Yoga for Neuropsychiatric Disorders

by Ram

"The demand for clinically efficacious, safe, patient acceptable, and cost-effective forms of treatment for mental illness is growing. Several studies have demonstrated benefit from yoga in specific psychiatric symptoms and a general sense of well-being." —Balasubramaniam, et al

Among the vedic sciences, Ayurveda is considered the healing side of yoga, and yoga the spiritual side of Ayurveda. Both these sciences are considered as two sides of the same coin, as they emphasize a complete approach to the well-being of the body, the mind, and the spirit. Both yoga and Ayurveda describe the disease process as taking its roots first in the mind. If we fail to recognize the disease process in the mind and continue to make wrong choices, the disease overflows into the physical body as specific symptoms. Thus, symptoms are simply the body’s voice communicating that we are living out of harmony. When we live out of harmony we suffer. When we change our life to bring greater harmony, our bodies reflect this change and there is less suffering.

Turn to yoga philosophy and one of the main tenets in the Yoga Sutras is:

Yogas chitta vritii nirodhah

yoga =union, to join; chitta = mutable thoughts of the mind-field; vritti = mental fluctuations/ modifications, nirodhah = coordination, regulation, channeling.

Swami Jnaneshvara translates this as: Yoga is the control (nirodhah, regulation, channeling, mastery, integration, coordination, stilling, quieting, setting aside) of the mutable thoughts/modifications (gross and subtle thought patterns) of the mind field. In other words, when you achieve a union of the body, mind and spirit, all mental fluctuations and turbulence cease.

The Shady Side of the Mountain by Brad Gibson

Dissect this tenet in more simple terms and this is the message: human being as a whole is a combination of body, mind and spirit, with physical, mental (psychological) and spiritual dimensions. When we just think of ourselves as a physical body and lose our connection with the mind and spirit, we become susceptible to mental and physical diseases. If this theory is hard to follow, understand that we share a close relationship with our environment, the world around us. If an individual is living in harmony with the environment, optimum health is possible. However, the further out of harmony an individual is living, the less likely it is that they will reach their full life potential in either length or quality of life. Healing is the process of returning to harmony by becoming one with our environment. Once back in harmony, the body and the mind have no reason to communicate symptoms. The body is at ease; the mind attains peace.

Mention the mind-body relationship to a scientist or a medical doctor and you will immediately notice their discomfort as this relationship lacks sufficient scientific backing. In addition, I have noticed that the general public is less likely to embrace some of these theories and alternative therapeutic interventions unless they have been proved by science. At one of the national Ayurveda/Yoga conferences, I had suggested some yoga modalities for ADHD patients but since I could not provide a scientific rationale, my suggestions were met with skepticism.  So does it surprise me now when a review published in the journal, Frontiers in Psychiatry titled Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders by Balasubramaniam, et al describes yoga to be “highly promising” as a complimentary care to medication for psychiatric disorders (the authors examined the literature for a gamut of psychiatric illness) but without the negative side effects that come with pills? Not in the least. Because all psychiatric disorders have a mind component, a mind-body integrative program, such as yoga, can definitely assist people in their pursuit of peace and calmness, and bring greater wholeness and integration in their lives.

Unfortunately, if you just mention this 5000-year-old ancient practice as a standalone solution, you will have skeptics. Bring in statistics, scientific methodology and other modern applications, however, and people will start believing you.

"There is emerging evidence from randomized trials to support popular beliefs about yoga for depression, sleep disorders, and as an augmentation therapy. Limitations of literature include inability to do double-blind studies, multiplicity of comparisons within small studies, and lack of replication. Biomarker and neuroimaging studies, those comparing yoga with standard pharmaco- and psychotherapies, and studies of long-term efficacy are needed to fully translate the promise of yoga for enhancing mental health."—Balasubramaniam, et al

But whatever it takes, the mind-body connection definitely needs to be considered seriously!

