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Schizophrenia and Yoga

According to Gordon Claridge and Caroline Davis in ”Personality and Psychological Disorders”, Bleuler, who first used the term “schizophrenia” to refer to a cluster of symptoms, always referred to “the schizophrenias”, as there are many ways in which this type of illness can present. Often a distinction is made between “positive” symptoms such as hallucinations, delusions and thought disorder, and “negative” symptoms such as apparent lack of dynamic motivation in thought, feeling, and movement. Yoga practice has been found to be more useful with negative symptoms as it demands concentration on the present perceptions along with controlled, focused action. DSM (Diagnostic and Statistical Manual of Mental Disorders) refers to several types of schizophrenia with varying symptoms. In addition, symptoms vary from person to person.

Some of the symptoms amongst students diagnosed with forms of schizophrenia are confusion, lack of concentration, auditory hallucination and slow processing of verbal inputs. In the paranoid type, there may be delusions about persecution as well as high levels of general anxiety and some expressions of anger. Some people may have only one episode of schizophrenia in their lifetime, others may have several episodes, but lead relatively normal lives between them. However, there are those who increasingly withdraw from life as it becomes more difficult to distinguish what is real from what is not. I remember one of the most challenging questions I have ever been asked by a student, She said, “if I can’t trust my own perceptions, how can I ever know what is real?”

Of course the teacher is not necessarily aware of auditory hallucination. This may seem obvious, but one student apologised with great concern after the final relaxation, in case her “voices” had disturbed the others. She was amazed when I said no one else could hear them. She then asked me “are my voices real then?” I, thinking on my feet and hoping I could say the right thing, responded “yes, real because they are your experience, but not necessarily true”. She was very amazed by this, and told me that her particular voices said she was a bad person. I asked her if she thought she was any worse than others who sometimes make mistakes in their behaviour, and if she thought she had done anything bad that morning. When she failed to remember any such act, I said that many people sometimes do things they regret, but that she couldn’t be a “bad person” or she’d be bad all the time! She then asked me what I thought she could do about the “voices”. Remembering chakra theories, I asked her where in her body the voices seemed to be. When she responded “in my head”, I asked if she found it helpful to put her attention in her navel and say to the voices “carry on as much as you wish, but I’m going in a different room.” The student found this idea both entertaining and useful.

My work as a yoga teacher for people with schizophrenic symptoms seems to focus on coping skills. There is evidence that stressful situations can make these symptoms more difficult to handle, so the first aim is to create a safe, self-accepting environment. Awareness of breathing patterns and a focus on maintaining a slow, comfortable breath in a variety of physical shapes helps to establish breath awareness as a coping skill. The fine tuning of muscular effort during posture practice leads to an awareness of how the body responds to mental events and how responses can be changed from automatic to controlled. Postures requiring balance such as Tree [image 1], Boat [image 4] , Warrior #3[image 2] are often very helpful as they improve concentration, and students find it difficult to focus on anything other than the demands of the posture.

When I first started teaching Yoga to mentally ill students, I thought that one of the most helpful qualities the students could develop was insight, or, in Patanjali’s words, “the seer” (Sanskrit drashta). However, in studying the experiences of those with psychosis, I have begun to question how far such self-perception is possible when in the midst of an episode. In some psychotic states there is a lack of insight into the bizarre nature of the experience. However, in the case of auditory or visual hallucination there can be good insight, which in fact makes the experience all the more terrifying because the patient realises they are distressed by seeing or hearing these things, but are unable to stop the process. I find that the use of descriptive imagery is very helpful for the development of students’ self awareness. I am not talking here of visualisation in relaxation which is contra- indicated in schizophrenia but of such descriptions as letting the arms “float into position like seaweed in water.” This can produce quite amazing responses, such as that from the student who answered my suggestion about strengthening the core of the body with “just like the core of an apple where the seeds of growth are.” When I first started teaching, I was told that people diagnosed with schizophrenia could only “think concretely”. I have not found this to be the case as long as the image is presented as a simile( i.e. “like seaweed”, or “as if you were a mountain”).

References

CLARIDGE, Gordon and DAVIS, Caroline Personality and Psychological Disorders

Stick Images used in the article above.

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