Yoga
and the Treatment of Schizophrenia
Rebecca
Morse
Lesley
University
CSOCS
3452.01
Introduction
Yoga
is a unique practice in its ability to invigorate and rejuvenate the body as
well as the mind. Yoga creates interplay between the mind and the body which has
been shown to be extremely beneficial to practitioners. As yoga becomes more
accepted and practiced in the Western Hemisphere, researchers have begun to pay
attention to the effects of yoga on a variety of disorders. One of these
disorders is schizophrenia. Researchers have paid special attention to the use
of yoga in the treatment of schizophrenia, and multiple studies show yoga to
have effects on the functioning and wellbeing of patients with schizophrenia. This
paper will explore existing research surrounding treatment interventions using
yoga for people diagnosed with schizophrenia and the cultural context within
which these treatment interventions are applied.
Schizophrenia
Schizophrenia
is commonly regarded as one of the most debilitating mental illnesses. It is a
degenerative disease which includes both positive and negative symptoms.
Positive symptoms may manifest as hallucinations, delusions, and disorganized
behaviors. These are changes in personality or affect which are in addition to
a person’s normal functioning. Negative symptoms show a reduction in a person’s
normal functioning, and include flattening of affect, apathy, social withdrawal,
and cognitive impairments. Schizophrenia affects between 2.6% and 2.8% of men
and women between the ages of 15 and 44 worldwide. Symptoms of schizophrenia
tend to worsen in relation to stress and anxiety in a person’s life, as well as
in response to difficulties with coping skills (Deckx et al, 2011).
Why Yoga?
Clinical
rehabilitation for people with schizophrenia focuses on maintaining and
building coping strategies which might help a person who has been diagnosed
with schizophrenia to deal with feelings of stress and anxiety which might
exacerbate symptoms of schizophrenia. Yoga is one clinical intervention used in
the treatment of patients with schizophrenia to help develop and retain coping
skills. Sufficient research does not exist to imply that yoga helps with reduction
of stress and anxiety when it is incorporated into treatment plans for those
diagnosed with schizophrenia, but yoga has been shown to create improvements in
levels of stress and anxiety for patients from other populations (Deckx et. al,
2011).
Elizabeth Visceglia,
a researcher of yoga and schizophrenia describes schizophrenia as “A lack of
groundedness- the literal disconnection from physical experience,” (Visceglia,
2007, 95). She argues that, for people diagnosed with schizophrenia, the mind
is experienced as an enemy because the person with schizophrenia loses control
of their mind, and they are attacked from within by internal stimuli. Visceglia
notes that the body can be used as a tool for grounding of the mind. It follows
that a yoga practice could be very beneficial to those diagnosed with
schizophrenia because it provides a fusion of mind and body. She argues that
the somatic nature of yoga can pull a person with schizophrenia out of their
internal world, and through mastery of the body they can achieve mastery of their
mind. Yoga also offers those diagnosed with schizophrenia a way to relax within
their bodies, and to not experience their bodies solely as places of pain or anxiety
(Visceglia, 2007).
Yoga can provide a
framework within a larger treatment model which can help patients in a number
of ways. Those with schizophrenia tend to experience the world as hostile and
alien and the internal stimuli that a person with schizophrenia might
experience can create those feelings of hostility and alienation in and about
the self. Yoga can begin to teach patients to trust their bodies again and
close some of the separateness which a person with schizophrenia feels within themselves
and about the world around them (Visceglia, 2007).
Current
Treatment Interventions
Those
with schizophrenia are generally treated with a mixture of anti-psychotic
medications and therapeutic approaches. There is no single cause of
schizophrenia, which means that there is no one treatment which is universally
effective in the rehabilitation of those diagnosed with schizophrenia. Traditional
“talk therapies” can make strides over a long period of time, but it is
generally acknowledged that therapy will have little effect on how
schizophrenia presents (Visceglia, 2007).
