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BI- POLAR DISORDER AND YOGA

Mania can be described as a state of intense disturbance of thinking, mood and behaviour. The person may act impulsively and may feel very energetic and euphoric. They may also feel irritable. There can be thought disorder and delusions of grandeur or superiority. There may or may not be alternating depressed moods, which is why the description bi-polar affective disorder is sometimes used. However, there can be depressive symptoms during a manic phase, and some investigators have concluded that mania in a complete absence of depressive history is extremely rare, although some researchers conclude that psychotic depression and melancholia are different diseases. In this article, I am focusing mainly on the manic symptoms, as yogic work with depressive symptoms is covered elsewhere.

A recent search on Medscape, found an article by Thomas A.M.Kramer,Associate Professor of Psychiatry at the University of Chicago. He says that at time of writing (2003) there was no cure for bi-polar disorder, nor a near prospect of one, though the patient can be “stabilised”. In addition, different treatments seem to work at different stages of the disease. Most patients encountered by a yoga teacher in a psychiatric hospital situation are likely to be moving from acute mania into a stabilised situation, so may be in different phases of the disease. He goes on to say that the most useful interventions in mania are anything that slows the patient down, reduces euphoria, and helps in the organisation of thinking. All these could be said of yoga practices. I wondered about the passage in Hatha Yoga Pradipika which says that when the breath stops, the thought stops. Could this be applied to the out of control process of manic thought? The problem for a teacher is that breath pausing might not be suitable for some others in a class, and also that the student experiencing mania sometimes does not have the focus to persevere with the practice

Other research available through Medscape and other searches mentions a chronobiological basis for mania. The supposition is that there are disturbances of the circadian rhythms in bi-polar disorder. In particular, disturbances of sleep/wake patterns can trigger mania in vulnerable people. I wondered whether yoga practices such as breathing ratios, without breath holding, and chanting could help establish and modify rhythms for such students. At least giving the brain experience of rhythmic somatic patterns might help to reduce chaos. Of course, this is just my own speculation, but, in teaching yoga to mentally disordered students, this is often all one has to rely on until one receives feedback from the students themselves.

One article by someone who experiences manic episodes, described it as a state of continual excitement, and compared it to childhood experience of anticipation of a birthday. He said that there is no gap between impulse and action and suggested techniques for developing such a pause. First, there need to be development of inhibition of the impulse to act and then an attention to the various bodily preparations before action takes place. This is, of course, mindfulness of thought and body, and depends on the development of the witness state of mind. These habits must obviously be established during a non-manic phase, and this is where simple yoga techniques, such as watching the breath can be offered for their future usefulness. During asana the mind can also be directed to notice unnecessary muscular tensions so that their release can become automatic. One very useful piece of advice is for the patient not to be alarmed if they become aware of their fast, strong, heartbeat when other stimuli are being reduced. He also mentions that, when the experience of reduced muscular tension sets in, it may be accompanied by boredom. The yoga teacher needs to be aware of this to keep the student’s interest and engagement with the yoga activity. The appreciation of “not doing” may take some time. Another effect he notes is that of shaking in various parts as body tension is released. Again, the yoga teacher needs to be aware of the various types of tremor which can be experienced, and to encourage the student to allow some as a release of tension, but to stop the asana if the shaking is because of muscle fatigue.

In one bipolar disorder forum (www.bipolaraware.co.uk ) I found a very interesting discussion on possible effects of brain laterality. Of course this is purely speculative, but some interesting questions were raised from the experiences of patients themselves. Bipolar disorder was described as a “storm” in the brain, similar to that causing convulsion from the motor cortex, but, in this case, affecting decision- making ability. One participant noticed that he spent most of the time breathing through the right nostril, indicating left hemisphere dominance, rather than a more normal cycling pattern of the dominant nostril. Other participants went on to link this with rhythm in general, speculating that the important consideration was not so much which hemisphere was active, but the loss of rhythmic cycling. This of, course, would directly indicate the use of alternate nostril breathing. I have, in fact, found this to be a well received and helpful technique, although there are sometimes difficulties with concentration, resulting in an increase of tension as students struggled to apply the correct fingers and nostrils. However, an imaginative, well trained, teacher should be able to devise ways to produce alternate nostril breath without stress. One way I have used is to use the index finger of each to rest on the same side nostril.

Recently, there was a very interesting episode in one of my psychiatric unit classes when someone in the class was already over- exited, talking and laughing inappropriately. After doing a strong version of Fish posture (matsyasana) image 20 which he enjoyed and repeated several times, he suddenly said he needed to take a break. He then sat out for a few moments and then stood up saying that he was becoming very over stimulated. I asked him if he could do something about it without disturbing the rest of the class as there was no one available to accompany him back to his ward. Amazingly he used deep breathing to try to settle himself, then rejoined the asana session. When we came to the final relaxation, I asked him if he was able to lie down ,but he said he would prefer to stand. He stood still with hands over his lower abdomen (svadisthana chakra) for the 60 seconds of the relaxation. As he left the room cheerfully with everyone else, I complimented him on his remarkable achievement.

DESCRIPTIONS

• Hathayogapradipika -Possibly the oldest extant text about Hatha Yoga, The Hatha Yoga Pradipika was written about the 15th century CE, by Swami Swatmarama. .
• Chronobiological - The study of the effects of time and rhythmical phenomens on life processes.
• Somatic patterns - repetitive body use
• Witness state of mind – the ability to watch ones thoughts and actions as they arise
• Asana – the physical postures of Yoga
• Brain laterality- often different functions on different side of the brain
• Alternate nostril breathing- a Yogic technique of breathing through alternate nostrils
• Svadisthana chakra – One of the Yogic divisions of consciousness known as chakras. This chakra is situated in the area between the navel and the pubic bone. Relates to strong, subconscious, forces of the personality.

Stick Images used in the article above.

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