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DRAFT: This module has unpublished changes.

Lillian Myers

November 28, 2010

Yoga History, Theory and Philosophy

Shri Bringi Devee and Nataraja Kallio

       Relief of Post Traumatic Stress Disorder thru Western Medicine and Yoga Therepy

            Post-traumatic stress disorder is a frequent occurrence in the high paced society of the United States. Commonly, Western medicine practitioners offer prescription drugs, exercise and psychotherapy for suffers of PTSD. Yoga therapy, however, is a viable alternative to compliment or substitute Western modalities. Practices such as Bhakti Yoga, pranayama, asanas, consciousness studies, awareness of the gunas, studying the The Bhagavad Gita and The Light on the Yoga Sutras and sankhya, holistically transform the entire lifestyle of the patient. Yoga therapy offers answers to existential questions, and simultaneously transforms the mind, body and spirit. 

            Post-traumatic stress disorder, PTSD, is one of five anxiety disorders described in the DSM- IV, the manual of Western psychoterapy. The disorder is commonly found in military veterans, torture and airplane crash victims, sexual abuse victims and in invasive medical treatments. PTSD is increasingly studied in relation to the caused by the fast race of modern society. PTSD occurs in higher frequency in perilous occupations and in higher crime areas with lower socio-economic status. People who are previously depressed, neurotic, or experienced behavioral issues in childhood are more susceptible to PTSD after trauma later in their lives.

            Symptoms which occur during the first month of an incident, such as shock, anger, depression and numbing, are healthy and adaptive ways to work with trauma. If symptoms do not persist a month after the event, the patient is diagnosed with acute stress disorder. However, the symptoms following PTSD are ongoing and resolution may not arrive. A month after an incident a patient experiences "flashbacks, nightmares, insomnia, anxiety and emotional numbing (pg. 101, (1999) Elkin).”  The reaction may be prolonged after exposure and may include "avoidance, anxiety, re-experiencing and hyper arousal" (pg.103). Symptoms include “…emotional, behavioral and interpersonal suffering, binging, purging, self-harming, isolation and mood-regulation... sleep disturbances, hopelessness, poor-self esteem, and suicidal thoughts... panic disorder, social phobia, obsessive compulsive order(pg.109).” Such dire signs are addressed through a variety of modalities in Eastern and Western practices. 5-10% of the American population will suffer from PTSD. (pg. 102) Yoga Therapy, mental therapy and drugs can be prescribed in unison or separately to alleviate PTSD.

            Practitioners of medicine in the West commonly refer clients to psychotherapists and prescribe pills to help abet PTSD. Commonly, Western doctors and practice manuals will reference Tricyclic antidepressants, such as Elavil and SSRI'S to reduce anxiety and avoidance behaviors.  Paroxetine and traxodone are advocated at night to aid in insomnia. Carbamezepine and valproate help with mood swings and flashbacks. Beta-blockers are offered to monitor anger.  (pg.108, Elkin) These practices are a replacement and/or compliment to Yoga therapy. Briefly illustrating Western healing modalities helps shed light on the contrasting procedures and supplements to the benefits of Yoga therapy.                        

            Commonly PTSD sufferers, as well as people with depression, ADHD or social isolation issues, who cannot afford pharmaceutical drugs, will self-medicate with crystal meth or marijuana. In Gabor Mate's book, In the Realm of the Hungry Ghosts, Mate rallies for holistic alternatives, such as Yoga therapy, to relieve stress. "If the necessary physical, psychological, and social supports were provided... it would not take long to diminish the appeal of methamphetamine and to wean the vast majority of stimulant addicts away from this harmful chemical (pg. 322, (2008) Mate).” Easier said than done, the patient, renamed as addict, is traumatized over and over again by ostracism, harassment, dire poverty and disease, as they self-medicate with illegal drugs and become  substance dependant. Although Mate does not mention Yoga as a psychological, physical and social support, he does mention psychotherapy.

            Individual psychotherapy counselors are effective to help PTSD patients process the trauma and symptoms of isolation, demoralization and fears.  Therapy is structured in several stages, including creating a safe environment, maintaining homeostasis and retelling the event through drama and storytelling. The final stage is the reexamination of one’s world-view, trust in others, and clarity in a personal existential debate.

            By undergoing a life-threatening occurrence, existential questions can arise. PTSD patients may ask, what is the meaning of life? What is death? What is the difference between duty and liberation? These inquiries may isolate the individual from their community who may not be concerned with existential quandaries. Isolation and invalidation due to a patient's unsimiliar experience from their community leads to increased psychopathology and Yoga therapy offers solutions to these uncertainties.