Medications are seen
as the more essential portion of a schizophrenia treatment plan. Anti-psychotic
medications date back thousands of years to an Ayurvedic herb by the name of
Rauwolfia Serpentia, which has been used in traditional Indian medicine to
treat “madness.” Pharmaceutical drugs have developed for the treatment of
schizophrenia over time. Many of these drugs have evolved out of Rauwolfia
Serrpentia. Anti-psychotic drugs affect neurotransmitter activity within the
brain, and, when effective, reduce the amount of dopamine that the brain receives.
They are most successful at reducing positive symptoms that a patient might
experience, such as hallucinations and delusions. While positive symptoms
decrease however, negative symptoms tend to increase. Patients may feel more
depressed and withdrawn, uninterested in activities which they once found stirring
(Visceglia, 2007).
Yoga as
Treatment
Yoga as a portion of a
treatment plan for a person diagnosed with schizophrenia can improve a person’s
experience of the world as well as help to decrease negative symptoms caused by
the illness and intensified by medication. In a study done by researchers at
the National Institute of Mental Health and Neurosciences, it was concluded
that the incorporation of a yoga practice into treatment does contribute to a reduction
in symptoms experienced by those diagnosed with schizophrenia (Duraiswamy,
Gangadhar, Nagendra, & Thirthalli, 2007). Another study by the National
Institute of Mental Health and Neurosciences found that when people diagnosed
with schizophrenia added yoga to their treatment plans, they showed marked
improvements in social skills. Especially noted was yoga’s positive effect on facial
emotion recognition deficits. This study also found that the most benefits of
yoga occurred at the end of the second month of yoga practice, and that these
benefits remained with participants for at least four months after ending a
supervised yoga practice (Arasappa et al., 2011).
Along with the lessening
in symptoms which may be seen in the course of a yoga practice, a study by the
Journal of Complementary and Alternative Medicine showed yoga to have significant
effects on brain chemistry. Researchers found that those who participated in a
yoga practice had increased levels of aminobutyric acid, or GABA. Decreased GABA
levels are generally associated with mood and anxiety disorders (Barch, et al.,
2010). People who have been diagnosed with schizophrenia experience high levels
of anxiety and instability of mood. Yoga can help to calm this anxiety and mood
instability. As this study suggests, yoga might have more of a chemical
difference than would be expected. This could account for the long term changes
seen in Arasappa et al.’s study on yoga and facial emotion recognition
deficits.
A yoga practice for
those with schizophrenia may look different than traditional yoga practices.
Traditional yoga practices tend to follow some school of methods, in which
there are specific asanas, or postures, and a theoretical base supporting that
particular kind of yoga practice. Elizabeth Visceglia promotes an integrated approach
to yoga, in which the instructor draws from various techniques and backgrounds
and creates a practice based on empowerment of the client. She offers that is
best to always come back to the breath. Yoga theory states that with steady
breath the mind can be controlled. Visceglia also discusses the need for the
yoga class to be a safe place, where a participant can feel comfortable
participating, and not compelled to do things which might exacerbate their
illness, such as shut their eyes. Because patients may not be in touch with
their bodies, a yoga practice can feel especially foreign to those diagnosed
with schizophrenia. Again, Visceglia emphasizes the need to allow participants to
feel like they are in control of their practice. She points out that an
instructor might come across poses which are difficult for those who have been
diagnosed with schizophrenia. She argues that it is more therapeutically effective
to allow participants to make the pose their own and to achieve a position that
they feel comfortable in, rather than pushing them beyond their limits
(Visceglia, 2007).
Cultural
Differences
As research around
yoga in therapy surfaces, yoga has begun to be viewed as a significant add-on
to therapy. Much of the literature and research focusing on yoga in therapy
with people diagnosed with schizophrenia suggests a multidisciplinary care approach
to treatment. Yoga, exercise, and physical therapy are shown to be positive additions
to treatment. Because those with schizophrenia struggle with remaining grounded
and connected to their bodies, these interventions can bridge the gaps between
mind and body. Catalan-Matamoros et al discuss the significance of a
multi-disciplinary approach to treatment. They stress the idea that the body is
nourished by the mind and the mind is nourished by the body (Catalan-Matamoros
et al, 2012). Arun Jha argues that this multi-disciplinary approach can begin
to rebuild upon some of the disconnect experienced in Western medicine (Jha,
2008). Western medicine focuses so much on curing ailments within one part of
the body. Yoga is a holistic practice which ties in the mind to the body.