The bipolar disorder pendulum: Depression as a compensatory adaptation

As far as explaining natural phenomena, Darwin was one of the best theoretical researchers of all time. Yet, there were a few phenomena that puzzled him for many years. One was the evolution of survival-impairing traits such as the peacock’s train, the large and brightly colored tail appendage observed in males.

Tha male peacock’s train is detrimental to the animal’s survival, and yet it is clearly an evolved trait ().

This type of trait is known as a “costly” trait – a trait that enhances biological fitness (or reproductive success, not to be confused with “gym fitness”), and yet is detrimental to the survival of the individuals who possess it (). Many costly traits have evolved in animals because of sexual selection. That is, they have evolved because they are sexy.

Costly traits seem like a contradiction in terms, but the mechanisms by which they can evolve become clear when evolution is modeled mathematically (, ). There is evidence that mental disorders may have evolved as costs of attractive mental traits (); one in particular, bipolar disorder (a.k.a. manic-depression), fits this hypothesis quite well.

Ironically, a key contributor to the mathematics used to understand costly traits, George R. Price (), might have suffered from severe bipolar disorder. Most of Price’s work in evolutionary biology was done in the 1970s; toward the end of his life, which was untimely ended by Price himself. For many years he was known mostly by evolutionary biologists, but this has changed recently with the publication of Oren Harman’s superb biographical book titled “The Price of Altruism: George Price and the Search for the Origins of Kindness” ().

Bipolar disorder is a condition characterized by disruptive mood swings. These swings are between manic and depressed states, and are analogous to the movement of a pendulum in that they alternate, seemingly gravitating around the "normal" state. See the figurative pendulum representation below, adapted from a drawing on Thinkquest.org.

Bipolar disorder is generally associated with creative intelligence, which is a very attractive trait (). Moreover, the manic state of the disorder is associated with hypersexuality and exaggerated generosity (). So one can clearly see how having bipolar disorder may lead to greater reproductive success, even as it creates long-term survival problems.

On one hand, a person may become very energetic and creative while in the manic state. This could be one of the reasons why many who suffer from bipolar disorder have fairly successful careers in fields that require creative intelligence (), which are many and not restricted to fields related to the fine and performing arts. Creative intelligence is highly valued in most knowledge-intensive professions ().

On the other hand, sustained acute mania or depression are frequently associated with serious health problems (). This is why the clinical treatment of bipolar disorder often starts with an attempt to keep the pendulum from moving too far in one direction or another. This may require medication, such as clinical doses of the elemental salt lithium, prior to cognitive behavioral therapy. The focus of cognitive behavioral therapy is on changing the way one sees and thinks about the world, particularly one’s “social world”.

Prolonged acute mania, usually accompanied by severely impaired sleep, may lead to psychosis. This, psychosis, is an extreme state characterized by hallucinations and/or delusions, leading to hospitalization in most cases. It has been theorized that depression is an involuntary compensatory adaptation () aimed at moving the pendulum in the other direction, out of the manic state, before more damage ensues ().

Elaborate approaches have been devised to treat and manage bipolar disorder treatment that involve the identification of mania and depression “prodromes” (), which are signs that a full-blown manic or depressive episode is about to start. Once prodromes are identified, cognitive behavioral therapy techniques are employed to prevent the pendulum from moving further in one direction or the other. The main goal of these techniques is to change one’s way of thinking about various issues (e.g., fears, pessimism). These techniques take years of practice to be used effectively.

Identification of prodromes and subsequent use of cognitive behavioral therapy seems to be particularly effective when dutifully applied with respect to manic episodes (). The reason for this may be related to one interesting fact related to bipolar disorder: manic episodes are not normally dreaded as much as depression episodes.

In fact, many sufferers avoid taking medication because they do not want to give up the creative and energetic bursts that come with manic episodes, even though they absolutely do not want the pendulum to go in the other direction. The problem is that, if depression is indeed a compensatory adaptation to mania, it seems reasonable to assume that extreme manic episodes are likely to be followed by extreme episodes of depression. Perhaps the key to avoid prolonged acute depression is to avoid prolonged acute mania.