            Hinduism is the religion of, and prior to, the Buddha and Yoga is a branch. During an existential crisis, Hindu scriptures may offer the calm focus a PTSD sufferer may need and respond to spiritual matters.  The practice of yoga is beyond an Eastern influenced exercise, but is the reconsideration of one's dharma, and uniting multiplicity to oneness, uniting Brahman and Atman, and prakriti and purusha. The intention of Vedanta and Yoga is to dissolve a sense of separate self. Yoga is the bedrock of Indian civilization, philosophy and physical and spiritual methodologies. Yoga is the ritual of tapping into our essential nature and invites liberation from ignorance for every sentient being. Such scriptures, meditations and actions may offer great wisdom to trauma victims who are reconsidering life, death and rebirth. Yoga therapy may dramatically alter a patient's life. The Yogic lifestyle will reconstruct a patient’s internal and external consciousness, stop the dukha of PTSD and rebuild the patient's well being.

            A question arises, “How can I be calm, I feel neurotic and anxious!” The Yogi replies, “Bhakti yoga!” Yoga therapy best responds to anxiety, the most common symptom of PTSD, through Bhakti Yoga, the yoga of devotion, meditation and asanas, which realigns the mind with the Ultimate and Supreme Self. Bhakti yoga is the realization of the Self within through the practice of dhyana and asanas. The guna for bhakti is tamas, the state of the subconscious mind.  "Still your mind in me, still your intellect in me, and without doubt you will be united with me forever." (ch.12.8, (1985) Easwaren) A being who chooses the path of bhakti, allows the experiences of life, pain and pleasure, lust and grief, come and past without becoming attached. The practitioner, with the guidance of an instructor, can experience sankya and travel from a state of Vritti in the Manas, to Ahamkara, to Self-Awareness, to Buddhi nature. The question arises for the practitioner, "How do I reconnect with self-awareness, I am sad, nervous and in pain!" The yogi replies, "Jhana Yoga! The path of wisdom." This is true knowledge, to seek the Self as the true end of wisdom always. To seek anything else is ignorance." (s.13.11, Iyengar) By studying the Bhavagad Gita, The Light on the Yoga Sutras of Patanjali, The Upanishads, and The Vedas!"  By studying the sutras, Bhagavad Gita and listening to gurus, and unite with the Supreme Self.

            If a PTSD sufferer continues with Yoga therapy, they will be guided to read The Light on the Yoga Sutras of Patanjali. The Yoga Sutras illuminate the five kleshas and the nature of meditation, helping the PTSD person detach themselves from pain and affliction. The sutras guide the patient in the quiet observation of the mind. Maintaining quiet moments brings about a "balanced state of consciousness (pg.186, (1993) Iyengar).”

The study of consciousness has four tendencies. The first tendency is avidya the wandering nature of the mind to the past and the future, which may relive trauma. The second tendency is the quality of discernment, nirodha samskara, lending itself to restraint of thoughts of injury. The third level is laksana parinama, offering mental tranquility through yoga without prescription pills. The forth stage is sadhka, the quality of prolonged intermission of sound, giving birth to liberation. (pg. 183, Iyengar) The Yoga Sutras offer meditation to couple with, or as an alternative, to anti-depressants.            

            In Yoga Therapy, a PTSD case is encouraged to learn to meditate and observe his consciousness patterns. Pranayama is the regulation and restraint of breath as the breath flows in and out. The Yoga Sutras of Patanjali muse, "The restraint of rising impressions brings about an undisturbed flow of tranquility." (pg. 179, (1993) Iyengar) The practitioner strives to sustain the pause between experience and impression to maintain peace. In nirodha parinama, rising thought waves are controlled and calmed. In silence, stillness blossoms.  In a state of silence, the soul blooms as the center of focus. "The weakening of scattered attention and the rise of one-pointed attention in the citta is the transformation towards samadhi." (pg.180, Iyengar) Learning to hold fast to one pointed meditation is smadhi parinama. When the consciousness rests in the seer, one becomes pensive and loses sense of birth and death, evolution and destruction as the sense of self rests in the realm of Shiva, beyond the binds of mortality. Similarly, when a patient of PTSD begins to meditate and rest the mind in Upekshana; they are able to let go of past traumas and release the physical energetic hold of memory locked in the body.            

            Utilizing Yoga therapy to live with PTSD, a person may study the Yoga Sutras to name and witness the five kleshas of their pain body. The kleshas are obscurations The first klesha is avidya, to mistake the transient for the permanent: a person begins to understand pain is passing, dark thoughts give way to the Ultimate, and anxiety gives way to peace. The second klesha is asmita or egoism. Asmita is untied when the seer realizes she is an instrument with the power of seeing. The third klesha is raga, the identification with pleasurable experiences; an enticing trap, because then one identifies with pain as well. Dvesha, is the forth klesha, is the aversion to pain and in consequence a difficulty in processing past grief. Abhinivesha is the fear of death and change, a universally shared klesha, and is a gift. By practicing yoga, a PTSD patient may rebalance by understanding the obstacles of the kleshas in one’s life.