Instead of focusing on curing one portion of the body, the participant is able
to focus on their whole self and grow from there.
In a survey of
patients experiencing hospitalization for severe mental illness, many
respondents identified yoga and meditation as “spiritual” activities which were
incorporated into their regular treatment models (Cash, Russinova, & Wewiorski,
2002). The idea of yoga as a spiritual activity and as a treatment for illness
in the Western world is a very controversial one. Cross-culturally, yoga is seen
in many different ways. In India and other parts of the Eastern Hemisphere,
yoga is a lifestyle and a spiritual practice which is akin to a religion. As of
2005 statistics, there were approximately 20 million yoga practitioners in the
U.S and Europe who regularly took part in a yoga practice (Currier et al.,
2005). As yoga has achieved this level of recognition in the West, it is more widely acknowledged
as a cure for an undesirable body or mind than as a lifestyle.
The idea of yoga as a
treatment or a cure for mental illnesses such as schizophrenia is a relatively
new inquiry. There are very few references in traditional yogic texts to the
use of yoga to improve mental illness (Visceglia, 2007); however, yoga’s
emphasis on controlling the mind makes it an intriguing candidate for use as a
therapeutic tool. As yoga has been adopted and adapted in the West, practices
and theory have changed. The Eastern philosophy of yoga as a lifestyle is not as
well understood, and is certainly not as easily found. It seems that some of
the disconnect in theory between the East and the West has lent itself to the use
of yoga as a treatment in mental health. Yoga is presented from a Western
perspective when it is assumed that yoga should be used as an addition to treatment
or as a cure for symptoms. Studies strongly support yoga in therapy for those diagnosed
with schizophrenia. The mixture of Eastern and Western theories and
philosophies may be key to the treatment of those diagnosed with schizophrenia.
Schizophrenia is a very complex disease in relation to the creation of
treatment models. Neither medicine nor therapy alone has proven to be efficacious
in the treatment of schizophrenia (Deckx et al, 2011) Studies show that yoga
has significant benefits to those diagnosed with schizophrenia. In this case, the
cultural divide between the East and the West seems to have had positive repercussions.
If researchers and clinicians in the Western world followed the philosophy that
yoga is not a cure, it is a lifestyle, yoga practice in the treatment of those
diagnosed with schizophrenia might not exist.
Schizophrenia and
other mental illnesses are very stigmatized in Western society. These are
diseases for which people are less likely to get help because they may feel
shamed by their disease or they may feel like they should be able to fix it on
their own. Angermeyer et al.’s study of public attitudes towards psychiatric
treatment found that people in the Western Hemisphere were more likely to seek
help for a mental illness, such as schizophrenia, if they felt that the disorder
was caused by brain disease and if they understood the cause of their mental
illness to lie in a chemical imbalance (Angermeyer et al., 2005). It is very
natural that yoga be practiced in response to this belief system. In the West,
yoga is viewed as a very individual practice. Yoga for people diagnosed with
schizophrenia is presented as empowering. It is meant to help patients take
back control of their minds and their bodies. Yoga is effective in treating many
symptoms of schizophrenia, and allows for participants to guide their own
practice. This fits in well to Western philosophy that schizophrenia is a brain
disease which, under the right circumstances, can be treated so that a person
diagnosed with the disorder may live a more full life.
Conclusion
People
who are diagnosed with schizophrenia have one of the worst prognoses in mental
illness. Because of the nature of the disease, it is very hard to treat.
