Adrienne Jamiel

YOGA THERAPY FOR WOMEN

A treatment model supported by yoga philosophy that views physical and emotional healing as a first step in spiritual connection.

By Adrienne Jamiel, MA, ERYT

In 2005, I received a NOK Foundation scholarship to attend the program "Yoga for Women" at the Krishnamacharya Yoga Mandiram (KYM) in Chennai, India. The program included an elaboration of the philosophical underpinnings of the KYM treatment model; personal practice and discussion of the yoga techniques used in treatment; and, case studies of students selected from the thousands of women who have been successfully treated. I acknowledge with great appreciation the NOK Foundation for its vision and support and the KYM program instructors who designed and presented this life-changing program. Finally, my good wishes to the group of women from all over the world who shared this experience with me and have since brought this powerful model of healing back to their communities.

INTRODUCTION

Thousands of years ago, Indian sages spent much of their lives in contemplation about the nature of life and the best way to live. The age old questions that concern us today about the meaning and purpose of life concerned them. Their insights gleaned from introspection, observation and experimentation formed the basis of yoga philosophy and the yogic way of life.

For thousands of years these insights were passed down from teacher to student through an oral tradition. Eventually these teachings were compiled into written form and illuminated in such texts as the Upanishads, the Bhagavad-Gita and the Yoga Sutra.

Yoga philosophy asserts that our true nature encompasses aspects of our being that cannot be comprehended through the avenue of normal human awareness. It elaborates that while we are unable to comprehend our true nature by intellect alone, we can come to fully know ourselves through practices that lead to an expanded awareness.

In the yogic tradition, becoming aware of the fullness of one's true nature is the purpose of life.

PHILOSOPHICAL FOUNDATION FOR YOGA THERAPY AT KRISHNAMACHARYA YOGA MANDIRAM (KYM)

In order to appreciate the treatment model used by KYM, it is necessary to understand the philosophical underpinnings upon which the therapy rests. One philosophical rationale for using yoga techniques for therapeutic benefit is found in the Yoga Sutra, a systematic presentation of yoga philosophy compiled by Patanjali sometime in the 1st or 2nd century. The Yoga Sutra states that one of the obstacles to the practice of yoga is illness (vyadhi). [1] Illness is considered to be an obstacle to the practice of yoga because when we are suffering it is difficult to steady the mind.

KYM utilizes a comprehensive model for the practice of yoga therapy to alleviate illness that rests solidly upon the following philosophical concepts from ancient texts.

Panchamaya Model of the Human Being

According to the text of the Taittiriya-Upanishad [2], a human being is made up of 5 sheaths known as koshas. The 5 sheaths are:

1. Anna Maya* (The Body Sheath)
2. Prana Maya (The Subtle Body)
3. Mano Maya (The Mind Sheath)
4. Vignyana Maya (The Intellect Sheath)
5. Ananda Maya (The Bliss/Emotional Body Sheath)


*Maya, which means "is-ness" in the Tamil language of southern India, is not to be confused with Maya from Sanskrit which means illusion.

The Gunas

Not only are we molded by the orientation of our culture, we also are born with certain qualities or tendencies of mind that influence our behavior.

Through centuries of observing human behavior, ancient healers defined three basic qualities known as gunas that influence everything that happens within the mind. It is the balancing of these three qualities of the mind -- Sattva, Rajas and Tamas -- that leads to harmony in life and healing of the body.

According to yoga philosophy, the purpose of the practice of yoga is to balance these qualities of the mind. In the Yoga Sutra, yoga is defined as "the cessation (nirodha) of the fluctuations of mind (chitta vritti)." [3]

Rajas

The dominant quality of some minds can be described as activity. In yoga philosophy the over-active quality of the mind is known as Rajas. When the rajasic quality dominates the mind, the person may be drawn to action, often without reflection. The person may experience emotions such as anger, frustration, irritation and impatience. She may feel restless or aggressive.

Tamas

When inertia is the predominant characteristic of the mind, yoga philosophy refers to that quality as Tamas. As this tamasic quality dominates, the person may experience mental dullness, feel fearful or tired, and may be unable to bring tasks to completion in a timely fashion.

Sattva

When the mind is in balance, that quality is known as Sattva. Practicing the tools of yoga (including a yogic diet) can help bring the mind into a Sattvic state. In this state we experience the ability to visualize well, think clearly and reflect before acting. We also experience rejuvenating rest, relaxation and sleep. When the mind is in a Sattvic state, we are able to feel compassion for ourselves and others.

The Cause of Distress and Suffering

Imbalance in the qualities of the mind is viewed as the cause of distress and suffering (duhkha). The ancient sages understood that the company that we keep, our lifestyle and our self-concept have a major influence on the qualities of the mind. Listed below are the primary factors that have been observed by the sages to lead to imbalance.

