, this awareness of the true self can be reached.  With this awareness of the true self, identity is rooted in the spiritual and eternal, rather than the “I” consciousness, and fear of letting go of the physical identity is diminished.    
                                   KRISHNAMURTI AND MEDITATION
    Meditation makes up a significant portion of the practice of yoga, and is considered to be an integral piece in developing the “undeviating mind” that is mentioned in the Bhagavad Gita.  In Jiddu Krishnamurti’s book This Light in Oneself, the definition and purpose of meditation are explained in thorough detail.  Although Krishnamurti identifies meditation as many different aspects of mindfulness combined, in one specific section he defines meditation as “the understanding of fear, of pleasure.  Meditation is the thing called love, and the freedom from death, the freedom to stand completely alone” (Krishnamurti, 1999, p. 89).  This definition parallels the expectations of the mind laid out in the Bhagavad Gita, while also incorporating aspects of the self shown in Vedanta.  
    Krishnamurti states, “where there is the activity of the self, meditation is not possible” (1999, p. 71).  Because meditation requires the mind to be emptied of all distractions and preconceived notions, being caught up in the self limits an individual’s ability to move beyond the physical level.  On the other hand, by training the mind to empty itself and let go of this consciousness, it is possible to transcend this base level of awareness in order to work toward a more spiritual and abstract understanding of the self.
    According to Krishnamurti, meditation and mindfulness are the most important part of yoga, but this idea directly contradicts the practice of yoga in Western culture.  In the United States today, yoga is primarily viewed as a physically healthy practice, intended for the improvement of the body rather than the mind.  The idea of a mental exercise as being healthier than a physical exercise is counter-intuitive to Americans, as most aspects of life are evaluated in terms exterior appearance rather than what is internal.  Krishnamurti refutes this idea, however, of our outward based idea of reality, saying “reality is inside the skull” (1999, p. 218).  This idea of reality as internal, however, pervades the majority of Eastern thought, and particularly those operating from the yogic perspective.
                              KUNDALINI AND SPIRITUAL EVOLUTION
    Kundalini yoga centers around the idea of spiritual evolution, and the word “kundalini” itself is defined as “awakened spiritual energy” (Kumar & Larsen, 2007, p. 21). The acquisition of this awakening paves the way for an easy transition into death.  In the words of Ravindra, “difficulty in the dying process is proportional to the level of attachment to the physical world.  Conversely, ease in the process of dying is proportional to the spiritual evolution of the person.” (Kumar & Larsen, 2007, p. 21).  This concept of physical attachment as a barrier in spiritual evolution is one that has remained a common thread throughout the various yogic perspectives we have looked at thus far, and it is especially prevalent in texts that discuss Kundalini yoga.  Several different steps can be taken to awaken spiritual energy, but two of the main components are yoga and meditation.  Kundalini energy is described as being awakened in one of two ways; first, through “active approaches” - visualization, physical exercises, and pranayama - and second, through “passive approaches” such as concentration, surrender, and meditating (Eastman, 1985, p. 38).  As these yogic techniques are implemented, this energy and attachment to the spiritual realm can be reinforced, leaving the physical attachment to dissolve.
                                YOGA AS AN “END OF LIFE” THERAPY
    Now that we have thoroughly addressed the philosophy and faith behind yoga, it is important to discuss some of the established practices in place that assist with death and dying.  Yoga therapy, and specifically what is referred to as “end-of-life” therapy, includes but is not limited to “1) the practice of dying while living, 2) support for individuals experiencing grief and loss, 3) support for individuals experiencing life-threatening illness, and 4) support for those transitioning from physical life to death.“ (Taylor, 2008, p. 97).  These therapies are designed to deal with the various physical, mental, emotional and spiritual aspects of “end of life” care, especially as they relate to preparation for death.  During scheduled therapy sessions, activities such as sharing, centering, body scans and breath scans, pranayama, mudra, asana, and savasana can be used (Taylor, 2008, p. 98).  According to Taylor (2008), the savasana is an essential component of the therapy, as it “provides an opportunity [for the student] to practice moving toward the ultimate letting go.” (p. 97).  By providing this space of experiencing and preparing for the eventual “letting go”, the therapist creates a safe space for the experiencing of the emotions related to the physical and mental suffering associated with dying.  This then helps the student to have an authentic experience without trying to force the feelings out of the way.
    Taylor shows that the idea of life and death as two disconnected entities is a side effect of the lens that we, as Westerners, look at life through.  Our society values youth, beauty, convenience, and speed, and therefore negative feelings such as grief, loss, and dying are seen as situations to move through, not as experiences that are natural and necessary parts of life.  Taylor, however, speaks out against this set of ideals, saying “contemporary society would benefit from a vision of death that is not dissociated from life” (2008, p. 97).  Because Westerners tend to view life - life in the tangible and physical sense - as temporary and a one-time-only occurrence, much weight is added to the situation, and therefore it is avoided entirely.  However, when death is “not disassociated from life” as Taylor says, the dying process can be seen not as the end of a cycle, but the middle of an ongoing one.
    The philosophical tradition of yoga calls students to be “aware of the polarities of life, as
well as the practical art of science and living” and the relationship between life and death can be seen as an unbroken cycle if viewed through a yogic perspective of self-awareness, mindfulness, meditation, and circulation (Taylor, 2008, p. 97).  By providing an atmosphere that cultivates these attitudes and practices, not only toward death but toward living, yoga therapy has the ability to offer a safe healing and learning environment that allows individuals to openly explore the range of emotions and experiences that take place between birth and death.  As stated earlier, the concept of life and death are typically viewed as being at odds with one another, but in the words of Taylor (2008), “yoga allows for the integration of opposites” (p. 102).  By being aware of these opposites, exploration of the balance between them can take place, and a more holistic comprehension of the interrelationship between what appear to be opposites can be reached.  