As someone with bipolar disorder becomes more and more excited with novel and racing thoughts (a prodrome of mania), it would probably make sense to identify and carry out calming activities – to avoid a fall into despairing depression afterwards.

Certain mental disorders may have evolved as costs of attractive mental traits

I find costly traits fascinating, even though they pose a serious challenge to the notion that living as we evolved to live is a good thing. It is not that they always deny this notion; sometimes they do not, but add interesting and somewhat odd twists to it.

Costly traits have evolved in many species (e.g., the male peacock’s train) because they maximize reproductive success, even though they are survival handicaps. Many of these traits have evolved through nature’s great venture capitalist – sexual selection.

(Source: Vangoghart.org)

Certain harmful mental disorders in humans, such as schizophrenia and manic–depression, are often seen as puzzles from an evolutionary perspective. The heritability of those mental disorders and their frequency in the population at various levels of severity suggests that they may have been evolved through selection, yet they often significantly decrease the survival prospects of those afflicted by them (Keller & Miller, 2006; Nesse & Williams, 1994).

The question often asked is why have they evolved at all? Should not they have been eliminated, instead of maintained, by selective forces? It seems that the most straightforward explanation for the existence of certain mental disorders is that they have co-evolved as costs of attractive mental traits. Not all mental disorders, however, can be explained in this way.

The telltale signs of a mental disorder that is likely to be a cost associated with a trait used in mate choice are: (a) many of the individuals afflicted are also found to have an attractive mental trait; and (b) the mental trait in question is comparatively more attractive than other mental traits that have no apparent survival costs associated with them.

The broad category of mental disorders generally referred to as schizophrenia is a good candidate in this respect because:
    - Its incidence in human males is significantly correlated with creative intelligence, the type of intelligence generally displayed by successful artists, which is an attractive mental trait (Miller & Tal, 2007; Nettle, 2006b).
    - Creative intelligence is considered to be one of the most attractive mental traits in human males, to the point of females at the peak of their fertility cycles finding creative but poor males significantly more attractive than uncreative but wealthy ones (Haselton & Miller, 2006).

The same generally applies to manic–depression, and a few other related mental disorders.

By the way, creative intelligence is also strongly associated with openness, one of the "big five" personality traits. And, both creative intelligence and mental disorders are seen in men and women. This is so even though it is most likely that selection pressure for creative intelligence was primarily exerted by ancestral women on men, not ancestral men on women.

Crespi (2006), in a response to a thorough and provocative argument by Keller & Miller (2006) regarding the evolutionary bases of mental disorders, makes a point that is similar to the one made above (see, also, Nettle, 2006), and also notes that schizophrenia has a less debilitating effect on human females than males.

Ancestral human females, due to their preference for males showing high levels of creative intelligence, might have also selected a co-evolved cost that affects not only males but also the females themselves though gene correlation between the sexes (Gillespie, 2004; Maynard Smith, 1998).

There is another reason why ancestral women might have possessed certain traits that they selected for in ancestral men. Like anything that involves intelligence in humans, the sex applying selection pressure (i.e., female) must be just as intelligent as (if not more than) the sex to which selection pressure is applied (i.e., males). Peahens do not have to have big and brightly colored trains to select male peacocks that have them. That is not so with anything that involves intelligence (in any of its many forms, like creative and interpersonal intelligence), because intelligence must be recognized through communication and behavior, which itself requires intelligence.

Other traits that differentiate females from males may account for differences in the actual survival cost of schizophrenia in females and males. For example, males show a greater propensity toward risk-taking than females (Buss, 1999; Miller, 2000), and schizophrenia may positively moderate the negative relationship between risk-taking propensity and survival success.

Why were some of our ancestors in the Stone Age artists, creating elaborate cave paintings, sculptures, and other art forms? Maybe because a combination of genetic mutations and environmental factors made it a sexy thing to do from around 50,000 years ago or so, even though the underlying reason why the ancestral artists produced art may also have increased the chances that some of them suffered from mental disorders.