Wrong company

Associating with groups or individuals who are not appropriate or suitable for us may lead to imbalance and in turn cause distress and suffering

Living a lifestyle inappropriate for us

Eating poor quality food or too much food can move the mind away from balance

Identifying with something inappropriate in ourselves

Identifying with an inflated ego or low self esteem leads to suffering

Abusing the senses

Watching too much television or listening to very loud music disturbs the senses and may agitate the mind

KYM'S MODEL OF YOGA THERAPY

The philosophical foundation for the treatment model used at KYM integrates elements from the Yoga Sutra, Nathamuni's Yoga Rahasya, the Hatha Yoga Pradipika and Ayurveda as well as additional elements from other sources.

In Nathamuni's Yoga Rahasya we find many verses addressing the use of yoga in the treatment of the ill. [4] The Yoga Sutra lists illness as an obstacle on the path to spiritual development [5]; therefore, it is important that one take action to address illness so that one can continue on the path.

According to yoga philosophy, just as there are various causes of illness, there are also various techniques for treating illness through yoga. In some cases a change of diet is suggested; in other cases breath regulation, chanting, visualization, asana or meditation are what is needed to restore the body and mind to balance. Most often a combination of the above techniques is optimal. KYM's treatment model is based upon an individualized orientation towards healing. TKV Desikachar, the student and son of T. Krishnamacharya, the creator of KYM's yoga therapy model says "The essence of my father's teaching is this: it is not that the person needs to accommodate himself or herself to yoga, but rather the yoga practice must be tailored to fit each person." [6]

The intention of the examination process used at KYM is to arrive at a clear understanding about the nature of the problem, the cause of the problem, the goal of treatment and the appropriate tools to be used in treatment.

Each person is viewed as an individual and consideration is given to all of the following elements before a yoga practice is developed for the individual.
1. Heyam - the problem of the person
2. Hetu - the cause of the problem
3. Hanam - the goal of treatment
4. Upayam - the appropriate tools to use in treatment in order to reach the goal

The Problem of the Person (Heyam)
What is the nature of the feeling of unease, pain or disease? The person must be aware of the problem but does not have to know the cause.

The Cause of the Problem (Hetu)
In determining the cause of the problem we must be mindful that humans are complex beings and that the physical, mental, emotional and spiritual aspects represented by the Panchamaya model are interconnected and interrelated. If the problem appears in one area (sheath), it should not be assumed that the cause does not lie in another area. It is the treatment of the underlying cause that is the goal rather than the treatment of the symptom.

Below is the method used at KYM in their process of deciphering the cause of the problem. A prerequisite for effective examination is that the person being examined must feel comfortable and relaxed.

The Tools of Examination
Darsanam - seeing.
Using observation to notice what is happening. With this tool of examination you use your senses to gather information by simply noticing qualities such as:
· color and texture of the skin
· walking
· body language
· how thoughts are expressed
· what is the quality of the breath
· does the head tilt to one side

Prasnam - questioning.
Insight into the problem gained from questions concerning all areas of life - physical, emotional, mental and spiritual. When using the tool of questioning, it is important to refrain from probing. The process needs to originate within the person. Examples of appropriate questions are:
· When did this problem begin?
· How long have you had this problem?
· What aggravates the problem?
· What makes the problem better?

Sparsanam - touching
Hands on examination through palpation (touching) noticing:
· Differences in temperature
· The hardness or softness of muscles
· The texture of the skin

Nadi Pariksanam - studying of the pulse
Determining the state of the body based upon
· the rhythm of the pulse
· the rate of the pulse

Studying of the pulse is incorporated in the KYM examination method from the native Indian system of medicine known as Ayurveda.

The Goal of Treatment (Hanam)

Having understood the problem (Heyam) and the cause (Hetu), the goals of practice have to be established. The first step in developing treatment goals is to consider the nature of the problem. At KYM, this is done by utilizing an Ayurvedic approach that classifies the severity of the problem and notes whether it is short term or chronic in nature.

The classifications used in developing treatment goals are:

· Susadhyam - a problem that can be easily solved and possibly resolved, for example, stiffness in the joints due to lack of movement
· Dusadhyam - a chronic problem, difficult but possible to heal with effort, for example, hypertension (high blood pressure) due to stress
· Asadhyam - a problem about which nothing can be done and for which palliative care is the only treatment, for example, an individual with a terminal cancer diagnosis who has declined further medical treatment would receive palliative care
· Yapyam - cannot be cured but with management can be kept under control, for example, adult onset diabetes

Once you have determined the classification of the problem, the priority of treatment goals would be determined as follows:

Samanam - to pacify
The first goal of treatment is to pacify the situation with techniques [7] that provide immediate pain relief, calm the mind, or improve sleep. Pacification may involve helping the individual find a comfortable position for relaxation, explaining how breath regulation has a calming effect, and developing rapport.

Sodhanam - to purify or cleanse
After pacification has been achieved, the long term goal would be to correct, eliminate or minimize the problem through step-by-step practice and development, being mindful that there are circumstances in which correcting, eliminating or minimizing the problem is not possible.