Symptoms can be managed through a number of approaches, including the addition
of yoga to an expansive treatment plan. Yoga is viewed as a great way to ground
and reconnect patients with themselves. As a person diagnosed with
schizophrenia continues a yoga practice, their brain chemicals can change and
the advances that they have made in practice can remain with them. Western and
Eastern culture and yoga theory present very different views on how yoga should
be used. Western culture promotes yoga for the advancement of the self and the
treatment of problems within the self. This is in stark contrast to Eastern
yogic theory which implies that yoga is a way of living. The advances seen in
therapy for people diagnosed with schizophrenia create questions regarding how
bad it truly is to practice yoga in order to treat a flaw or imperfection
within the self. The changes in brain chemistry that yoga causes suggest that, despite
contradictory intentions behind practicing yoga, a person’s yogic practice can intimately
affect their life and in turn how they live it. This is especially true for
people diagnosed with schizophrenia. Perhaps they do not intend to live a yogic
lifestyle, but they may shape their brains and their bodies into new and wholly
different beings.
References
Angermeyer,
M. C., Breier, P., Dietrich, S., Kenzine, D., & Matschinger, H. (2005a).
Public attitudes toward psychiatric treatment. Social Psychiatry &
Psychiatric Epidemiology, 40(11), 855-864.
doi:10.1007/s00127-005-0958-x
Arasappa,
R. R., Behere, R. V., Gangadhar, B. N., Jagannathan, A. A., Thirthalli, J. J., Varambally,
S. S., & Venkatasubramanian, G. G. (2011). Effect of yoga therapy on facial
emotion recognition deficits, symptoms and functioning in patients with
schizophrenia. Acta Psychiatrica Scandinavica, 123(2),
147-153. doi:10.1111/j.1600-0447.2010.01605.x
Cash,
D., Russinova, Z., &Wewiorski, N. J.
(2002). Use of alternative health care practices by persons with serious mental
illness: Perceived benefits. American Journal Of Public Health, 92(10),
1600-1603. doi:10.2105/AJPH.92.10.1600
Catalán-Matamoros,
D., De Hert, M., Gómez-Conesa, A., Lundvik-Gyllensten, A., Probst, M.,
Skjaerven, L., & Vancampfort, D. (2012). Systematic Review of the Benefits
of Physical Therapy Within a Multidisciplinary Care Approach for People With
Schizophrenia. Physical Therapy, 92(1), 11-23.
doi:10.2522/ptj.20110218
Currier,
M., Lavey, R., Mueser, K. T., Osborne, D. D., Sherman, & Wolfe, R. (2005). The
effects of yoga on mood in psychiatric inpatients. Psychiatric
Rehabilitation Journal, 28(4), 399-402.
Deckx,
S., De Hert, M., Demunter, H., Knapen, J., Probst, M., Wampers, M., & Vancampfort,
D. (2011). State anxiety, psychological stress and positive well-being
responses to yoga and aerobic exercise in people with schizophrenia: a pilot
study. Disability & Rehabilitation, 33(8), 684-689.
doi:10.3109/09638288.2010.509458
Duraiswamy,
G. G., Thirthalli, J. J., Nagendra, H. R., & Gangadhar, B. N. (2007). Yoga
therapy as an add-on treatment in the management of patients with schizophrenia
– a randomized controlled trial. Acta Psychiatrica Scandinavica, 116(3),
226-232. doi:10.1111/j.1600-0447.2007.01032.x
Jensen,
J., Karri, S. K., Owen, L., Rein, T., Streeter, C. C., Whitfield, T. H., & Yakhkind,
A. (2010). Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA
Levels: A Randomized Controlled MRS Study.Journal Of Alternative &
Complementary Medicine, 16(11), 1145-1152.
doi:10.1089/acm.2010.0007
Jha,
A. (2008). Yoga therapy for schizophrenia. Acta Psychiatrica
Scandinavica, 117(5), doi:10.1111/j.1600-0447.2008.01151.x
Visceglia,
E. (2007). Healing Mind and Body: Using Therapeutic Yoga in the Treatment of
Schizophrenia. International Journal Of Yoga Therapy, (17), 95-103.
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