Teaching Asana to mentally ill students

Some possible aims and objectives of an asana programme

Awakening and balancing physical energy. To overcome inertia, or counteract agitation or mania. Consciousness of energy use.
Pleasure. Exercise is shown in many studies to be a help in depression. Most studies have focused on cardiovascular exercise routines e.g Ashtanga Vinyasa. However there has been some work saying that any exercise works as well. This is good news for couch potatoes like me! Further good news is that the less exercise you take normally, the greater the uplifting effect of a gentle session. However be aware of the possibility of mental/emotional stress in sports people esp. cricketers apparently. The important factor is the non- competitive nature of asana.
Expansion of constricted parts – always being aware that constriction may be part of a coping process.
Stabilising base eg legs or sitzbones. ANDRE LAPPA says Ha= Strength; Tha= extension of energy from that strength. (I think this is in one of his excellent DVDs)
Limbering – working with flexibility and strength as appropriate – this gives a sense of well being and mastery which, hopefully, will transfer to daily life. Even if students take away only one posture which they have found helpful, the session has done its healing work
Empowerment as well as calming
Releasing areas of movement restriction – esp. shoulders and lower back where there can be a sort of armour plating or a curl up reflex. These can become semi- permanent muscular habits and need gentle retraining. Another area of immobility can be the lower spine and hip area.These are all defensive coping mechanisms and should be worked on with care and respect. E.xamples of release work are, supine leg raises, supine twists, bridge-setu bandhasana [image 9] + with arms overhead to rest on floor. Banana pose ( Lying on back with legs together, gently curving to on side, then the other in a banana shape).
Opening restricted areas of breathing mechanism. All movements should be skilfully adapted and graded to suit students’ ability and experience. Camel approach sequence to open front chest. see DON STAPLETON “Self Awakening Yoga”. Cat pose [image 15] to stabilise core and open back chest. Garudasana [image 16]. Psoas work. Brahma mudra for neck release (Turning head to right, left, looking down and looking up without squashing the back of the neck. This can be achieved by tipping the chin up and the back skull down on its axis. Chin and skull can be supported by hands if necessary). Also, as psoas and diaphragm join the spine in the same area, psoas release work can improve breathing capacity.
Changing breathing patterns can change our response to stress. I have come to think that this may be one of yoga’s most profound contributions to mental health. However, be aware that consciously changing breath patterns can also cause stress, eg watching the point at which the inhalation changes to the exhalation can trigger a release of memories. I have had students who experienced this – not necessarily a bad thing if there is a suitable person available to help the student deal with it.
Sometimes flowing breath work is good, but beware of fatigue

Cautions

Usual safety precautions of a responsible yoga teacher e.g blood pressure problems, heart problems, joint injuries, care in not moving too extremely at first or beyond capacity. Lists of precautions and prohibitions can be found from many sources

Touching - This may be especially inappropriate with some students who have suffered abuse. In general be very careful of touching or adjusting without consent.

Breathing with too much inner focus - can cause an emotional overwhelm

Relaxation problems -

Relaxation anxiety because of unaccustomed sensation. Can give a sensation of paralysis- much of our sense of self comes from movement and its related sensory inputs.
Students who have had psychotic episodes may experience the phenomenon called depersonalisation. This has been defined as a feeling of disconnection from one’s sense of self and is often allied to a condition called derealisation, which can be defined as a disconnection from the world around one. This can lead to a perception that one is not in control of one’s own actions and speech, or even that one in some way does not exist.
Delusional effects in absence of stimulation

Visualisation - Contraindicated because some students have difficulty with reality testing, though I do use a lot of visual imagery in describing postures.

Music - can be troublesome to schizophrenics

Manic students doing extreme postures - Also manic students who invade another’s space.

Asana

Savasana to begin

Establishes the required atmosphere in the room. Gives a chance to see if anyone is manic and cannot settle, or keeps talking. It may become obvious at this stage that some students need to do the session in a chair. Also, it gives me a chance to observe breathing, facial expression, skin colour etc.