    The concept of interrelationship and a cyclical route from life to death can be seen in an examination of the Pancha Maya Kosha Model, as outlined by Taylor as well as Dubrovsky.  Dubrovsky explains the according to the kosha model “we are comprised of five dimensions or layers: the physical body (annamaya), the breath or life force (pranamaya), the intellect (manomaya), the personality (vijnanamaya), and the heart, which is the seat of bliss (anandamaya).” (2011).   According to this model, although each of these layers has its own characteristics and can be defined concretely, the movement from one to another is fluid and flexible, and an individual can float between levels of awareness of the self despite having reached “deeper” levels.  Awareness of the paradoxes through each of the koshas allows for movement toward freedom from experiences.  
    According to this model, the student goes through various stages of being as he or she engages in the practice of yoga, getting more and more in touch with each state of consciousness and focus of awareness.  In addition to being exercises of the body, these yogic approaches exercise the mind, stretching it to a place in which it can be self-aware and mindful.  Yoga instructor Arthur Kilmurray stated in an interview, “the foundational work of yoga therapy is staying present, noticing our current perceptions, finding ways to increase sensitivity and stay relaxed”, and these are some of the objectives reached through the use of the yoga practices mentioned above (Kilmurray, 2008, p. 33).  
    But what is the advantage of this self-awareness from the yogic perspective?  “When we are aware of our suffering we have a relationship to it but it is no longer one’s whole identity,” says Kilmurray,“suffering demands that we deal with it” (2008, p. 32).  By going through suffering rather than around it, we learn to process information, emotions, and events not only fro a yogic perspective, but also from a healthier perspective.  While pain is unavoidable, learning coping mechanisms and establishing a support system often proves to be invaluable.  Although we cannot eliminate physical death, we can begin to prepare ourselves for what may come after, as that remains to be seen.
                                                         CONCLUSION
    Although death is an ongoing, universal, and entirely natural aspect of life, the dying process is for each individual overwhelming and full of uncertainty.  Once the dying process has begun, the individual is forced to rescind control over his or her physical body, and the idea of this alone is enough to create severe anxiety and fear.  Often the fear of death itself is minimal in comparison to the fear of what is unknown, uncertain, and out of one’s own realm of control.  Ram Dass once stated that the vast majority of fear lies in the “thought of losing [our] entity-ness”, but according to the yogic perspectives outlined above, this idea of losing your wholeness or conscious self at death is not supported (Dass, 2004, p. 204).  With the proper balance of mindfulness, self-awareness, and yoga practice, this identity crisis can be averted, and the fear of death, stemming from the fear of nonexistence, can be eradicated.  Yoga instructor Gary Kraftsow says, “when you have a life threatening or serious condition, you can’t rely on what you could rely on before.  Yoga is like a raft that can help you go through these things,” (Dubrovsky, 2011).
    In the words of Woody Allen, “It’s not that I’m afraid to die, I just don’t want to be there when it happens” (Taylor, 2008, p. 100).  This sentiment is one that I believe reflects the majority of Western thought on the topic of dying, and it speaks to not only a fear of death itself, but also to the fear of being fully present and resolved to experience what we as a society deem as unpleasant.  Prone to quick fixes, our culture frowns upon the idea of patience or trusting anything other than our own self-sufficiency; both of which are concepts that must be embraced if a yogic approach is going to be taken.  
    Because Western culture relies so heavily on what is concrete and measurable, much of the value of yoga is typically lost in favor of what Anna Dubrovsky refers to as the “notion that yoga is an exercise regimen” (2011).  The paradox that we as Westerners run in to, however, is that we are blocking our own selves from this enlightenment of sorts by remaining contained by this preoccupation with the physical and visible.  It is obvious through every single one of the yogic perspectives previously described that in order to benefit from the practice of yoga, both as meditation and as therapy, it is necessary to let go of our Western perspective of what health is.  “Yoga isn’t about getting to know the postures,” Dubrovsky explains further, “it is about getting to know yourself (2011).
     J.T. Gire of Washington University’s Center for Cross-Cultural Research discusses the cultural aspects of death and dying at great length, coming to the conclusion that although all must eventually face death, the conceptualization of dying, death, and the afterlife by people within each culture creates the driving force behind lifestyle choices and what he refers to as “readiness to die” (Gire, 2002, p. 2).  This idea of being prepared to die is a thread that runs through nearly every piece of research on the yogic perspective of death, and presents itself as an obvious influence on lifestyle choices within the yogic community.  If an individual believes in life after death, certainly he or she will be more likely to care more for spiritual health and fulfillment in this life.  But on the other hand, if higher value is placed upon the physical existence and there is not a firm belief in any life after the present, more emphasis will be placed upon perfection of the body than the mind.
    If an individual is able to take the time and go through the process of un-learning the Western ideals that have become so entrenched within our collective cultural consciousness, it is possible to develop the “undeviating mind” that the Bhagavad Gita speaks of, and to shift our paradigm in a way that allows for a more fluid and abstract understanding of consciousness.  With this new mindset, according to yogic perspective, it is then possible to conquer death, as its power over us is eliminated.                                                           