Often there will be a need to prioritize the goals. There may need to be a series of goals, some short term, some intermediate and some long term. It may be necessary to set multiple goals in order to reach the long term goal. Goals must always be sensible, realistic and achievable.

The Tools for Treatment (Upayam)
Given that individuals possess different qualities of mind (gunas), different sets of problems and different lifestyles, it becomes apparent that the tools for practice must be individualized. The question then becomes: what tools does yoga offer to help an individual move towards a more balanced state of mind? The following is a list of the most commonly used tools for treatment at KYM:

Yoga Poses (Asana)
When asanas are used in treatment, the focus is on adapting the pose to fit the person.

Breath Regulation (Pranayama)
The efficacy of the techniques practiced can only be known by the quality of the breath. By being keenly aware of the breath before and after practice, we can learn what techniques are effective. As stated in the Hatha Yoga Pradipika, "Respiration being disturbed, the mind becomes disturbed. By restraining respiration, the Yogi gets steadiness of mind." [8]

Chanting
Chanting has been an integral part of the practice of yoga for thousands of years. As a therapeutic tool, chanting aids in cultivating calmness by focusing the mind and by lengthening the exhalation.

Visualization (Bhavana)
A practitioner can influence vital energy (Prana)* within the body by focusing on the breath and by using visualization known as Bhavana. Focusing on the breath and bringing awareness to a particular area of the body directs the vital energy (Prana) to that area.

*Prana means "that which pervades everything" and according to yoga philosophy, Prana is responsible for maintaining all the functions of the body. Prana expresses itself in the body as breath.

Mudra (Hand-posture)
This technique is used to focus the mind and direct energy flow.

Meditation
Meditation is a state in which the body is consciously relaxed and the mind is allowed to become calm and focused.

Corpse Pose (Savasana)
Savasana is a reclining resting posture in which the senses are drawn inward and the physical body is at ease. "The practice of Savasana removes fatigue from the body and calms the mind." [9]

Diet
A yogic diet consists of foods that are appropriate for the individual and that help maintain a calm (Sattvic) state of mind.

The Link
At Krishnamacharya Yoga Mandiram the most important tool in yoga therapy is considered to be the individual's link: with the teacher, with the institution or with one's spiritual path.

YOGA THERAPY AND WOMEN

The question may arise: if yoga is a state of mind and this state of mind is genderless, why is a distinction made between the practice of yoga for women and men? Since disturbances in the mind are often mirrored by disturbances in the body, we need to be cognizant of the differences in female and male anatomy, physiology and reproductive life cycle (Anna Maya sheath) in order to create individualized programs that are tailored to meet the specific needs of women. While a distinction is made between female and male in determining the cause of the problem (Hetu) and the appropriate tools for healing (Upayam), at KYM there is no distinction made between women and men when interpreting yogic philosophy.

When determining the cause of the problem (Hetu), we must be mindful during examination of the ways in which women and men differ physically. The Panchamaya model lists the following areas among these differences:

Muscle mass
Strength
Amount of body fat stores
Location of body fat stores
Skeletal structure
Density of the bones
Hormonal fluctuations
Length of the urethra
Reproductive organs
Place in the reproductive life cycle
Sacroiliac joint issues
Eating/Food issues
Voice quality
The tendency to baldness and color blindness


PRACTICAL APPLICATION

As previously stated, it is in the selection and practice of the yoga techniques and not in the interpretation of the philosophy where distinctions are made between women and men.

Below is a case study presenting examination findings and an individualized treatment plan.

Case Study

Sita (not her real name)
Age: 29


Sita was in the ninth month of her second pregnancy. She came to KYM for therapy because she was being tormented by fear inducing thoughts due to the fact that she had lost her first child during pregnancy.

Sita's Problem (Heyam)
Tormented by fear

The Cause of Sita's Problem (Hetu)
The loss of her 1st child during pregnancy

The Goal of Treatment (Hanam)
Divert Sita's mind

The Tools Selected for Treatment (Upayam)
Visualization (Bhavana) on whatever interests her [10]
Listening to music
Mingling in discussion group
Chanting

The technique of diversion was considered to be the best practice since it is difficult to practice asana when the mind is greatly agitated.

By practicing these techniques of diversion, Sita was able to calm her fears. She delivered a healthy baby girl.

CONCLUSION

The goal of KYM's yoga therapy is not to teach yoga asana or pranayama but rather to heal; and healing does not necessarily mean the elimination of the problem. A change in outlook resulting in the acceptance of the problem and the ability to view the challenge positively is valued as healing.

As mentioned earlier, illness can be an obstacle to expanded awareness. The removal of this obstacle through yoga therapy opens us to the possibility that our yoga practice may lead us to the experience of our true nature. This is the ultimate gift of yoga.

Copyright 2006 Adrienne Jamiel. All rights reserved