The teacher needs to be very aware of what is happening to the students. Do any feel vulnerable in the supine (lying on back) position? Has anyone gone to sleep because of medication? Iis anyone’s breathing suppressed? Consider how to proceed if there are any such problems.

Preparation for postures

I have been asked if I prepare for postures with these students. I may only see them once, and there are many conditions of mental and physical health in the class, so I don’t feel I can spend a class building to a particular posture. Nor, often, can I build over several classes. Therefore, what I do is do a mini build to a posture to test the individuals’ limitations and capacities. They then do the posture to feel its “meaning” at whatever level they can.
Examples would be:- tree - vrkasana [image 1], standing forward bend - uttanasana [image 11], cobra – bhujangasana [image 13], locust- salabhasana [image 14], the dancer- natarajasana [image 5]

The session

I start with stick pose- dandasana [image 10]. At this stage I can observe backs, hamstrings, tremor, exhaustion/drowsiness and may recommend some students to lie down until they want to join in, or just to lie and listen. (You will, of course lose some students who will sleep the whole session!). I ask students to try not to sleep but medication sometimes dictates otherwise.

Start with gentle movements lying on the floor. This gives nervous or highly medicated students a chance to feel how much movement they want to do today, and gives me a further chance to observe breathing and general movement parameters of each student. I would usually start with supine (lying on back) leg hugging and rocking. Then, from the supine position, single leg raising with focus and care. Of course there must be emphasis on not going too far, and a chair seats can often be used as support for the raised leg.

Then I often ask participants to do gentle floor twists, resting for a while on each side and feeling the degree of comfort. Then to perceive the effort required in moving to a different position. This is the beginning of mindfulness

If the class is fairly able, I go on to tree - vrkasana [image 1] and warriors – virabhadrasana 1&2 [image 17 and image 18]. This enables me to bring in ideas such as balance, steadiness, self acceptance, own grounded space. Tree can be modified with heel resting on opposite foot rather than raised up the opposite leg. Use of props such as one hand on the wall to help balance. Relaxation of shoulders can be emphasised as arms lift. Hunched shoulders are a common problem in many new students.

Different teachers have recommended certain asana for depression.
see AMY WEINTRAUB “Yoga for Depression”. She does say, though, that the main components of any such asana practice are self awareness and self acceptance. Some teachers recommended forward bending to help in depression. Several consider forward bending to be relaxing, whilst back bending is thought to be stimulating and heart opening. I have not come to any conclusions about this from my own experience, and try to do a balanced session. I attended a course which included an interesting session on doing asana in an inner focused, and then an outer focused, way, for different conditions. This seemed to me a useful idea to explore.

Symbolism of postures

Use of philosophy during asana. Of course, this depends on the students—sometimes I do this between postures to give students rest—lying still with an unoccupied mind can cause agitation for some. A creative teacher can think of many stories and insights around the various postures. For example, warrior postures can be given as examples of the different kinds of energy required on “the Battlefield of Life” (kurukshetra - Bhagavad Gita)

Asana as an expression of Prana.

Our own physical universe is expressed in our own body. Patanjali suggests that we move psychologically from limitation to ananta (endlessness, limitlessness).

The Buddhist scripture Anguttara Nikaya says “There is no making an end of suffering and stress without reaching the end of the cosmos. Yet it is just within this fathom-long body, with its perception and intellect, that I declare that there is the cosmos, the origination of the cosmos, the cessation of the cosmos, and the path of practice leading to the cessation of the cosmos”

EXPLANATIONS – DEFINITIONS

Ashtanga Vinyasa Yoga is a style of Yoga which creates a dynamic flow to connect postures. The breath dictated the movement and the length of time postures are held. The practice is a series of postures, always done in the same order, with specific breathing patterns. It is an energetic type of practice.

Asana is a Sanskrit word used in yoga to mean particular poses. It is a plural but often used as a singular in English.

Prana. A yogic term for breath, energy, life force.

Patanjali (somewhere between 3rd century BCE and 3rd century AD) is the author of “The Yoga Sutras” on which the philosophy of much modern yoga teaching is based.