                                                           References
Dass, R. (2004). Paths to god: living the Bhagavad Gita. New York, N.Y.: Harmony Books.

Dubrovsky, A. (n.d.). Radical Healing: Yoga with Gary Kraftsow « Himalayan Institute. Himalayan
    Institute. Retrieved April 15, 2012, from  
http://www.himalayaninstitute.org/yoga-international-magazine/inspiration-articles/radical-healing-yoga-with-gary-kraftsow/

Eastman, D. (1985, September). Kundalini Demystified. Yoga Journal,64, 37-43.

Gire, J. (2002). How death imitates life: Cultural influences on conceptions of death and dying..Online
    Readings in Psychology and Culture, 14, 1-10.

Kilmurray, A. (2008, Fall). Wholeness as Healing. Integral Yoga Magazine,20, 31-34.

Krishnamurti, J. (1999). This light in oneself: true meditation. Boston: Shambhala.

Kumar, R., & Larsen, J. (2007). The kundalini book of living and dying: gateways to higher  
    consciousness. Delhi: Motilal Banarsidass.

Pravrajika, B. (2001, September). Vedanta: Death and the Art of Dying.CrossCurrents Journal
    of Addiction and Mental Health, 358, 335-340. Retrieved April 15, 2012, from  
    http://www.nyu.edu/classes/gmoran/BRAHMAPRANA.pdf

Taylor, J. (2008). End-Of-Life Yoga Therapy: Exploring Life and Death. International Journal of
    Yoga Therapy,18, 97-103.

The Bhagavad Gita: text translation, and commentary by Swami Sivananda. (10th ed.). (1989).  
    Shivanandanagar: Divine Life Society.