Wednesday, May 2, 2012

Yoga and the Treatment of Schizophrenia











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
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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 Scandinavica123(2), 147-153. doi:10.1111/j.1600-0447.2010.01605.x
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