A heritable trait possessed by males and perceived as very sexy by females has a very good chance of evolving in any population. That is so even if the trait causes the males who possess it to die much earlier than other males. In the human species, a male can father literally hundreds of children in just a few years. Unlike men, women tend to be very selective of their sexual partners, which does not mean that they cannot all select the same partner (Buss, 1999).

So, if this is true, what is the practical value of knowing it?

It seems reasonable to believe that knowing the likely source of a strange and unpleasant view of the world is, in and of itself, therapeutic. A real danger, it seems, is in seeing the world in a strange and unpleasant way (e.g., as a schizophrenic may see it), and not knowing that the distorted view is caused by an underlying reason. The stress coming from this lack of knowledge may compound the problem; the symptoms of mental disorders are often enhanced by stress.

As one seeks professional help, it may also be comforting to know that something that is actually very good, like creative intelligence, may come together with the bad stuff.

Finally, is it possible that our modern diets and lifestyles significantly exacerbate the problem? The answer is "yes", and this is a theme that has been explored many times before by Emily Deans. (See also this post, by Emily, on the connection between mental disorders and creativity.)

Reference
(All cited references are listed in the article below. If you like mathematics, this article is for you.)

Kock, N. (2011). A mathematical analysis of the evolution of human mate choice traits: Implications for evolutionary psychologists. Journal of Evolutionary Psychology, 9(3), 219-247.

The Mental Side of Going Fitness Alone Married or Not......Part 1

Hi Readers!!!

As I gathered my ideas to write this article, before I knew it, 2 pages of inclusions developed and I realized this one would have to be broken down into parts, otherwise the book I intend to write would exist on the blog. So, as you read, remember that this is a "to be continued" article. The mental/emotional/feelings hiding deep inside each of us when it comes to getting healthy is a topic that simply is not addressed in books, etc.....and it is so HUGE....and so I am going there....and as you already know...I am a up front, tell it like it is, HONEST, fitness professional here to help you every way that I can....

The Mental Side of Going Fitness Alone... Married or Not.....

Feeling unsupported.......
Are you sitting home waiting for life to happen for you, for someone to make it happen for you? Do you want to feel motivated by your partner, but all you get is a roll of the eyes. Are you living alone and feeling lonely….there is a difference. Is this keeping you from being the person you dream of being. You may very well be in a situation where you receive no support at all, but you know what…..it is up to YOU to achieve your own goals. True happiness, success, and complete health come from each individual person within….so why keep looking on the outside for someone or something to make it happen for you?

People around but feel alone.......
Do you feel crappy because you are with someone, surrounded by your family, and want so much for everyone to be on YOUR same page to get healthy …..wake up….this is not realistic. The best you can do is create YOUR own page, be an example, and inspire your mate and family to appreciate and hopefully desire what they see in you.

Alone and can't do it alone.....
Are you completely alone and feel no motivation at all to get healthy? Are you stuck in a hum drum routine of going through the motions of life, and hiding from what life could be? It may be a scary thing, but walking through a bit of fear and insecurity WILL be necessary to start your journey to getting healthy. Check out a few online fitness meet up groups in your area and look for physical activities that sound fun and non intimidating at first. This is a gentle way of meeting people who more than likely feel just like you, making new friends, and guess what….gaining a support group and the best motivation through workout partners.

The fear to change is real but you can do it.......
Living an unhealthy lifestyle can come from such deep and hurtful emotional pain, and choosing to hide ourselves in an unhealthy package serves as a security blanket or protection from further emotional pain. I realize that the fear and how you feel is real, but believe that YOU CAN DO IT…..getting healthy is a work in progress. Taking little steps and eventually letting go of that which has trapped the person you really are can happen. Checking out support groups may sound like a HUGE step that just can not be stomached, but if you open up just a little and allow a bit of vulnerability to take place, your journey to shedding that blanket can begin.