            Yoga and Yoga therapy is founded on the studies and practices of the Vedanta,  the culmination of the Vedas, originating from 500 B.C. The Vedanta is made up of the Gita, Upanishads and the commentaries on the Upanishads. The core of Vedanta is the realization of Sankya, and "seeks to liberate the individual purusha from prakriti." (pg.285, (1985) Easwaren) Purusha is formlessness, spirit and man's undying nature. Prakriti is our objects of consciousness, nature and form. A sufferer of PTSD can release the manas, ahamkara, self-awareness  into Buddhi and redefine how they filter the world. In consequence, the ahmakara can be released to purusha and experience sankya.

            According to the Yogic tradition, PTSD qualities, such as hopelessness, poor-self esteem, social phobia and obsessive compulsive order, parallel the guna of tamas. The three gunas represent the unfolding of time, transformation and nature of life. The state of tamas is the unconscious rest needed to forget details and suffering. However though study, the patient can transcend tamas to be in a state of rajas. In Rajas, the sufferer may begin to imagine the future without pain. And externalize their desires, becoming active in their lives again. A state of rajas is riddled with apunya and one may begin to feel angry and resentful towards the past. Soon, the path may evolve to Satva, representing the Buddhi nature of a tranquil, clear mind, full of sukha, mudita and punya. The three gunas, woven together, represent prakriti, and by witnessing each guna, we do not attach to Satva, Rajas nor Tamas, and allow ourselves to transcend to gunatita

            The epic, sacred story of the Bhagavad Gita outlines the three paths of yoga, bhakti, karma and jhana yoga. In the Gita, Krishna outlines the three paths of yoga, "Some realize the Self within them through the practice of meditation, some by the path of wisdom, and others by selfless service (ch.13: 24, (1985) Easwaren).” "But better still is surrender of attachment to results, because there follows immediate peace (ch. 12: 12, Easwaran).” Within each path there are specific renunciations, goals and liberations. The three paths are linked to the three gunas within Sankhya.

            The most common entry into Yoga therapy is the practice of postures, or asanas. Asana, an aspect of ashtanga yoga, allows the mind and body to unite in harmony, and enter a space of samadhi. To paraphrase Kallio, 'if one is depressed they should do thirty sun salutations, there is no way they could be depressed then.' (Sept.11, 2010, personal interaction, Nataraja Kallio) Through the path of Bhakti we realize, "The wise grieve neither for the living nor for the dead." (ch.2:11, (1985) Eswaren) Ultimately, one empties the wheel of the mind and surrenders at the feet of the divine.

            In addition to the numerous benefits of asanas, pranayama and meditation of Yoga therapy, one may go to an Ayurvedic doctor and receive treatments to reduce PTSD. In causal consultation with Anu, an Ayurvedic doctor and yoga professor at Southern California University for Health, at the American Public Health Association Conference in Denver in November, Anu promoted Ayurvedic for stress. Anu noted in Ayurveda the initial stage of stress management is satvavajaya chikitasa, speaking with the patient and making them comfortable. In conversation, the doctor and patient focus on the cause of the stress, identify the root and continue with the rejuvenating treatment. The Ayurvedic treatments are shirodhara, the process of dripping sacred, blessed herb infused oils on the third eye. Taila dhara, to drip oil all over the body, is deeply relaxing. Shiroabhyanga is a head massage and abhyanga is a full body massage also relieves the body of stress. Asanas and pranayama, as mentioned above, are also very beneficial for relaxing the mind and body. Ayurveda recommends reading the Vedas, spiritual books always uplift the mind and will give peace to the body and brain. (Anu, Personal Communications, Nov.7, 2010)

            The questions arise, how can we bring Yoga Therapy into conventional hospital settings in the United States? How do we introduce Hindu spiritual principles as solutions to PTSD to non-Hindu's? With the increase of soldiers returning from war, rising rates of traumatic incidents, there is an urgent need for therapeutic practices to prevent addiction, depression and further self-harm. Asanas and Bhakti Yoga practice are becoming increasingly popular in gyms and health clubs. Asanas will wave the flag for yoga, introducing pranayama to the West. PTSD patients may benefit from a simple introduction into Yoga philosophy through postures, and then be encouraged to explore meditation, the gunas, and the paths of karma and jhana Yoga.

 

Namaste

 

 

 

 

Resources:

Easwaran, Eknata. (1985) The Bhavagad Gita. Nilgiri Press, Berkeley, California.

Elkin, David G. (1999) Introduction to Clinical Psychiatry. Lange Medical Books, San   Francisco.

 Fuerstein, Georg.(1998) The Yoga Tradition. Hohm Press, Prescott, Arizona.

 Iyengar, B K S. (1993) The Light on the Yoga Sutras of Patañjali. Harper Collins, New York.

 Maté, Gabor. (2008) In the Realm of the Hungry Ghosts. North Atlantic Books, Lyons, Colorado. 

 

 

DRAFT: This module has unpublished changes.