It is OK to set the example and be motivated by what YOU want.....
Have you lost yourself in someone else, and have given up what motivates you? Why???? It is healthy, fabulous, and fun to be motivated by what makes up YOU, and even better to set the example of a healthy lifestyle through what makes you happy. Believe me, happiness is contagious and what was once lost….will definitely make a BIG impression.

Change with a smile and positive attitude......
Are you changing and getting healthy for yourself? I hope so and doing so with a smile and positive attitude because it is a choice that YOU made. Again, this is not about changing for someone else, or hoping that the one you are with will change…..sometimes this does not happen and acceptance of this is crucial because regardless of anyone else, it is YOU who has control of YOU, your happiness, and your health for life.

Feeling angry about your mate......
Getting healthy and angry that your mate is not joining the party? Why? Each one of us is responsible for how we respond to life’s circumstances and people. This includes those near and dear…..those we love. Take a look at your parents, grandparents, children, etc…..are you angry with them or do you accept them as they are regardless of the quality of their health. This stance needs to be taken with your partner as well….your choice to improve the quality of your life is just that….YOURS. In a perfect world, we would all be healthy and happy, but all of us are on our own time clocks for life transitions. The very best you can do, is enjoy the journey to good health, and be a walking example of your life. So, grab an apple, give a kiss to the couch potato and go for a walk/jog. I have found over the years of working with clients that have significant others, that the partner wanted the physical and emotional changes of the client. Bingo….they are both working out together, eating wonderful new healthy foods, and enjoying the refresh of the relationship.

Why blame he/she for who they are….the only thing you can change is YOU
The blame game…..such a trap for unhealthiness and unhappiness. Are you there? Do you find yourself dwelling on past hurts, pains, and events and feel stuck and unable to move forward? Think about it…….what is this doing for you each day of your life except causing stress, depression, zapping your physical and emotional health, and a loathing nag that life really sucks....well THAT really sucks. Why Why Why??? The past can not be changed, and you definitely can not change the people who caused such pain for you…..what can you do…work on changing YOU. Accepting that the behaviors of others are not about you and out of your control, although disappointing, is essential to your being able to move forward. Sometimes this takes a few sessions with a counselor that you have interviewed, bonded with, and feel comfortable taking steps of sharing with. We all at times need help putting our lives into perspective, and it is definitely worth your health and happiness. The past is gone, the future is not yet here, but this moment is your gift to live the way YOU CHOOSE.

Accept others for who they are….
I may be repetitive on this one….but this is so true…especially for relationships now struggling with identity crisis. Who the hell is this person? I no longer know you? Why don’t you do this or that? Well….take a look at yourself….stop focusing on them and focus on YOU….you have NO control of what is going on in someone else’s brain and body…their thoughts, activities, and decisions. This is always the set up for unrealistic and REALLY disappointing SELF expectations we place on others and often times without they being aware of it. How unfair is that??? and how dissapointed are YOU because of it??? STOP STOP STOP creating within your own mind what he/she was supposed to do, what they were supposed to say and how it was to be said, how the birthday, anniversary, holiday that played such the perfect movie in your head with that person did not happen how YOU expected....hell....they did not even see the movie. Expect everything from your own actions, thoughts and feelings and have zero expectations from others, and consider yourself truly blessed and appreciative when something thoughtful happens to you......because that is the beginning of letting go and realizing YOU do not control ANYONE....but sure as hell can love them for who they are and at that REALISTIC MOMENT be truly thankful. Sometimes that which once felt like a dream seems like a nightmare, but taking control of feeling great for yourself through controlling your own responses to life with your own healthy thoughts, actions, and decisions for yourself will reap healthy benefits beyond belief….

I realize that this is digging deep into truly getting healthy, and removing bandaids covering the crap hiding and keeping a healthy lifestyle from even being able to happen.....but going into the mental side of making the choice to begin a healthy journey is the key to open the door for a lifetime of good quality living.

to be continued........

Stay Healthy!!!!

Darla Benfield, LCPT, LCMT